Background:Pain after total knee arthroplasty is severe and impacts functional recovery.Objectives:We performed a retrospective study, comparing conventional patient control analgesia (PCA) modalities versus continuous femoral nerve blockade (CFNB) for 1582 post-TKA (total knee arthroplasty) patients.Patients and Methods:Using our electronic acute pain service (APS) database, we reviewed the data of 579 patients who had received CFNBs compared with 1003 patients with intravenous PCA over 4 years.Results:Our results show that the incidence of a severe pain episode was higher in the PCA compared with the CFNB group. Lower pain scores were observed in the CFNB group compared with the PCA group from postoperative day (POD) 1 to 3, primarily due to lower rest pain scores in the CFNB group.Conclusions:Our study shows that there is improvement in pain scores, at rest and on movement, as well as a reduction in incidence of severe pain, in patients who receive CFNB versus those who receive intravenous PCA.
In total knee arthroplasty, postoperative pain control is imperative in facilitating physical therapy and rehabilitation. Our study promotes use of continuous femoral nerve blocks for pain relief post total knee arthroplasty. ambulation, which hastens recovery and reduces hospital length of stay (5). The risk of postoperative complications, such as venous thromboembolism and nosocomial infections (6), has also been shown to decrease with early mobilization.Pain control modalities for post-TKA include intravenous patient-controlled analgesia (PCA), peripheral nerve blockade, and continuous epidural analgesic techniques. All methods have been shown to be efficacious in relieving postoperative pain. However, conventional techniques that use intravenous PCA with morphine and fentanyl are associated with side effects, such as respiratory depression, sedation, pruritus, nausea and vomiting, hypotension, constipation, and urinary retention (7); epidural analgesia is associated with hypotension and bilateral motor blockade if local anesthetics are used (8, 9).
Severe COVID-19 patients demonstrate hypercoagulability, necessitating thromboprophylaxis. However, less is known about the haemostatic profile in mild COVID-19 patients. We performed an age and gender-matched prospective study of 10 severe and 10 mild COVID-19 patients. Comprehensive coagulation profiling together with Thromboelastography and Clot Waveform Analysis were performed. FBC, PT, APTT, D-dimer, fibrinogen and CWA were repeated every 3 days for both groups and repeat TEG was performed for severe patients up till 15 days. On recruitment, severe patients had markers reflecting hypercoagulability including raised median D-dimer 1.0 μg/mL (IQR 0.6, 1.4) ( p = 0.0004), fibrinogen 5.6 g/L (IQR 4.9, 6.6) ( p = 0.002), Factor VIII 206% (IQR 171, 203) and vWF levels 265.5% (IQR 206, 321). Mild patients had normal values of PT, aPTT, fibrinogen and D-dimer, and slightly elevated median Factor VIII and von Willebrand factor (vWF) levels. Repeated 3-day assessments for both groups showed declining trends in D-dimer and Fibrinogen. CWA of severe COVID-19 group demonstrated hypercoagulability with an elevated median values of aPTT delta change 78.8% (IQR 69.8, 85.2) ( p = 0.001), aPTT clot velocity (min1) 7.8%/s (IQR 6.7, 8.3) ( p = 0.001), PT delta change 22.4% (IQR 19.4, 29.5) (p = 0.004), PT min1 7.1%/s (IQR 6.3, 9.0) ( p = 0.02), PT clot acceleration (min 2) 3.6%/s 2 (IQR 3.2, 4.5) ( p = 0.02) and PT clot deceleration (max2) 2.9%/s 2 (IQR 2.5, 3.5) ( p = 0.02). TEG of severe patients reflected hypercoagulability with significant increases in the median values of CFF MA 34.6 mm (IQR 27.4,38.6) ( p = 0.003), CRT Angle 78.9° (IQR 78.3, 80.0) ( p = 0.0006), CRT A10 67.6 mm (IQR 65.8, 69.6) ( p = 0.007) and CFF A10 32.0 mm (IQR 26.8, 34.0) ( p = 0.003). Mild COVID-19 patients had absent hypercoagulability in both CWA and TEG. 2 severe patients developed thromboembolic events while none occurred in the mild COVID-19 group. Mild COVID-19 patients show absent parameters of hypercoagulability in global haemostatic tests while those with severe COVID-19 demonstrated parameters associated with hypercoagulability on the global haemostatic tests together with raised D-Dimer, fibrinogen, Factor VIII and vWF levels. Supplementary Information The online version contains supplementary material available at 10.1007/s11239-021-02575-4.
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