Randomized Clinical Trial Comparing Mixed Liposomal Bupivacaine versus Continuous Catheter for Interscalene Block during Shoulder Arthroplasty: A Comparison of Analgesia, Patient Experience, and Cost.

Background: Continuous interscalene catheters extend analgesia beyond 24 hours but are resource-intensive, while the efficacy of liposomal bupivacaine for single-injection interscalene blocks remains uncertain. The purpose of this investigation was to examine the analgesic efficacy, quality of recovery, and treatment costs between interscalene nerve block using either an indwelling catheter or single shot block using liposomal bupivacaine, in patients undergoing shoulder arthroplasty.

Methods: In this single-center, parallel, unblinded, randomized clinical trial, 83 patients undergoing primary shoulder arthroplasty were assigned to either a continuous interscalene catheter group (n=44) or a single-injection liposomal bupivacaine interscalene block group (n=39).

Spinal Versus General Anesthesia in Contemporary Revision Total Hip Arthroplasties.

Background: Spinal anesthesia is increasingly used in complex patient populations including revision total hip arthroplasties (THAs). This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a large institutional series of revision THAs.

Methods: We retrospectively identified 4,767 revision THAs (4,533 patients) from 2001 to 2016 using our institutional total joint registry.

Spinal Versus General Anesthesia in Contemporary Revision Total Knee Arthroplasties.

Background: Interest in spinal anesthesia utilization in revision total knee arthroplasties (TKAs) is rising. This study investigated the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a single institution series of revision TKAs.

Methods: We identified 3,711 revision TKAs (3,495 patients) from 2001 to 2016 using our institutional total joint registry.

Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project - Phase III Outcomes.

Background: Our institution initiated the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies (OASIS) project in 2017 to improve the quality and efficiency for hip and knee arthroplasties. Phase III of this project aimed to: 1) increase same-day discharge (SDD) of primary total joint arthroplasties (TJAs) to 20%; 2) maintain or improve 30-day readmission rates; and 3) realize cost savings and revenue increases.

Methods: All primary TJAs performed between 2021 and 2022 represented our study cohort, with those in 2019 (prepandemic) establishing the baseline cohort.

Spinal versus general anaesthesia in contemporary primary total knee arthroplasties.

Aims: Spinal anaesthesia has seen increased use in contemporary primary total knee arthroplasties (TKAs). However, controversy exists about the benefits of spinal in comparison to general anaesthesia in primary TKAs. This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anaesthesia in primary TKAs from a single, high-volume academic centre.

Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties.

Background: The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution.

Methods: We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry.

Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation.

Objective: To compare the relative value of 3 analgesic pathways for total knee arthroplasty (TKA).

Patients And Methods: Time-driven activity-based costing analyses were performed on 3 common analgesic pathways for patients undergoing TKA: periarticular infiltration (PAI) only, PAI and single-injection adductor canal blockade (SACB), and PAI and continuous adductor canal blockade (CACB). Additionally, adult patients who underwent elective primary TKA from November 1, 2017, to May 1, 2018, were retrospectively identified to analyze analgesic (pain score, opiate use) and hospital outcomes (distance walked, length of stay) after TKA based on analgesic pathway.

Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project-Phase II Outcomes.

Background: Our institution previously initiated a perioperative surgical home initiative to improve quality and efficiency across the hospital arc of care of primary total knee arthroplasty and total hip arthroplasty patients. Phase II of this project aimed to (1) expand the perioperative surgical home to include revision total hip arthroplasties and total knee arthroplasties, hip preservation procedures, and reconstructions after oncologic resections; (2) expand the project to include the preoperative phase; and (3) further refine the perioperative surgical home goals accomplished in phase I.

Methods: Phase II of the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies project ran from July 2018 to July 2019.

Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project: Phase I Outcomes.

Background: This study aimed to improve institutional value-based patient care processes, provider collaboration, and continuous process improvement mechanisms for primary total hip arthroplasties and total knee arthroplasties through establishment of a perioperative orthopedic surgical home.

Methods: On June 1, 2017, an institutionally sponsored initiative commenced known as the orthopedic surgery and anesthesiology surgical improvement strategy project. A multidisciplinary team consisting of orthopedic surgeons, anesthesiologists, advanced practice providers, nurses, pharmacists, physical therapists, social workers, and hospital administration met regularly to identify areas for improvement in the preoperative, intraoperative, and post-anesthesia care unit, and postoperative phases of care.

More Predictable Return of Motor Function with Mepivacaine Versus Bupivacaine Spinal Anesthetic in Total Hip and Total Knee Arthroplasty: A Double-Blinded, Randomized Clinical Trial.

Background: Spinal anesthesia provides several benefits for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), but historically comes at the cost of slow and unpredictable return of lower-extremity motor function related to the use of long-acting local anesthetics. In this prospective, double-blinded, randomized clinical trial we sought to determine if an alternative local anesthetic, mepivacaine, would allow more consistent return of motor function compared with low-dose bupivacaine spinal anesthesia during primary THA and TKA.

