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Sàbado-Bundó H, Sánchez-Garcés M, Camps-Font O, Gay-Escoda C. Intraarticular injections of hyaluronic acid in arthrocentesis and arthroscopy as a treatment of temporomandibular joint disorders: A systematic review. Cranio 2024; 42:122-131. [PMID: 34027829 DOI: 10.1080/08869634.2021.1925029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a therapeutic option for temporomandibular joint disorders. METHODS An electronic search in PubMed, Cochrane Library, and Scopus databases was conducted in order to answer the following PICOS question: "In clinical trials with patients treated with arthroscopy or arthrocentesis, did the subsequent use of HA IAI provide a better control of postoperative pain and temporomandibular joint function compared to those patients who did not receive it?" RESULTS Following PRISMA criteria, six randomized controlled clinical trials were selected. HA IAI showed significant differences in terms of pain reduction in three of them and improvement of mandibular function in two, compared to the control group. CONCLUSION Based on scientific evidence, the level of recommendation found regarding this type of intervention is type B (recommendation based on inconsistent or limited-quality patient-oriented evidence).
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Affiliation(s)
- Helena Sàbado-Bundó
- Department of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - MaÁngeles Sánchez-Garcés
- Master's Degree Program in Oral Surgery and Implantology, University of Barcelona, Barcelona, Spain
- Researcher of the IDIBELL Institute, Barcelona, Spain
| | - Octavi Camps-Font
- Department of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Researcher of the IDIBELL Institute, Barcelona, Spain
| | - Cosme Gay-Escoda
- Oral and Maxillofacial Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Oral Surgery and Implantology, FUCSO, Implantology and Maxillofacial Surgery Department, EFHRE International University, Teknon Medical Center, Barcelona, Spain
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Rodriguez-Merchan EC. The role of intraarticular injections of hyaluronic acid in joint pain relief in hemophilic arthropathy. Expert Rev Hematol 2023; 16:811-817. [PMID: 37837349 DOI: 10.1080/17474086.2023.2271660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/12/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Chronic pain in hemophilic patients is due to joint degeneration associated with hemophilic arthropathy. In addition to appropriate hematological treatment (primary prophylaxis), pharmacologic management and Physical Medicine and Rehabilitation should be indicated. When such measures are not sufficient, intraarticular injections (IAIs) of hyaluronic acid (HyA) may be considered. AREAS COVERED In order to determine whether IAIs of HyA are effective in terms of pain relief in individuals with painful moderate hemophilic arthropathy, a PubMed and Cochrane Library search using 'hemophilia hyaluronic acid' as keywords was performed on 18 July 2023. EXPERT OPINION In a study of individuals with hemophilic arthropathy (elbows, knees and ankles), 91% of them improved pain after a mean follow-up of 6 years. In another study of individuals with knee arthropathy, after a 7-year follow-up 82% reported an improvement in pain. As for hemophilic ankle arthropathy, in a study 67% of patients showed relief of joint pain at 6-month follow-up. Although the literature on the subject is very heterogeneous and difficult to interpret, it appears that IAIs of HyA can relieve the joint pain of painful moderate hemophilic arthropathy for months. Moreover, the IAIs can be repeated every 6-12 months.
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Mozella ADP, Assunção TND, Cobra HADAB, Minamoto STN, Salim R, Leal AC. Microbiological Profile of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries. Rev Bras Ortop 2023; 58:443-448. [PMID: 37396091 PMCID: PMC10310415 DOI: 10.1055/s-0042-1758368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/12/2022] [Indexed: 07/04/2023] Open
Abstract
Objective We studied the microbiological profile of periprosthetic knee infections treated in a Brazilian tertiary hospital. Methods The study included all patients undergoing revision surgery for total knee arthroplasty (RTKA) between November 2019 and December 2021, with a diagnosis of periprosthetic infection confirmed per the 2018 International Consensus Meeting (ICM) criteria. Results Sixty-two patients had a periprosthetic joint infection (PJI) per the 2018 ICM criteria. Cultures were monomicrobial in 79% and polymicrobial in 21% of cases. The most frequent bacterium in microbiological tissue and synovial fluid cultures was Staphylococcus aureus , observed in 26% of PJI patients. Periprosthetic joint infection with negative cultures occurred in 23% of patients. Conclusion Our results show the following: i) a high prevalence of Staphylococcus as an etiological agent for knee PJI; ii) a high incidence of polymicrobial infections in early infections; iii) the occurrence of PJI with negative cultures in approximately one fourth of the subjects.
