Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.

Conclusion Dexmedetomidine as an adjuvant to 0.2% ropivacaine in ultrasound guided interscalene blockade is more efficacious than dexamethasone in hastening the onset, prolonging sensory blockade and delaying the time of request for rescue analgesia. Dexmedetomidine produces mild sedation compared to dexamethasone as an adjuvant.

Background: Total knee arthroplasty is a well-established procedure in the management of terminal stage arthritis. Among the techniques (posterior-stabilized vs posterior cruciate retaining total knee arthroplasty) it is unclear whether one design has superior outcome over another. The purpose of the present study was to directly compare clinical and radiological outcomes of these two designs. Methods: A prospective study involving 29 patients who received a cruciate-retaining implant were compared to 30 patients who received posterior-stabilized prosthesis. The patients were followed up at 3 monthly intervals in the first year and 6 monthly thereafter. At 2years follow-up time clinical and radiological evaluation done and results were analyzed. Results: At 2 years follow-up time mean knee society scores improved from 47.19/34.2 (clinical/functional score) points to 91.9/89.25 points in the cruciate-retaining group and from 46.2/37.5 (clinical/functional score) points to 93.4/92.2 points in the posterior-stabilized group. The ranges of motion were 120.2° (range, 90° to 130°) and 125.3° (range, 100° to 140°) in the cruciate-retaining and posterior-stabilized group respectively, at 2-year follow-up. One had superficial infection (treated with dressing) and one patient with superficial infection required debridement. Conclusions: This study did not conclusively demonstrate the superiority of one knee design over the other, but clinical and functional score and range of motion were marginally better in patients with posterior stabilized implants which were not statistically significant.

Introduction: Pain management in total knee arthroplasty is aimed to minimize postoperative pain and improve functional outcomes in patients. Although there are many methods used for controlling the pain there has been no consensus on most appropriate or the best protocol. Adductor canal block (ACB) has the unique advantage of providing localized analgesia but it doesn't provide pain relief to the posterior capsule, it has been postulated that IPACK (interspace between the popliteal artery and the capsule of the knee) combined with ACB will provide better pain relief than ACB alone. Materials and Methods: 60 Patients were studied in two groups. Group A had those patients with ACB+ ipack and Group B had ACB. Group A -Patient were subjected to combined ACB block with IPACK. Group B -Patient in this group were given ACB. Patient were studied for pain score VAS on Day 0 and Day 1 morning and evening, range of movement at postoperative Day 1 and distance walked on Day 1. Results: Group B had better outcome as compared to Group A. The mean VAS score for the ACB+IPACK group was less than for ACB alone at end of Day 0 and Day 1 in morning and evening. The ROM for the ACB+IPACK group was better than ACB alone and number of steps walked by patients were more in ACB+IPACK as compared to ACB alone. The statistical difference was significant when Adductor +IPACK group was compared to Adductor group for VAS, ROM and number of steps walked. Conclusion: ACB+IPACK is better mode than ACB for control of postoperative pain in patient undergoing Total knee replacement. IPACK is relatively safe and combined with adductor canal block decreases posterior pain in TKR patients.

Twenty-eight total knee replacement (TKR) surgeries were performed using cruciate retaining implants at Sanjay Gandhi institute of trauma and orthopedics from October 2016 to October 2018. All patients were evaluated pre-operatively & post-operatively with knee society clinical, functional score. Average pre-operative knee society clinical score was 47.1 & functional score was 34.32. Main indication for T.K.R was osteoarthritis. Follow up period ranged from 6 months to 2 years. 96.5% of our patients scored 80 points or better for a rating of excellent by knee society clinical, functional score system. The mean post-operative knee society clinical score was 91.6, knee society functional score was 89.28. 90% patients had little/no pain post operatively, whereas walking ability similarly improved & was unlimited in 85% of the patients postoperatively. Average alignment of prosthesis was 4.9 degrees valgus. No radiolucency's about the tibial component &femoral component were found at the end of 2 years of follow up. No evidence of D.V.T /pulmonary embolism. Post-operative complications included knee stiffness in 2 post op cases, extensor lag in 2 cases, post-operative surgical site infection in 2 post-operative case and persistent fixed flexion and varus deformity in 1 case. 96.5% of the patients had excellent results (knee score of>80) 3.6% of the patients had good (knee score between 60 to 80) results. T.K.R provided pain relief, adequate stability, and measurable change in the range of motion in severely painful, refractory unstable knees. Total knee arthroplasty has in the past 4 decades revolutionized the treatment of primary osteoarthritic and secondary osteoarthritic knees. With these excellent results we conclude that cruciate retaining total knee arthroplasty provided measurable pain relief, adequate stability, remarkable range of motion in severely painful knees refractory to conservative management. If performed taking into consideration proper selection of patients, meticulous attention to surgical technique and asepsis, Intra-operative soft tissue balancing, correct alignment of prosthesis and postoperative rehabilitation of patients, cruciate retaining total knee replacement has yielded excellent results. By this we can conclude that cruciate retaining total knee replacement is an established effective surgery in the treatment of osteoarthritic knees.