Lower limb surgery

2005 ◽  
pp. 165-208
Keyword(s):  
Lower Limb ◽  
Lower Limb Surgery

scholarly journals Efficacy of intrathecal midazolam on enhancing analgesic effect of fentanyl in patients undergoing lower limb surgery

2018 ◽  
Vol 5 (10) ◽  
pp. 2726-2732
Author(s):  
Masoum Khoshfetrat ◽  
Sima Davarpanah ◽  
Aliakbar Keykha
Keyword(s):  
Nerve Block ◽  
Lower Limb ◽  
Analgesic Effect ◽  
Synergistic Effects ◽  
Sensory Nerve ◽  
Study Groups ◽  
The Third ◽  
Significant Difference ◽  
Lower Limb Surgery ◽  
The Mean

Background: Co-administration of drugs with synergistic effects is considered as one of the methods to increase the effectiveness of intrathecal anesthesia and to reduce the need for injectable analgesics. The purpose of this study was to investigate the efficacy of intrathecal midazolam on enhancing the analgesic effect of fentanyl in patients undergoing lower limb surgery. Materials: The present double-blinded clinical trial was conducted on 90 candidate patients undergoing lower limb orthopedic surgery in 2017 at Khatam-Al-Anbiya Hospital in the city of Zahedan, Iran. To this end, the patients were selected via convenience sampling method and then randomly divided into three groups. Afterwards, 3 cc of 0.5% hyperbaric Marcaine was injected intrathecally in the first group, 3 cc of Marcaine + 25 ug of fentanyl was administered to the second group, and 3 cc of Marcaine + 25 ug of fentanyl + 1 mg of midazolam was administered to the third group (the final volume of all three syringes was brought up to 3.7 cc with normal saline). The duration of sensory nerve block and those of motor block and analgesia, as well as changes in vital signs, were then measured in these groups. Moreover, the data were analyzed using SPSS Statistics (Version 22.0) through Chi-square test and one-way analysis of variance (ANOVA). Results: The mean age and gender distribution of the patients in the three study groups did not differ significantly. The mean duration of sensory nerve block was equal to 98.6+/-11.1 min in the first group, 142.2+/-12.4 min in the second group, and 174.3+/-10.9 min in the third group; all showed a statistically significant difference (P=0.0001, P=0.001, P=0.000).The mean duration of analgesia was also reported to be 204.43+/-0.3 min in the first group, 323.62+/-7.4 min in the second group, and 526.22+/-0.9 min in the third group, indicating a statistically significant difference between the three study groups (P=0.0001, P=0.000, P=000). Conclusion: The results of this study demonstrated that adding midazolam to intrathecal fentanyl could significantly increase the duration of sensory nerve block and that of post-operative analgesia.  

scholarly journals A Patient Satisfaction Survey Investigating Pre- and Post-Operative Information Provision in Lower Limb Surgery

2020 ◽  
Author(s):  
Maxwell Stanley Renna ◽  
Andrew Metcalfe ◽  
David Ellard ◽  
David Davies
Keyword(s):  
Patient Satisfaction ◽  
Lower Limb ◽  
Cruciate Ligament ◽  
Recovery Period ◽  
Information Provision ◽  
Free Text ◽  
Healthcare Provision ◽  
Major Trauma Centre ◽  
Lower Limb Surgery ◽  
The Impact

