Nerve-stimulator-guided PNB using a pararectal approach proved to be easy and safe, with acceptable patient tolerance. In addition, it can be used for a variety of anorectal procedures where relaxation of anal tone is required.
Category: Other Introduction/Purpose: Full weightbearing(WB) three dimensional computed tomography(3D CT) is an excellent imaging tool. However, due to its high cost, it is only used in a few hospitals. We evaluated the usefulness and cost-effectiveness of axial loading(AL) 3D CT by comparing bony alignments with standing radiographs, and assessed reproducibility according to the degree of AL. Methods: Eighty patients(156 feet), who underwent standing radiographs and 3D CT with an AL device from January 2016 to May 2017, were investigated. According to the degree of AL(AL force×100/body weight), the patients were randomly assigned to three groups: Group A(30-50%; n=21, 40 feet), Group B(50-70%; n=32, 63 feet), and Group C(70-100%; n=27, 53 feet). The following angles were measured three times by two orthopedists: hallux valgus(HVA), 1st-2nd intermetatarsal(IMA1-2), and talo-navicular coverage(TNCA), calcaneal pitch(CPA), talo-1st metatarsal(T1MA), and talo-calcaneal angle(TCA). Agreements between the two imaging methods were analyzed and compared according to the degree of axial loading in each group. Results: Intra- and interobserver reliability was excellent (>0.75). In Group A(30-50% AL), all of the angles except HVA and IMA1-2 differed (p<.05). In Group B(50-70%), TNCA (p= .023), T1MA (p= .017), and TCA (p=.035) differed. In Group C(70-100%), none of the angles differed between the two imaging methods (p> .05). Higher agreement between the two imaging methods was realized when 70% or more(>70%) AL was applied. Conclusion: AL 3D CT with >70% axial load has full WB effects and can be substituted for expensive full WB 3D CT.
Category: Basic Sciences/Biologics Introduction/Purpose: There have only been a few studies on optimal concentrations, doses, and volume of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine with respect to anesthetic time, intraoperative, postoperative pain, and patient’s satisfaction. Methods: A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a single institution between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5% 42 ml), B (0.6%, 30 ml), and C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain (during the first 10 minutes of the surgical procedure), and postoperative pain (6, 12 hours after operation) were evaluated using a visual analog scale (VAS) score. Patient’s satisfaction (0~10) was investigated 12 hours after the operation. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively. Results: There were 108, 118, and 113, in groups A, B, and C, respectively. The complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The intraoperative VAS scores were 2.04, 0.62, and 0.24; and the postoperative VAS scores (6hours / 12hours) were 2.41 / 4.08, 0.26 / 1.24, and 0.38 / 1/53. The patient’s satisfactory scores were 8.53, 9.38, and 9.4 respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p<0.05) and higher intra, postoperative VAS scores (all p<.05). Group B showed longer complete anesthetic time (p<0.05), but no significant difference of intra, postoperative VAS scores (all p>.05). Patient’s satisfactory scores in both group A and B were similar to group C(p>.05, p>.05). There were no adverse reactions in all groups. Conclusion: Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.
Category: Trauma Introduction/Purpose: We compared the radiographic results and clinical outcomes of patients with displaced, intra-articular calcaneal fractures treated via the extended sinus tarsi approach (ESTA) and the extended lateral approach (ELA). Methods: We retrospectively studied the utility of the ELA (46 patients, 52 feet) and the ESTA (56 patients, 64 feet) in patients operated upon between January 2009 and September 2014. We evaluated pre- and post-operative X-rays and computed tomography (CT) data. Pain, patient-reported functional outcomes, patient satisfaction, and postoperative complications, were investigated at the three year follow-up. Results: Neither the postoperative nor three year follow-up Böhler angles, nor the calcaneal width, differed significantly between the two groups (both p > 0.05). The maximum step-off of the posterior facet on the three month CT follow-up of the ESTA was significantly less than that of the ELA (p < 0.05). We found no significant between-group differences in terms of postoperative translation (p = 0.232) or angulation of the sustentacular fragment (p = 0.132), three year follow-up mean visual analog scale pain score at rest (p = 0.641) or during weight-bearing (p = 0.525), Foot Function Index (FFI) (p = 0.712), and self-reported satisfaction (p = 0.823). The ELA experienced significantly more wound complications (p = 0.039) and nonunions (p = 0.014) than the ESTA. Conclusion: Compared with the ELA, the ESTA afforded comparable radiological results and clinical outcomes, associated with a reduced operative time and fewer wound complications and nonunions. We suggest that the ESTA is an efficient surgical option when treating displaced, intra-articular calcaneal fractures.
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