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Affiliation(s)
- Alan de Paula Mozella
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Thales Nunes de Assunção
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | | | - Sandra Tie Nishibe Minamoto
- Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Rodrigo Salim
- Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP-RP), São Paulo, SP, Brasil
| | - Ana Carolina Leal
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
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Pujalte G, Hudspeth LJ, Troyer WD, Shapiro SA. Ultrasound-guided injection of the long head of the biceps tendon sheath with concomitant subacromial bursa injection through the same needlestick. Clin Anat 2023; 36:400-405. [PMID: 36210353 DOI: 10.1002/ca.23961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
Sonography and specific shoulder positions allow for injections into both the long head of the biceps tendon sheath (LHBTS) and the subacromial space (SS) with one needlestick. We validated this technique using cadavers. An experienced proceduralist injected latex solution into 12 unembalmed cadaveric shoulders, aiming for the LHBTS and SS, using an ultrasound-guided injection technique that employs a single-needle entry point. An experienced surgeon dissected each specimen and graded latex location as: (1) completely accurate (in both the SS and LHBTS); (2) partially accurate (in either the SS or LHBTS); (3) accurate with overflow (in both locations, but also elsewhere); (4) partially accurate with overflow (in either location, but also somewhere else); or (5) completely inaccurate (no latex in either location). All 12 ultrasound-guided injections using the technique accurately placed latex into both LHBTS and SS (100% accuracy). Latex was also found in adjacent regions after two (17%) injections: one within the shoulder joint and one within the deltoid musculature. This newly described technique allows highly accurate access to the LHBTS and SS with single-needle entry. This technique could become a favored alternative to subjecting patients to two needlesticks and preparing separate injections to address often concomitant pathologies.
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Affiliation(s)
- George Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Loren J Hudspeth
- Orthopedic Surgery, Piedmont Atlanta Hospital, Macon, Georgia, USA
| | - Wesley D Troyer
- Division of Sports Medicine, Mayo Clinic, Jacksonville, Florida, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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de Sire A, Lippi L, Mezian K, Calafiore D, Pellegrino R, Mascaro G, Cisari C, Invernizzi M. Ultrasound-guided platelet-rich-plasma injections for reducing sacroiliac joint pain: A paradigmatic case report and literature review. J Back Musculoskelet Rehabil 2022; 35:977-982. [PMID: 35431228 DOI: 10.3233/bmr-210310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Sacro-iliac joint (SIJ) pain is an often-misdiagnosed cause (up to 30% cases) of atypical low back pain (LBP) that might be treated with a wide range of conservative interventions. However, Platelet-Rich-Plasma (PRP) ultrasound-guided injections at SIJ level in subjects with mitochondrial disorders have not yet been investigated. CASE PRESENTATION A 52-year-old Caucasian male with fluoroquinolone-related mitochondrial dysfunction referred to a Physical Medicine and Rehabilitation Outpatient, complaining of severe SIJ pain (Numeric Pain Related Scale, NPRS=8). We performed two bilateral PRP ultrasound-guided injections at the sacro-iliac level. PRP is a simple, efficient, and minimally invasive approach. After the first PRP injection, there was a considerable reduction of pain (NPRS=8 vs 5). The second PRP infiltration was performed after 2 weeks and in both cases no adverse events. At the 6-month follow-up evaluation, the patient showed good physical recovery, with the absence of pain (NPRS=0). CONCLUSION To the best of our knowledge, this is the first report in the literature assessing the safety and effectiveness of PRP ultrasound-guided injections for SIJ pain in a patient affected by mitochondrial disorders. Thus, this case report might have relevant clinical implications in the treatment of SIJ pain in patients affected by this rare pathological condition, albeit further observational studies are warranted to confirm these findings.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Raffaello Pellegrino
- Antalgic Mini-invasive and Rehab-Outpatients Unit, Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti-Pescara, Italy
| | - Gennaro Mascaro
- Transfusion Medicine and Immunohematology Unit, University Hospital "Maggiore della Carità", Novara, Italy
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.,Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Abstract
OBJECTIVES To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated. DESIGN Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: (knee) AND (osteoarthritis OR OA) AND (injections OR intra-articular) AND (saline OR placebo). The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines. RESULTS Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain -13.4 mean difference (MD) (95% confidence interval [CI]: -21.7/-5.1; P < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain -3.3 MD (95% CI: -3.9/-2.7; P < 0.001). Other significant improvements were WOMAC-stiffness -1.1 MD (95% CI: -1.6/-0.6; P < 0.001), WOMAC-function -10.1 MD (95% CI: -12.2/-8.0; P < 0.001), and Evaluator Global Assessment -21.4 MD (95% CI: -29.2/-13.6; P < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the "minimal clinically important difference" for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes. CONCLUSIONS The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.
