Tyrimo tikslas: nustatyti infekcinių komplikacijų rizikos veiksnius ir jų kontrolės valdymo mechanizmą artroskopinių operacijų metu. Tyrimo metodai. Anketinė apklausa, stebėjimo tyrimas operacinėje, dokumentinė analizė ir statistinė analizė. Anketavimui buvo naudojami klausimynai, o stebėjimo tyrimui – kriterijai, įtakojantys infekcijų kontroliavimą operacijų metu. Tiriamieji. Tyrimas vyko 2013 m. sausio – balandžio mėnesiais. Jo metu buvo sudarytos dvi tiriamųjų grupės (anketinis tyrimas) ir atliktas operacinės personalo stebėjimo tyrimas. Pirmąją grupę sudarė 6 (85,7 proc.) Ortopedijos traumatologijos skyriuje dirbantys chirurgai. Antrąją grupę tiriamųjų sudarė Ortopedijos traumatologijos skyriaus operacinėje 14 (93,3 proc.) dirbančių operacinės slaugytojų. Stebėjimo tyrimo metu operuojant pacientus, buvo stebima operacinėje dirbančių chirurgų ir operacinės slaugytojų veiksmai, kurie įtakoja infekcijos kontrolės valdymą. Šio tyrimo metu išoperuotas 51 pacientas. Operacijos atliktos LSMUL KK Ortopedijos traumatologijos klinikoje Ortopedijos traumatologijos skyriaus operacinėje. Po operacijų pacientai gulėjo LSMUL KK Ortopedijos klinikoje Ortopedijos traumatologijos skyriuje. Rezultatai. Palygintos chirurgų ir operacinės slaugytojų žinios apie infekcijos kontrolės valdymą, nustatyti operacinio personalo judėjimo ypatumai artroskopinių operacijų metu bei įvertinta chirurgų ir operacinės slaugytojų nuomonė apie veiksnius, kurie padėtų valdyti infekcijų riziką. Išvados... [toliau žr. visą tekstą] / Aim of research: to identify risk factors for infectious complications and the control mechanism during arthroscopic surgery. Research methods: A questionnaire, an observational study at operating, documentary analysis and statistical analysis. Question forms were used in questionnaires; whereas the criteria that influence infection controls during operations were used for the observation research. Research. The study took place in January – April, 2013. Two groups of persons under investigation (questionnaire survey) have been formed and the operating personnel tracking study was carried out. The first group consisted of 6 surgeons (85.7 percent) working at Orthopedics and Traumatology departments. The second group consisted of 14 (93.3 percent) Orthopedics and Traumatology department surgery nurses. Infection control management practices of operating surgeons and nurses that make an influence on infection controls have been monitored on surgery patients. 51 patients underwent surgeries in the course of this study. Surgeries were made at Orthopedic Traumatology Clinics of Orthopedics and Traumatology Department at LUHS Kaunas Clinics. After surgery, the patient were staying at Orthopedic Traumatology Department of LUHS Kaunas Clinics Orthopedic Clinic. Results. A comparison of infection control management knowledge between surgeons and surgery nurses was made, movement characteristics of operational staff during arthroscopic surgeries were identified and the infection... [to full text]

Thesis(M.S.)--Auburn University, 2005. / Abstract. Vita. Includes bibliographic references.

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 2003. / Bibliyografya var.