Abstract BackgroundPlanned lower limb surgery is common, with over 90,000 hip replacements, 95,000 knee replacements and 15,000 anterior cruciate ligament reconstructions performed in the UK each year. Patient satisfaction an important element of healthcare provision that is usually measured by functional outcomes but influenced by many other factors. Few studies have assessed patients’ views on the information given to them pertaining surgery and patients are infrequently consulted when designing leaflets and information packs which can lead to confusion during the recovery period and poor long-term outcomes. We aimed to assess if patients were satisfied with the information they received around their operations and identify potential improvements.MethodsSet in a major trauma centre in the West Midlands, a multiple choice and free-text answer survey was administered to patients who used the orthopaedic service over the course of one month. Surveys were designed in Qualtrics and administered face-to-face on paper. Thematic content analysis was performed. ResultsEighty patients completed the survey, of which 88.8% of patients were satisfied with the information they received. Discussions with surgeons were the most useful resource and 53% of patients requested more internet resources. Post-operative patients were statistically more likely to be dissatisfied with information provision. Over 20% of patients requested more information on post-op pain and recovery timelines. ConclusionsAlthough patients were satisfied in general, areas for change were identified. Suggested improvements take the form of webpages, a mobile platform or forum for asking healthcare professionals questions. Extra resources could contain educational videos, patient experiences and an interactive recovery timeline. These suggestions may enable NHS Trusts to “get into the digital age”, however, more research on patient satisfaction around information provision and the impact it has on recovery and decision making is needed.

scholarly journals COMPARATIVE EVALUATION OF TRAMADOL AND FENTANYL FOR EPIDURAL ANALGESIA IN LOWER LIMB SURGERIES

2020 ◽  
Vol 8 (12) ◽  
pp. 811-816
Author(s):  
Hp Singhl ◽  
◽  
Naveen Jindal ◽  
Jaspreet Singh ◽  
◽  
...  
Keyword(s):  
Lower Limb ◽  
Comparative Evaluation ◽  
Epidural Block ◽  
Epidural Fentanyl ◽  
Epidural Administration ◽  
Double Blind ◽  
Sensory Blockade ◽  
Catheter Technique ◽  
Lower Limb Surgery ◽  
History Of

Background:Epiduralandspinalblocksaremajorregionaltechniques with along history of effectiveuseforavarietyofsurgicalprocedures and pain relief. Epidural block with the catheter technique gives a better control of the level of analgesia and can be used for providingpost-operativepainreliefbyopioidsorlocalanaestheticagents.The purposeofthepresentstudywastocomparethe safetyandefficacyofepiduraltramadolversusepiduralfentanylas adjuvantstobupivacaineforlowerlimbsurgeries. Materials and methods:100 patients werer an domisedin to two groups with50 patient sineach group: Group BB-epidural administration of 20mL 0.5% plain bupivacaine with [50 mg (1 mL) tramadol + 1 mL NS= 2 mL].Group BF- epidural administration of 20 mL 0.5% plain bupivacainewith100mcg(2mL)of fentanyl.Settings and Design- Randomised double-blind trial. Results:The mean onset of sensory blockade and time for maximum sensory blockade was observed to be significantly reduced with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. The results showed statistically significant increase in the duration of analgesia with the addition of fentanyl to bupivacaine as compared to tramadol and bupivacaine. Conclusion:We can conclude that tramadol and fentanyl were effective adjuvants to bupivacaine when used epidurally in patients undergoing lower limb surgery. Although, epidural fentanyl with bupivacaine produces significantly faster onset of sensory blockadecompared to epiduralhowever,epiduraltramadolwithbupivacaineproducessignificantlyprolonged durationofanalgesiacomparedtoepiduralfentanyl.

Role of ultrasound guided epidural anesthesia for lower limb surgery in children with previously repaired meningomyelocele

2017 ◽  
Vol 28 (3) ◽  
pp. 287-290 ◽  
Author(s):  
Vrushali C. Ponde ◽  
Vinit V. Bedekar ◽  
Dilip Chavan ◽  
Anuya Gursale ◽  
Dipal Shah
Keyword(s):  
Epidural Anesthesia ◽  
Lower Limb ◽  
Ultrasound Guided ◽  
Lower Limb Surgery

225Intrathecal lidocaine or preservative-free chlorprocaine for outpatient lower limb surgery

2006 ◽  
Vol 31 (5) ◽  
pp. 43-43
Author(s):  
M BACIARELLO ◽  
M ZASA ◽  
A CASATI ◽  
G DANELLI ◽  
S ADAMANTI ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lower Limb Surgery ◽  
Preservative Free

scholarly journals Impact of ankle-foot orthoses on gait 1 year after lower limb surgery in children with bilateral cerebral palsy