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Affiliation(s)
- Davide Previtali
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland
| | - Giulia Merli
- Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Giulia Merli, Applied and Translational
Research Center, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10,
Bologna 40136, Italy.
| | | | - Christian Candrian
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland
| | | | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland,Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Derwich M, Mitus-Kenig M, Pawlowska E. Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review. Int J Mol Sci 2021; 22:ijms22147405. [PMID: 34299024 PMCID: PMC8308010 DOI: 10.3390/ijms22147405] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022] Open
Abstract
Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.
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Affiliation(s)
- Marcin Derwich
- ORTODENT, Specialist Orthodontic Private Practice in Grudziadz, 86-300 Grudziadz, Poland
- Correspondence: ; Tel.: +48-660-723-164
| | - Maria Mitus-Kenig
- Department of Experimental Dentistry and Prophylaxis, Medical College, Jagiellonian University in Krakow, 31-008 Krakow, Poland;
| | - Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 90-419 Lodz, Poland;
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Uemura Y, Sakai Y, Tsutsumi YM, Kakuta N, Murakami C, Satomi S, Oyama T, Ohshita N, Takasago T, Hamada D, Sairyo K, Tanaka K. Postoperative nausea and vomiting following lower limb surgery :a comparison between single-injection intraarticular anesthesia and continuous epidural anesthesia. J Med Invest 2020; 66:303-307. [PMID: 31656294 DOI: 10.2152/jmi.66.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Study Objective : the incidence of postoperative nausea and vomiting (PONV) following single-injection intraarticular anesthesia was compared to that following continuous epidural anesthesia. Design : Prospective, double-blind, randomized study. Setting : University-affiliated teaching hospital. Patients : Forty-eight patients finally participated in this study, and each group contained twenty-four patients. Interventions : Patients scheduled to undergo lower limb surgery under general anesthesia were randomly allocated into two groups, to receive either single-injection intraarticular or continuous epidural anesthesia for postoperative analgesia. Measurements : The incidence and severity of PONV, complete response rates (i.e., no vomiting or rescue antiemetic use), and pain scores were recorded 2, 24, and 48 h postoperatively. Main results : No significant differences between groups were observed in the incidence and severity of PONV, rescue antiemetic use, or complete response rate at any of the time points, but only the use of rescue analgesics was significantly less in continuous epidural anesthesia group during the 2-24h postoperative period (P=0.04). Conclusion : While the use of single-injection intraarticular anesthesia following lower limb surgery did not prevent PONV more than continuous epidural anesthesia in this study, the intraarticular technique still provides greater simplicity, safety, and cost-effectiveness. J. Med. Invest. 66 : 303-307, August, 2019.