The way surgical trainees acquire technical skills is changing in modern surgical training programmes: simulation is proposed as a key part of those changes. Arthroscopy is a surgical technique that is increasing in both incidence and technical complexity; where simulation is becoming common, but evidence is limited. Real-world performance improvements can be measured following simulation training in other fields, but equivalent measures of intra-operative performance are inadequate. Thus, although surgical simulation is popular and improves simulated performance, there is little objective evidence that it improves intra-operative performance. The original contribution of this thesis is to objectively demonstrate the transfer of simulation training into improved intra-operative technical skills. To achieve this, a systematic literature review investigated the quantitative metrics currently used to measure arthroscopic performance, identifying wireless motion analysis as a potential method to assess performance intra-operatively. Motion analysis is a recognised objective method to measure surgical activity which correlates with surgical experience, so wireless motion analysis was validated against a wired motion analysis method commonly used in simulation but not feasible for intra-operative use. Wireless motion analysis metrics were further validated with a simulated arthroscopy list: this environment allowed deliberate practice of arthroscopic sub-skills with proximate feedback for independent practice. This simulated arthroscopy list with wireless motion analysis was used in two randomised studies: the penultimate study of this thesis investigated the impact of simulated practice on the arthroscopic learning curve and showed that performance improved rapidly with independent practice but was not modified by feedback, while the final study investigated additional simulation practice during early surgical training, and objectively demonstrated that additional simulation training improved intra-operative performance compared to traditional training alone. This thesis is the first to objectively show that simulation affects intra-operative behaviour. It sets the groundwork for further investigations into efficient, cost-effective simulation and the impact of simulation training on patient outcomes.

O objetivo do presente trabalho foi o estudo artroscópico das articulações do ombro e do joelho no cão. Durante o exame artroscópico avaliou-se possibilidade de visibilização das estruturas intra-articulares, facilidades e dificuldades inerentes à técnica e complicações. Fez-se análise citológica de líquido sinovial e histopatológica de membrana sinovial da articulação do joelho. Realizou-se a artroscopia em 10 articulações (9 cães) do ombro portadoras de osteocondrite dissecante e em 53 articulações (50 cães) do joelho, as quais apresentaram ruptura de ligamento cruzado cranial total ou parcial associada ou não a lesão de menisco medial ou lateral e luxação medial de patela. Na articulação do ombro as complicações consistiram na dificuldade de confecção dos portais artroscópico e instrumental pela técnica de triangulação, lesão iatrogênica de cartilagem, deslocamento prematuro do artroscópio e acúmulo de fluído nos tecidos moles periarticulares. As estruturas observadas foram sulco intertubercular, tubérculo supraglenoidal, tendão do M. bíceps braquial, cartilagem da cabeça do úmero (cranial e caudal) e da cavidade glenoidal, ligamento glenoumeral medial, bolsa articular caudal e sinóvia. As lesões de cartilagem observadas durante estudo artroscópico destas articulações foram condromalácea, erosão, eburnação e fibrilação na cabeça do úmero e erosão na cavidade glenoidal, além de retalho de cartilagem livre (próximo ao defeito na cabeça do úmero, na bolsa articular caudal, próximo ao tendão do M. bíceps braquial e na porção medial da articulação) ou fixo junto ao defeito na cabeça do úmero. Em um animal o retalho de cartilagem foi removido via artroscopia e nos demais através de artrotomia. Durante exame artroscópico da articulação do joelho observou-se região suprapatelar, patela, tróclea, côndilo lateral e medial do fêmur, côndilo lateral e medial da tíbia, menisco lateral e medial, tendão do M. extensor digital longo, ligamento cruzado cranial e caudal, ligamento intermeniscal, ligamento mucoso e sinóvia. Complicações consistiram principalmente