Thermal injury in tonsils and its relation to postoperative pain—a histopathological and clinical study

Objectives The aim of this study was to compare thermal injury and depth of necrosis of using different monopolar power settings in partial tonsillectomy and correlate the results with the postoperative pain score. Results The study included a total of 15 patients with mean of age of 5.7 ± 2.57 years. The mean depth of injury was significantly higher for the 25 W side (0.973 ± 0.613) versus the 15 W side (0.553 ± 0.218) (p = 0.023). The postoperative pain score showed no significant differences between both sides. Conclusion The histopathologic depth of thermal injury is significantly higher with the 25 W monopolar microdissection in comparison to the 15 W; however, it does not seem to correlate with the postoperative pain level. Apparently, power settings of 25 W can be safely used for pediatric intracapsular tonsillectomies, without added postoperative morbidity despite the deeper tissue injury observed in the tonsil.

The Influence of Assisted Fixation on Pain Relief for Subtrochanteric Femur Fractures in Children

Background : Subtrochanteric femur fractures of children usually recover slower than the intertrochanteric femur fracture and tends to increas the rate of deformity. The difference among treatment options in postoperative pain level should be considered as a crucial factor while tailoring patients’ therapeutic schedules, but has not been paid enough attention to. This study aimed to evaluate and compare the postoperative pain level of hip spica casting, abduction brace and skin traction as assisted fixation to operative interventions. Methods Forty-seven children with subtrochanteric femur fractures on one side were admitted and divided into three groups according to the different assisted fixation they received. Operating time, intraoperative blood loss, follow-up time, postoperative fixation time, days in hospital, time to union, Harris scores, CHEOPS scores (before treatment, after treatment and at the last follow-up time) and VAS scores (before treatment, after treatment and at the last follow-up time) were collected. Results No significant difference of demographic characteristics data was found between the three groups before treatment(P > 0.05). After treatment and at the last follow-up time, the CHEOPS scores and the VAS scores of the three groups were all significantly lower than before(P > 0.05). But there is still no difference between the three groups(P > 0.05). Conclusion Hip spica casting, skin traction and abduction brace have the same ability to relieve the pain of subtrochanteric femur fractures in children.

PLATELET-RICH PLASMA (PRP) AND TRANEXAMIC ACID (TXA) APPLIED IN TOTAL KNEE ARTHROPLASTY

ABSTRACT Objective: To evaluate the efficacy of platelet-rich plasma (PRP) and tranexamic acid (TXA) applied in total knee arthroplasty. Methods: We selected and randomized 84 patients. TXA was applied in 23 patients, PRP in 20, and PRP in combination with TXA in 20. Hemoglobin was measured preoperatively and 24 and 48 hours postoperatively. The function questionnaire, pain scale and gain of knee flexion were monitored until the second postoperative year. Results: There was a difference (p <0.01) in the decrease in hemoglobin 48 hours after surgery between the TXA group and the control and PRP groups. In terms of pain, the TXA group at 24 and 48 hours after surgery and the PRP group at 48 hours after surgery showed advantages (p <0.01). Knee flexion gain in the first 24 hours postoperatively was better in the TXA group (p <0.05). Conclusion: TXA was effective in lowering the drop in hemoglobin level, reducing pain and improving movement gain 48 hours after the procedure. PRP was not effective in reducing bleeding or improving knee function after arthroplasty, but provided better control of postoperative pain. Level of Evidence I, Randomized, blinded, prospective clinical trial.

Continuous Wound Infiltration After Hallux Valgus Surgery

Background: Hallux valgus surgery is associated with significant early postoperative pain. The aim of this study was to investigate the use of continuous wound infiltration (CWI) with ropivacaine for pain management after hallux valgus surgery. Methods: In this prospective, randomized, double-blind, and placebo-controlled single-center trial, 50 patients undergoing distal metatarsal osteotomy for idiopathic hallux valgus were allocated to CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h or placebo for 24 hours postoperatively. Average and peak pain levels on the verbal numeric rating scale (NRS; 1-10) during the first 48 hours after surgery were recorded as primary outcome parameters. Secondary outcome parameters included consumption of narcotics, clinical outcome, incidence of postoperative complications, and patient satisfaction. Results: No significant difference in mean ( P = .596) and peak ( P = .353) postoperative pain level was found for CWI with either ropivacaine (mean NRS 1.9 ± 0.8; peak NRS 3.5 ± 2.0) or placebo (mean NRS 2.0 ± 0.7; peak NRS 3.9 ± 1.7) during the early postoperative course. Furthermore, no significant difference between both groups was detected regarding narcotic consumption ( P = .354) and all other secondary outcome parameters. Two severe complications (local dysesthesia with CWI, catheter accidentally fixed by a suture) and 5 catheter dislocations were observed. Conclusion: CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h for 24 hours after hallux valgus surgery did not reduce postoperative pain level in an inpatient setting. Level of Evidence: Level I, prospective randomized trial.