Topical versus interlesional mitomycin C in auricular keloids

BACKGROUND

The Keloid is an elevated fibrous scar that may extend beyond the borders of the original wound.

OBJECT

To compare between topical and intralesional mitomycin C in the treatment of auricular keloids.

PATIENTS AND METHODS

Prospective randomized study in which 40 patients with auricular keloids were included. The patients were divided into 2 groups, Group I included 32 patients who underwent topical mitomycin C application after the surgical removal of the auricular keloids, while Group II included 8 cases who underwent intra-lesional injection of mitomycin C after surgical removal of the auricular keloids.

RESULTS

The two groups showed no significant difference regarding patient or lesion criteria (p>.05). VSS decreased significantly from 10.63 and 11.0 down to 1.38 and 3.0 after treatment in the topical and intra-lesional groups respectively (p<.001). However, greater improvement and satisfaction was detected in the topical group.

CONCLUSION

Both topical and intra-lesional mitomycin C injection are effective methods in managing auricular keloids. However, better VSS scores and patient satisfaction are reported with topical administration.

Combination gel of 2% amitriptyline and 0.5% ketamine to treat refractory erythromelalgia pain - a case report of pain control success

Erythromelalgia (EM) is a rare autosomal dominant neuropathy characterized by the combination of severe burning pain and erythematous warm extremities. Chronic pain control is most often unsuccessful and a completely effective therapy is yet to be identified. Recent studies have reported significant improvements in pain management using a combination of amitriptyline and ketamine in a topical formulation. We describe a 1-year follow-up pain control success case of a male patient with EM, proposed for topical use of a 2% Amitriptyline and 0.5% Ketamine gel.

Combination gel of 2% amitriptyline and 0.5% ketamine to treat refractory erythromelalgia pain - a case report of pain control success

Erythromelalgia (EM) is a rare autosomal dominant neuropathy characterized by the combination of severe burning pain and erythematous warm extremities. Chronic pain control is most often unsuccessful and a completely effective therapy is yet to be identified. Recent studies have reported significant improvements in pain management using a combination of amitriptyline and ketamine in a topical formulation. We describe a 1-year follow-up pain control success case of a male patient with EM, proposed for topical use of a 2% Amitriptyline and 0.5% Ketamine gel.

Topical, intravenous tranexamic acid and their combined use are equivalent in reducing blood loss after primary total hip arthroplasty

OBJECTIVE

To determine the equivalence of tranexamic acid (TXA) administration topically, intravenously or the combination of both routes are equivalent in reducing blood loss after primary total hip arthroplasty.

MATERIAL AND METHODS

In this prospective study, we divided 285 total hip arthroplasty into 4 groups. Group A received 2,5g of intraarticular topical TXA, Group B did not receive TXA, Group C received 1g intravenous TXA and group D a combination of topical and intravenous TXA. The main outcome was blood loss according to Nadler's formula and total hemoglobin.

RESULTS

Blood loss was significantly greater in Group B (Group A. 797.13ml; Group B: 1,308.24; Group C: 986.30 and Group D: 859.09ml; P<.01) with no differences between the other groups. Hemoglobin loss was greater in Group B (11.81, 19.46, 14.52 and 12.78 respectively, P<.001). Two patients (3,1%) were transfused in Group A, 4 (5,3%) in Group B, 3 (3,4%) in Group C, and 1 (1,8%) in Group D (P=.75). The mean reduction in hemoglobin at 48hours was less in the topical Group (P<.05). In comparison with Group B the mean reduction in hemoglobin after 48hours was greater (P<.001) and we can also see a longer hospital stay (P<.001). One patient in Group A presented pulmonary thromboembolism 72hours after surgery, which was resolved without complications.

CONCLUSIONS

The administration of TXA topically, intravenously or in combination in primary total hip arthroplasty, is a simple and safe procedure that provides equivalent reductions in hemoglobin and blood loss.

[Comparison of two doses of intra-articular tranexamic acid on postoperative bleeding in total knee arthroplasty: a randomized clinical trial]

INTRODUCTION

Tranexamic Acid (TXA), an antifibrinolytic that inhibits the fibrinolytic activity of plasmin is used to decrease perioperative blood loss and transfusion requirements in orthopedic surgery. The aim of our study was to compare postoperative bleeding in two intra-articular doses (1g and 2g) of tranexamic acid in adult patients undergoing unilateral total knee replacement.