de infiltração de tecidos moles periarticulares e obstrução do campo de visão pelo coxim adiposo infrapatelar. Diferenças entre o diagnóstico artroscópico e a confirmação após artrotomia concentraram-se na diferenciação entre ruptura completa e parcial do ligamento cruzado cranial (n=3) e afecção de menisco (n=6). A artroscopia trouxe informações sobre a membrana sinovial, alteração em menisco lateral e ligamento cruzado caudal não perceptível durante artrotomia. O estudo citológico denotou processo não inflamatório na maioria das articulações estudadas. Em análise histopatológica obteve-se processo inflamatório crônico, agudo e uma articulação com sinovite linfocitica plasmocitica. A artroscopia é uma técnica endoscópica que demanda intenso treinamento para a sua realização; e, permite um exame rico em minúcias que traz informações significativas que poderão ajudar a elucidar as afecções articulares que acometem a espécie canina. / The aim of this approach is shoulder and knee arthroscopic study in the dog. During the arthroscopic exam it was analyzed the possibility to see the structures into the joint; facilities and difficulties concerning the technique and its complications. Cytological synovial fluid and histopathological synovial membrane studies of the knee joint were performed. The arthroscopy was carried out in ten shoulder joints (nine dogs) which had osteochondritis dissecans and in fifty-three knee joints (fifty dogs), which had complete or partial cranial cruciate ligament rupture associated or not with medial or lateral meniscal damage and medial patella luxation. In the shoulder joint the complications consisted of the difficulty in doing the arthroscopic and instrumental portal using the triangulation technique, iatrogenic lesion, premature removal of the arthroscopy and periarticular infiltration. The observed structures were intertubercular groo, supraglenoid tubercle, tendon of biceps brachii muscle, cartilage of the humeral head (cranial and caudal) and glenoid cavity, medial glenohumeral ligament, caudomedial gutter and synovium. The lesions of the articular cartilage observed during the exam in the shoulder joint were chondromalacia, erosion, eburnation, fibrillation in the humeral head and erosion of the glenoidal cavity besides joint mice (near the defect on the humeral head, on the caudomedial gutter, near the tendon of biceps brachii muscle and in the medial gutter) and flap in the caudomedial humeral head. In one animal the flap was removed by arthroscopy while in the others it was removed by arthrotomy. During the arthroscopic exam of the knee joint it was remarked suprapatellar joint pouch, patella, trochlea, lateral and medial femoral condyle, lateral and medial tibial condyle, lateral and medial meniscus, tendon of long digital extensor muscle, cranial and caudal cruciate ligament, intermeniscal ligament and synovium. The main complications consisted of periarticular infiltration and obstruction of the field of vision by the infrapatellar fat pad. The differences between the diagnostic after arthroscopy and confirmation by arthrotomy were the differentiation between complete and partial rupture of the cranial cruciate ligament (n=3) and meniscal lesion (n=6). The arthroscopy exam provides information about lateral meniscal and caudal cruciate ligament lesion which are not noticeable by arthrotomy. The cytological study showed no-inflammatory process in most of the joints. In the histopathological analysis the results were chronic and acute inflammatory process and one joint having plasmacytic lymphocytic synovitis. The arthroscopy is an endoscopic technique that requires continuous training to be achieved and gives a detailed exam with significant information which could help to explain a lot of diseases in joints of the canine species.