2018 ◽  
Vol 43 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Ingrid Skaaret ◽  
Harald Steen ◽  
Terje Terjesen ◽  
Inger Holm
Keyword(s):  
Cerebral Palsy ◽  
Gait Analysis ◽  
Lower Limb ◽  
Three Dimensional ◽  
Foot Orthoses ◽  
Important Improvement ◽  
Gait Dysfunction ◽  
Ankle Foot Orthoses ◽  
Profile Score ◽  
Lower Limb Surgery

Background: Different types of ankle-foot orthoses are commonly used following lower limb surgery in children with bilateral spastic cerebral palsy. After three-dimensional gait analysis 1 year postoperatively, many children are recommended continued use of ankle-foot orthoses. Objectives: Our aims were to quantify the impact of ankle-foot orthoses on gait 1 year postoperatively and evaluate predictors for clinically important improvement. Study design: Prospective cohort study. Methods: A total of 34 ambulating children with bilateral cerebral palsy, with mean age 11 years (range 6–17), comprising 12 girls and 22 boys, were measured with three-dimensional gait analysis preoperatively (barefoot) and 1 year postoperatively (barefoot and with ankle-foot orthoses). Outcome was evaluated using gait profile score, key kinematic, kinetic and temporal–spatial variables in paired sample comparisons. Logistic regression was used to evaluate predictors for clinically important improvement with orthoses (⩾1.6° change in gait profile score). Results: Walking barefoot 1 year postoperatively, major improvements were seen in gait profile score and key variables. With ankle-foot orthoses, there were significantly improved step length and velocity, additional moderate reduction/improvement in gait profile score and knee moments and decreased stance ankle dorsiflexion compared to barefoot. Children using ground reaction ankle-foot orthoses ( n = 14) decreased stance knee flexion from 13.9° walking barefoot to 8.2° with orthoses. High gait profile score and more gait dysfunction preoperatively were significant predictors of clinically important improvement walking with orthoses. Conclusion: The results indicate improved gait function walking with ankle-foot orthoses versus barefoot 1 year after lower limb surgery. Stronger impact of ankle-foot orthoses was found in children with more pronounced gait dysfunction preoperatively. Clinical relevance The 1-year postoperative three-dimensional gait analysis is a useful method to assess treatment outcome after lower limb surgery in children with bilateral cerebral palsy and could also guide clinicians whether further treatment with ankle-foot orthoses is indicated, using clinically important differences as thresholds to evaluate their impact on gait.

COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST-OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

2021 ◽  
pp. 29-31
Author(s):  
Anant Prakash ◽  
Rahul Kumar ◽  
Chandeshwar Choudhary ◽  
Debarshi Jana
Keyword(s):  
Comparative Study ◽  
Lower Limb ◽  
Heart Beat ◽  
Epidural Administration ◽  
Visual Analogue Pain ◽  
Post Operative Period ◽  
Epidural Bupivacaine ◽  
Lower Limb Surgery ◽  
Group A ◽  
Group B

Background: Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post-operative period as epidural analgesia. It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post-operative analgesia in abdominal and lower limb surgery. Methods: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 aged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm mark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post-operative period the following parameters were studied, 1. Onset of analgesia, 2. Duration of analgesia, 3. Vital parameters such as heart beat, blood pressure, respiratory rate, sedation score and visual analogue score were recorded, 4. Side effects like nausea, vomiting, hypotension, respiratory depression, and pruritus allergic reaction were looked for. Results: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine) was 7.35 min. When compared to Group B which 15.5 min, which is statically signicant (P<0.05). Duration of analgesia in Group A is 17.23 hrs compared to Group B, which is 5.2 hrs, this is statically signicant (P<0.05). Visual analogue scale was reduced in Group A compared to Group B Conclusions: Addition of buprenorphine to bupivacaine by epidural injection for post-operative analgesia improves the onset, The duration and the quality of analgesia

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