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Affiliation(s)
- Yuta Uemura
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
| | - Yoko Sakai
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
| | - Yasuo M Tsutsumi
- Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima JAPAN
| | - Nami Kakuta
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
| | - Chiaki Murakami
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
| | - Shiho Satomi
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
| | - Takuro Oyama
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
| | - Naohiro Ohshita
- Department of Anesthesiology, Osaka Dental University, Osaka JAPAN
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, University of Tokushima Graduate School, Tokushima, JAPAN
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, University of Tokushima Graduate School, Tokushima, JAPAN
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, University of Tokushima Graduate School, Tokushima, JAPAN
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University, Tokushima JAPAN
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Aytuluk HG, Gultekin A, Saracoglu KT. Comparison of intraarticular bupivacaine-dexmedetomidine and bupivacaine-magnesium sulfate for postoperative analgesia in arthroscopic meniscectomy: a randomized controlled clinical trial. Hippokratia 2019; 23:51-57. [PMID: 32265584 PMCID: PMC7127915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Arthroscopic meniscus surgery can lead to pain at various levels. In this study, we aimed to compare, in patients undergoing arthroscopic meniscectomy under spinal anesthesia, the efficacy of the combination of magnesium sulfate and dexmedetomidine with local anesthetics administered intraarticularly for postoperative pain management Methods: This prospective, randomized, controlled, double-blind study comprised of 52 patients who were randomly assigned into two groups depending on the combination injected intraarticularly at the end of the procedure: bupivacaine and dexmedetomidine (group D) or bupivacaine and magnesium sulfate (group M). Perioperative data, postoperative visual analog scale (VAS) scores, and total analgesic consumption were recorded. CLINICAL TRIAL REGISTRATION NCT03479216 Results: No statistically significant differences were found in mobilization times, rescue analgesic times, and non-steroidal anti-inflammatory consumption. The maximum mean VAS values at rest and during movement in group D were measured at the 6th hour while in group M peaked at the 8th hour. CONCLUSION Both intraarticular dexmedetomidine and magnesium sulfate, in combination with bupivacaine, have similar effects on reducing postoperative pain in arthroscopic knee surgery. HIPPOKRATIA 2019, 23(2): 51-57.
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Affiliation(s)
- H G Aytuluk
- Department of Anesthesiology and Reanimation, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - A Gultekin
- Department of Orthopedics and Traumatology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - K T Saracoglu
- Department of Anesthesiology and Reanimation, University of Health Sciences, Dr Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Stamatopoulos A, Stamatopoulos T, Kenanidis E, Potoupnis M, Sayegh F, Tsiridis E. Intravenous and intraarticular tranexamic acid plus epinephrine for the man-agement of blood loss after cemented total knee arthroplasty: a case-control study. Hippokratia 2018; 22:86-90. [PMID: 31217681 PMCID: PMC6548522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is efficiently used to control blood loss during total knee arthroplasty (TKA). The role of intraarticular epinephrine needs further clarification. Limited data exist, concerning the combined use of intravenous and intraarticular TXA plus epinephrine in the intraoperative management of blood loss in patients undergoing TKA. METHODS This study aimed to evaluate the safety and efficacy of intravenous and intraarticular TXA plus epinephrine in the intraoperative blood management in primary TKA. In this case-control study, 204 patients undergoing primary cemented TKA were enrolled. One hundred two patients received one gr TXA intravenously and intraarticular injection of a mixture containing 500 mg TXA and 0.6 mg epinephrine. They compared to a historical control group comprised of 102 patients that received the same drug combination without epinephrine. The two groups were comparable concerning age, sex, the grade of osteoarthritis, and preoperative hemoglobin and hematocrit. RESULTS The epinephrine group had significantly higher postoperative hemoglobin (11.70 vs 10.75, p <0.001) and hematocrit (35.70 vs 32.25, p <0.001) compared to the control group at the first postoperative day. The epinephrine group received fewer transfusions, not reaching statistical significance (p =0.110), compared to the control group during hospitalization. The rate of complications was similar between the groups. The combined use of TXA and epinephrine was positively associated with a smaller postoperative hemoglobin drop. CONCLUSION The combination of intravenous and intraarticular TXA plus epinephrine was safe and reduced the drop of hemoglobin at the first postop day but not significantly the rate of transfusions, in patients undergoing primary TKA. Future higher-level of evidence studies are needed to validate these results. HIPPOKRATIA 2018, 22(2): 86-90.
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Affiliation(s)
- A Stamatopoulos
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - T Stamatopoulos
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - E Kenanidis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - M Potoupnis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - F Sayegh
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
| | - E Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.), Center of Interdisciplinary Research and Innovation (C.I.R.I.), Aristotle University Thessaloniki, Thessaloniki, Greece
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