Orientador: William Dias Belangero / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T10:43:02Z (GMT). No. of bitstreams: 1 LinoJunior_Waldo_D.pdf: 5333220 bytes, checksum: 4d6c975ca8305a2b6b11726f152edba6 (MD5) Previous issue date: 2008 / Resumo: Realizamos o tratamento artroscópico da instabilidade traumática do ombro anterior e ântero-inferior, associando três procedimentos ¿ a reparação do lábio da glenóide, a redução do volume capsular e o fechamento do intervalo rotador ¿ com o objetivo de analisar os resultados, considerando estabilidade e função. Entre janeiro de 1999 e dezembro de 2003, 27 pacientes foram submetidos ao tratamento artroscópico, por reparação do lábio da glenóide com âncoras metálicas, redução do volume capsular por capsulorrafia térmica e sutura do espaço rotador. Esses pacientes foram avaliados no pré e pós-operatórios, pelas escalas de UCLA e Rowe e, no pós-operatório, utilizando a escala de ASES. Durante um período de seguimento médio de 32,4 meses (variando de 22 a 74 meses), todos os ombros permaneceram estáveis. Usando a escala da UCLA, houve melhora do período pré-operatório, passando de 24,7 pontos (em média) para 32,81 pontos (em média) no período pós-operatório. A melhora também foi observada pela escala de Rowe, com a média 39,81 no pré-operatório, para 90,74 no período pós-operatório. Na escala de ASES a média foi de 92,22. Todos os ombros permaneceram estáveis e houve melhora funcional marcante dos pacientes que foram tratados. Esses resultados são comparáveis àqueles observados na cirurgia aberta, considerando critérios de seleção de pacientes similares / Abstract: We performed arthroscopic treatment of traumatic anterior and anteroinferior shoulder instability combining three procedures--labrum repair, reduction of capsular volume and suture of the rotator cuff interval--with the aim of analysing the results with regard to stability and function. Between January 1999 and December 2003, 27 patients underwent arthroscopic treatment for labrum repair with metal anchors, reduction of capsular volume through thermal capsulorrhaphy and suture of rotator cuff interval. These patients were evaluated in the pre- and postoperative period using the UCLA and Rowe scales and in the postoperative period using the ASES scale. During a mean follow-up period of 32.4 months (range 22-74 months) all shoulders remained stable. Using the UCLA scale, there was improvement from the preoperative period, with a mean score of 24.7, to the postoperative period, with a mean of 32.81. Improvement was also shown by the Rowe scale, with a mean score of 39.81 in the preoperative period and 90.74 in the postoperative period. On the ASES scale the mean score was 92.22. All shoulders remained stable and there was marked functional improvement in the patients who were treated. These results are comparable to those obtained with open surgery, observing similar patient selection criteria / Doutorado / Pesquisa Experimental / Doutor em Cirurgia

A utilização do tramadol por via sistêmica é uma ótima opção no tratamento analgésico pós-operatório em outras espécies, promovendo analgesia satisfatória e de duração moderada com mínimos efeitos colaterais. Entretanto, os efeitos do emprego deste fármaco na espécie eqüina ainda são pouco conhecidos, bem como sua real aplicação, pois faltam estudos clínicos nesta espécie. Portanto, este estudo teve o intuito de comparar a ação analgésica da administração de tramadol, fenilbutazona, ou ambas combinações em cavalos submetidos à cirurgias de artroscopia. Avaliou-se o efeito analgésico através da escala numérica de dor, escala descritiva composta, escala facial e escala proposta por Lascelles. Foram também avaliadas as alterações na freqüência cardíaca, freqüência respiratória, alterações de motilidade gastrointestinal, recuperação anestésica, bem como os níveis sérico de cortisol, TNF-α, IL-1Ra, e IL-10. Foram utilizados 18 animais provenientes do Serviço de Cirurgia do Hospital Veterinário da Universidade de São Paulo. Estes animais foram distribuídos em 3 grupos de forma aleatória, com 6 animais em cada grupo. Os animais receberam os analgésicos antes do estímulo cirúrgico, o grupo T recebeu tramadol, na dose de 2 mg/kg pela via intravenosa, o grupo F recebeu fenilbutazona, na dose de 4,4 mg/kg pela via intravenosa e o grupo TF recebeu a associação de ambos os fármacos. Os parâmetros FC, FR, temperatura, motilidade intestinal e analgesia foram avaliados por 6 horas. Os resultados foram analisados estatisticamente pelos testes de Kruskal-Wallis, Friedman, ANOVA, e ao pós teste de Tukey, com nível de significância de 5%. Não houve diferença entre os tratamentos em relação ao peso, idade, tempo cirúrgico, escore de recuperação anestésica, FC, FR, temperatura, motilidade gastrointestinal, dosagem sérica de cortisol e citocinas, e nas escalas de avaliação de dor. Com base nos resultados obtidos, pôde-se concluir que o tramadol, a fenilbutazona e a