METHOD

We conducted a single-operator, randomized, and controlled, double-blind study in two groups. The G1 group received 1g of intra-articular TXA and the G2 group 2g of intra-articular TXA. Both groups received 15mg.kg^-1 IV before the surgical incision (TXA induction dose) and then 10mg.kg^-1, orally, 6 and 12hours after the induction dose of TXA. The primary endpoint was bleeding measured by blood loss in postoperative drainage. Secondary outcomes were change in hemoglobin and hematocrit levels on the first and third postoperative days, and the need for transfusion during hospitalization.

RESULTS

In total, 100 patients were randomized, and 100 were included in the analysis. Blood loss in postoperative drainage was similar in both groups (200±50 vs. 250±50mL, G1 and G2 groups respectively). Change in hematocrit and hemoglobin values (% of change) between preoperative and day 3 were not statically significant between groups G1 and G2 (18±5 vs. 21±4; 21±7 vs. 22±5 respectively). No patients received blood transfusion.

CONCLUSIONS

Our study did not show superiority of 2g of intra-articular tranexamic acid compared to 1g. ClinicalTrials.gov Identifier NCT04085575.

Efficacy and safety of topical tranexamic acid in knee arthroplasty

INTRODUCTION AND OBJECTIVE

Tranexamic acid (TXA) is commonly used to control postoperative blood loss in total knee arthroplasty. In order to avoid adverse effects associated with intravenous administration, topical use has been proposed as an alternative. Our aim was to evaluate the efficacy and safety of topical TXA in total knee arthroplasty.

MATERIAL AND METHODS

A total of 90 patients scheduled for unilateral total knee arthroplasty were included in a prospective randomised study. All surgeries were performed under spinal anaesthesia, tourniquet and the same postoperative protocol. Patients were allocated to one of the 3 groups according to the application of TXA: group A (n=30) 1g of topical TXA; group B (n=30) 1g of TXA intravenous and in group C or the control group (n=30) no drug was administrated. Parameters related to blood loss and drain outputs were compared between the 3 groups.

RESULTS

The results revealed that post-operative decrease in haemoglobin level was significantly lower in group A (1.95g/dL) than group B (2.25g/dL) and group C (2.96g/dL), P<.01. Total postoperative blood loss was lower in group A (195mL) than group B (466mL) and group C (718mL), P<.01. There was no significant difference in complications and allogenic blood transfusion rate between the 3 groups.

CONCLUSIONS

According to the results, topical application of 1g TXA significantly reduced blood loss in patients undergoing total knee arthroplasty more than intravenous or no administration of TXA.

Topical diltiazem for pain after closed hemorrhoidectomy

BACKGROUND

Anal sphincter spasm contributes to the appearance of postoperative pain following hemorrhoidectomy.

AIM

To determine the efficacy of topical diltiazem in the control of post-hemorrhoidectomy pain.

MATERIAL AND METHODS

A randomized, prospective, experimental, double-blind study was conducted on 2 groups of patients in the postoperative period of closed hemorrhoidectomy. Each group consisted of 17 patients. Group A received topical diltiazem in the anal region 3 times a day and group B received a placebo. Ketorolac was administered to both groups as rescue therapy.

RESULTS

In group A, the mean score on the visual analog scale was 2.97±1.18cm at 24h, 1.51±1.18cm at 48h, and 0.84±0.92cm at 72h. In group B, it was 6.82±1.9cm at 24h, 5.3±1.66cm at 48h, and 4.32±2.13cm at 72h (P<.001, 95% CI). The mean number of analgesic doses in group A was 2.41±0.87 at 24h, 1.11±0.85 at 48h, and 0.94±0.96 at 72h. In group B, it was 3.82±0.52 at 24h, 3.64±0.70 at 48h, and 2.88±1.26 at 72h (P<.001, 95% CI).

CONCLUSIONS

In this study, topical administration of diltiazem resulted in a statistically significant reduction of postoperative pain in patients that underwent closed hemorrhoidectomy.