Methods: This trial was conducted at a single academic institution.

Peripheral electrical stimulation reduces postoperative hypoxemia in patients at risk for obstructive sleep apnea: a randomized-controlled trial.

Purpose: Severity of hypoxemic events resulting from obstructive sleep apnea (OSA) is correlated with increased risk of complications and sudden death. We studied the use of a peripheral transcutaneous electrical stimulus (TES) on the magnitude and duration of sleep apnea associated hypoxemia in postoperative patients at high risk for OSA.

Methods: In this randomized, double-blind, controlled, single-centre trial, 106 adult patients undergoing elective surgery who were at medium to high risk for OSA (sleep apnea clinical scores of 18-35) were randomized to either TES (active stimulus group, n = 53) or control (non-stimulus group, n = 53) during their stay in the postanesthesia care unit.

Ultrasound-Assisted Combined Spinal-Epidural Anesthesia for Cesarean Delivery in a Parturient With Currarino Triad: A Case Report.

Currarino triad is a rare hereditary condition characterized by anorectal malformation, sacral dysgenesis, and a presacral mass. Neuraxial anesthetic techniques pose increased risks to patients with spinal malformations. Ultrasound imaging improves accuracy of intervertebral level identification compared to clinical estimation.

Interspace between Popliteal Artery and posterior Capsule of the Knee (IPACK) Injectate Spread: A Cadaver Study.

Objectives: Local anesthetic injection into the interspace between the popliteal artery and the posterior capsule of the knee (IPACK) has the potential to provide motor-sparing analgesia to the posterior knee after total knee arthroplasty. The primary objective of this cadaveric study was to evaluate injectate spread to relevant anatomic structures with IPACK injection.

Methods: After receipt of Institutional Review Board Biospecimen Subcommittee approval, IPACK injection was performed on fresh-frozen cadavers.

Acute Benefits After Liposomal Bupivacaine Abdominal Wall Blockade for Living Liver Donation: A Retrospective Review.

Objective: To investigate whether the addition of liposomal bupivacaine abdominal wall blocks to a multimodal analgesic regimen improves postoperative numeric rating scale pain scores and reduces opioid consumption in patients undergoing living liver donation.

Patients And Methods: We conducted a single-center, retrospective review of patients who underwent living liver donation from January 1, 2011, through February 19, 2016, and received multimodal analgesia with (block group) or without (control group) abdominal wall blockade. The block solution consisted of liposomal bupivacaine (266 mg) mixed with 30 mL of 0.

Clinical implications of de Barsy syndrome.

Background: De Barsy syndrome is a rare, autosomal recessive syndrome characterized by cutis laxa, progeroid appearance, ophthalmic opacification, skeletal malformations, growth delays, and intellectual disability.

Aims: The aim of this case series is to identify the anesthetic considerations in the clinical management of patients with de Barsy syndrome.

Methods: A retrospective case review from 1968 to 2016 was performed at a single tertiary medical center to identify patients with de Barsy syndrome who underwent anesthesia for diagnostic and surgical procedures.

Impaired Ventilation and Oxygenation After Emergency Cricothyrotomy: Recommendations for the Management of Suboptimal Invasive Airway Access.

Invasive airway access by emergent cricothyrotomy remains an essential treatment modality in "can't intubate/can't ventilate" scenarios. Although numerous commercial devices are available, limited comparative data exist with regard to the ventilation and oxygenation parameters of these devices. We report a case of severely compromised respiratory function while using the Quicktrach II, a commercially available emergency cricothyrotomy device.

Perioperative comorbidities and complications among patients undergoing primary total knee arthroplasty: a retrospective analysis and prospective survey.

Study Objective: To determine the demographic characteristics of patients undergoing primary total knee arthroplasty during the years 1989, 1999, and 2009 at our institution and determine whether their characteristics mirror the changing US demographic characteristics.

Design: Retrospective chart review of patients and prospective survey of experienced anesthesia providers in total knee arthroplasty.

Setting: Tertiary care academic medical center.

Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value.

While tranexamic acid (TXA) reduces transfusion in total joint arthroplasty (TJA), it remains unclear whether there is a preoperative hemoglobin (Hgb) threshold above which it is no longer beneficial. 2100 primary TJA patients were retrospectively categorized by preoperative Hgb; 1161 (55%) received TXA. Transfusion rates decreased with TXA in all groups; with Hgb>15 the transfusion rate was 0.

Positioning artifact causing retained foreign object appearance in a radiograph of a venous catheter.

In preparation for an abdominal tumor debulking procedure, a patient had a right internal jugular central venous catheter (CVC) inserted. A radiologist interpreted a postoperative chest radiograph as containing a 7-cm foreign body in the distal lumen of the CVC. After removal, dissection of the CVC revealed a polyurethane plug in the distal lumen.