associação tramadol-fenilbutazona promoveram analgesia de boa qualidade no pós-operatório de artroscopia em cavalos; o tramadol na dosagem de 2 mg/kg mostrou eficácia analgésica semelhante à fenilbutazona; e não foram observado efeitos adversos relacionados aos parâmetros fisiológicos durante o período do estudo. / The use of tramadol systemically is a great option for treating postoperative pain in other species, providing satisfactory analgesia with moderate duration and minimal side effects. However, the effects of this drug in horses are still poorly understood, and also its application, because clinical trials are lacking in this species. Therefore, the present study aimed to compare the analgesic effect of tramadol, phenylbutazone, or both combinations in horses undergoing arthroscopic surgery. The analgesic effect was evaluated using numeric pain scale, descriptive composite pain scale, facial scale and the scale proposed by Lascelles. Changes in heart rate, respiratory rate, gastrointestinal motility, anesthesia recovery, and the serum levels of cortisol, TNF-α, IL-1Ra, and IL-10 were also evaluated. Eighteen animals from the Department of Surgery of the Veterinary Hospital at the University of São Paulo were used. These animals were divided into 3 groups randomly, with 6 animals in each group. The animals received analgesics before surgical stimulus, group T received tramadol, 2 mg/kg intravenously, group F received phenylbutazone, 4,4 mg/kg intravenously, and group TF received the combination of both drugs. The parameters HR, temperature, motility and analgesia were assessed for 6 hours. The results were statistically analyzed by the tests Kruskal-Wallis, Friedman, ANOVA and Tukey post test, with significance level of 5%. There was no difference between treatments in relation to weight, age, duration of surgery, anesthetic recovery score, HR, temperature, gastrointestinal motility, serum cortisol and cytokines, and the rating scales of pain. Based on these results, we conclude that tramadol, phenylbutazone and tramadol-phenylbutazone promoted good analgesia in arthroscopy postoperative period in horses; tramadol dosage of 2 mg/kg presented similar analgesic efficacy to phenylbutazone, and there was no adverse effect related to physiological parameters during the study period.

O presente estudo teve por objetivo avaliar protocolo de reabilitação para o período pós-operatório inicial de artroscopias visando diminuir a inflamação no local operado e aumentar a mobilidade articular. Foram utilizados 12 equinos (total de 20 articulações) encaminhados para artroscopia com diagnóstico de osteocondrite dissecante. Dessas, dez articulações receberam protocolo de reabilitação nos primeiros cinco dias do período pós-operatório. O protocolo consistiu em crioterapia, movimentação passiva da articulação e exercício controlado de baixa intensidade, além de uso sistêmico de anti-inflamatório. O outro grupo, também composto por dez articulações, recebeu apenas a terapia utilizada rotineiramente no HOVET-USP, consistido de repouso em baia e antiinflamatório. As articulações foram avaliadas quanto à circunferência em centímetros, ângulo de flexão, termografia, grau de claudicação. Amostras de líquido sinovial foram coletadas imediatamente antes do procedimento cirúrgico (D1), após 48h (D3) e após 96h (D5) para análise física, qualidade do coágulo de mucina, e quantificação de biomarcadores (IL-1, IL-6 e IL-10, PGE2 e SAA). As análises de exame de claudicação, circunferência articular, ângulo de flexão articular e termografia não apresentaram diferenças significativas entre os grupos, nem entre os diferentes dias do mesmo grupo. Na análise do líquido sinovial, a cor e o aspecto apresentaram piora do D1 para o D3, de amarelo claro para avermelhado e de límpido para turvo, respectivamente, nos dois grupos. No entanto, no grupo tratado houve melhora do D3 para o D5, tanto para cor (de avermelhado para maioria xantocrômica e amarela) como aspecto (de maioria turva para ligeiramente turva). No grupo controle os líquidos permaneceram sem alteração em cor e aspecto de D3 para D5, e nas comparações entre os grupos não houve diferença para D1, D3 e D5. A viscosidade do líquido sinovial no grupo controle diminuiu significativamente quando comparados D1, D3 e D5. Já no grupo tratado a diminuição da viscosidade só foi observada quando comparados D1 e D5. O coágulo de mucina apresentou piora de D1 para D3 no grupo controle, com elevação não significativa de D3 para D5, enquanto que para o grupo tratado não houve diferença significativa de D1 para D3 e de D3 para D5, quando comparados o D5 dos dois grupos, o tratado obteve melhor qualidade. As concentrações de interleucina nas amostras não forneceram dados suficientes para análise. Na análise das concentrações de PGE2 não houve diferença entre os grupos nos diferentes momentos, ocorrendo elevação de D3 para D5 em ambos os grupos, porém, no grupo tratado não há diferença entre D1 e D5. Já para SAA os grupos apresentaram comportamento similar de resposta, com elevação de D1 para D3 e queda de D3 para D5, porém menos acentuado no grupo tratado, o que levou a diferença entre os grupos em D3. Pode-se concluir, que o protocolo de reabilitação, apesar de não gerar diferença significativa para as avaliações de exame físico dos animais, proporcionou melhor qualidade de líquido sinovial quanto a cor, aspecto, viscosidade e precipitado de mucina, além de evidenciar menores elevações nas concentrações de marcadores inflamatórios no liquido sinovial durante o período estudado. / The purpose of this study was to evaluate a rehabilitation protocol for the initial postoperative period of metatarsophalangeal, metacarpophalangeal and tarsocrural´s arthroscopies, which seeks to, minimize local inflammation, diminish swelling, promote better joint range of motion and pain relief during such period. Twelve horses participated in this study - amounting to 20 joints - with dissecans ostheochondritis diagnosis. The first group was formed by ten joints, which were treated under rehabilitation protocol for the first 5 days as from the surgery (Treated group). The rehabilitation protocol consisted of cryotherapy, passive range of motion, low intensity exercise and non-steroidal anti-inflammatory drug. The second group also formed of ten joints received the standard HOVET-USP therapy, which consists of rest and non-steroidal anti-inflammatory drug Both groups were treated with the same non-steroidal anti-inflammatory drugs. The joints were measured for circumference, maximal flexion angle, thermography, and lameness score on the day before the surgery (D0) and during the first four days after the surgery. Synovial fluid samples were collected immediately before surgery (D1), within 48 hours (D3), and within 96 hours from the surgery (D5). The analysis evaluated gross appearance (color and aspect), viscosity and mucin clot quality, as well as biomarkers (Il-1, Il-6, Il- 10, PGE2, and SAA) quantification. Lameness examination, joint circumference, flexion angle and thermography evaluation were not significantly different between groups. In synovial fluid analyses de color and aspect have worsen from D1 (clear light yellow) to D3 (turbid hemorrhagic) in both groups. On treated group color and aspect improved from D3 (turbid hemorrhagic) to D5 (xanthochromic and yellow slightly turbid). On treated group there was no difference between D3 and D5. When the groups were compared, none significant differences was seen. The fluid viscosity of control group had significant decrease from D1, to D3 and from D1 and D5. In treated group this viscosity decrease was only seen between D1 and D5. The mucin clot formation worsened when D1 e D3 of control group was compared and remains similar from D3 to D5. In treatment group there were no differences when compared D1 with D3 and D3 with D5. The comparison between groups of D5 has shown treated group improved clot. The interleukin couldn´t be measured on sufficient number of samples for the statistics method. There were no differences between groups on all moments. The PGE2 response was similar in both group with a rise on concentration from D3 to D5. In treated group D1 was similar to D5. This results suggests more evident inflammatory response in the control group. For the SAA the groups have shown similar responses, with an increase from D1 to D3 and decrease from D3 to D5. The response on treated group was less intense and demonstrates lower values in D3 when compared with D3 control group. It was concluded with this study that rehabilitation protocol improved synovial fluid analyses for, color, aspect, viscosity and mucin clot. It even had promoted lower concentrations of inflammatory biomarkers for the treated group during the period.

Abstract The number of ambulatory surgical procedures is increasing throughout the world. This is partly due to the development of a number of new anaesthetic, analgesic and adjuvant drugs, each with more rapid onset and shorter duration of action, over the past two decades. An interest in the issues discussed in this thesis arose out a desire to improve the quality of anaesthesia for patients who undergo day-case surgery. A second aim was to compare the different anaesthetic methods in terms of recovery from anaesthesia and costs. A total of 233 patients undergoing day-case knee arthroscopy under either 2% or 5% lidocaine spinal anaesthesia or general anaesthesia with desflurane, isoflurane, propofol or sevoflurane were investigated in two prospective, randomised clinical trials. The overall aims were to find the most suitable, satisfactory and economically feasible method for adult ambulatory knee arthroscopy and to assess the factors that affect the immediate postoperative period and the one-week recovery profile at home. The patients were highly satisfied with all the methods of anaesthesia. There was a slight tendency in favour of general anaesthesia compared to spinal anaesthesia. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively and continued to be low during the first postoperative week. After short-acting general anaesthesia with desflurane, isoflurane and propofol, home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Home readiness was significantly delayed after 2% lidocaine spinal anaesthesia compared to sevoflurane inhalation anaesthesia. General anaesthesia with isoflurane was cheaper than the other general anaesthetics, i.e. desflurane, sevoflurane, propofol, or 2% and 5% lidocaine spinal anaesthesias. Propofol anaesthesia was the most expensive. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia. In busy ambulatory surgery units, remarkable savings may be achieved by using short-acting general anaesthetics, i.e. desflurane and isoflurane, instead of propofol or sevoflurane general anaesthesias or lidocaine spinal anaesthesia. This is due to the lower costs of desflurane and isoflurane compared to sevoflurane and propofol and the shorter time needed for postoperative care compared to spinal anaesthesia.

BACKGROUND: Hip preservations surgeries are a type of surgical intervention used to often delay or prevent arthritis in patients before damage has occurred. A hip arthroscopy, a type of hip preservation surgery, allows for a minimally invasive method by using an arthroscope, a small fiber-optic tube with a camera attached, and surgical tools to perform the surgery. Hip preservation surgeries are often linked with moderate to severe postoperative pain, often leading to the use of substantial anesthesia. Nerve blocks have become increasingly popular for certain procedures as there may be advantages with postoperative pain and other same-day recovery advantages. Nerve blocks continue to be investigated in their role in lowering postoperative pain, postoperative opioid consumption, length of stay/time in postoperative anesthesia care unit, and patient satisfaction of pain control. OBJECTIVE: The objective of this systematic review was to determine the efficacy of nerve blocks for postoperative pain management in hip arthroscopies. METHODS: Two reviewers (J.A., E.B.) independently conducted a literature search in January 2022 with adjudication by a third reviewer using the databases Pubmed, EMBASE, and Medline. The included studies were systematically screened and reviewed, and data was analyzed. RESULTS: With a quadratus lumborum block, a study showed a significant difference in postoperative VAS pain scores in the study group with a block compared to the control from admission into the PACU through 24 hours after the operation (P<.001). In postoperative opioid consumption, another significant difference was reported in the group with a lumbar plexus block compared to control from the PACU all the way to 24 hours post operation (P<.001). When comparing a fascia iliaca block versus a local infiltration analgesia, a study found that 1 hour post operation the patients reported a significantly lower mean pain level. However, it was found that a fascia iliaca block may be less effective in reducing the number of opioids consumed in the PACU compared to a lumbar plexus block (P=.020). With a femoral nerve block, reports show a significant reduction in postoperative pain using VAS at 30 minutes (P=.009), 1 hour (P=.004), 2 hours(P=.003), 4 hours(P=.006) and 6 hours (P=.0002). Patients who receive a femoral nerve block consumed a mean amount of 47.6 milligrams of morphine equivalents compared to 59.2 milligrams of morphine equivalents in the control group which is significantly less (P=.006). Patients with a lumbar plexus block reported a lower mean pain score compared to a combined spinal epidural (P=.048) at 48 hours (YaDeau et al., 2012). There was no difference observed in pain scores when a lumbar plexus block was compared to a pericapsular injection. The lumbar plexus block had no differences in opioid consumption when compared to both combined spinal epidural and pericapsular injection. CONCLUSION: The use of nerve blocks provides sufficient pain management in hip arthroscopies. The effectiveness of these blocks may be more than other types of analgesic methods in lowering postoperative pain and postoperative opioid consumption.