Preoperative optimization to prevent periprosthetic joint infection in at-risk patients.

Periprosthetic joint infection (PJI) remains an important complication with devastating consequences after total joint arthroplasties. With the increasing number of arthroplasties worldwide, the number of PJI will increase correspondingly with a significant economic burden to our healthcare system. It is likely impossible to completely eradicate PJI; hence, assessment and optimization of its risk factors to preventing such a disastrous complication will be the key.

A Virtual Reality Simulation Model of Spinal Ultrasound: Role in Teaching Spinal Sonoanatomy.

Background And Objectives: Ultrasound assessment of the lumbar spine improves the success of spinal and epidural anesthesia, especially for patients with underlying difficult anatomy. To assist with the teaching and learning of ultrasound-guided neuraxial anesthesia, we have created an online interactive educational model (http://www.usra.

Is Ultrasound a Valid and Reliable Imaging Modality for Airway Evaluation?: An Observational Computed Tomographic Validation Study Using Submandibular Scanning of the Mouth and Oropharynx.

Objectives: Ultrasound (US) imaging of the airway may be useful in predicting difficulty of airway management (DAM); but its use is limited by lack of proof of its validity and reliability. We sought to validate US imaging of the airway by comparison to CT-scan, and to assess its inter- and intra-observer reliability. We used submandibular sonographic imaging of the mouth and oropharynx to examine how well the ratio of tongue thickness to oral cavity height correlates with the ratio of tongue volume to oral cavity volume, an established tomographic measure of DAM.

Functional outcome and cost-effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery. A retrospective cohort study.

Study Objective: To compare the postoperative functional outcome and the total cost associated with outpatient vs inpatient care following complex hind-foot and ankle surgery.

Design: Retrospective, cohort study.

Setting: Tertiary care center.

Anesthesia Technique and Mortality after Total Hip or Knee Arthroplasty: A Retrospective, Propensity Score-matched Cohort Study.

Background: This propensity score-matched cohort study evaluates the effect of anesthetic technique on a 30-day mortality after total hip or knee arthroplasty.

Methods: All patients who had hip or knee arthroplasty between January 1, 2003, and December 31, 2014, were evaluated. The principal exposure was spinal versus general anesthesia.

The future of regional anesthesia education: lessons learned from the surgical specialty.

Purpose: Application of ultrasound in regional anesthesia has now become the standard of care and its use has shown to reduce complications. Nevertheless, gaining expertise in ultrasound-guided regional anesthesia requires the acquisition of new cognitive and technical skills. In addition, due to a reduction in resident working hours and enforcement of labour laws and directives across various states and countries, trainees perform and witness fewer procedures.

The Nerves of the Adductor Canal and the Innervation of the Knee: An Anatomic Study.

Background And Objectives: Adductor canal block contributes to analgesia after total knee arthroplasty. However, controversy exists regarding the target nerves and the ideal site of local anesthetic administration. The aim of this cadaveric study was to identify the trajectory of all nerves that course in the adductor canal from their origin to their termination and describe their relative contributions to the innervation of the knee joint.

Adductor Canal Block Provides Noninferior Analgesia and Superior Quadriceps Strength Compared with Femoral Nerve Block in Anterior Cruciate Ligament Reconstruction.

Background: By targeting the distal branches of the femoral nerve in the mid-thigh, the adductor canal block (ACB) can preserve quadriceps muscle strength while providing analgesia similar to a conventional femoral nerve block (FNB) for inpatients undergoing major knee surgery. In this randomized, double-blind, noninferiority trial, the authors hypothesized that ACB provides postoperative analgesia that is at least as good as FNB while preserving quadriceps strength after outpatient anterior cruciate ligament reconstruction.

Methods: A total of 100 patients were randomized to receive ACB or FNB with 20 ml ropivacaine 0.

IV and Perineural Dexmedetomidine Similarly Prolong the Duration of Analgesia after Interscalene Brachial Plexus Block: A Randomized, Three-arm, Triple-masked, Placebo-controlled Trial.

Background: Perineural and IV dexmedetomidine have each been suggested to prolong the duration of analgesia when administered in conjunction with peripheral nerve blocks. In the first randomized, triple-masked, placebo-controlled trial to date, the authors aimed to define and compare the efficacy of perineural and IV dexmedetomidine in prolonging the analgesic duration of single-injection interscalene brachial plexus block (ISB) for outpatient shoulder surgery.

Methods: Ninety-nine patients were randomized to receive ISB using 15 ml ropivacaine, 0.

An Expedited Care Pathway with Ambulatory Brachial Plexus Analgesia Is a Cost-effective Alternative to Standard Inpatient Care after Complex Arthroscopic Elbow Surgery: A Randomized, Single-blinded Study.

Background: Common standard practice after complex arthroscopic elbow surgery includes hospital admission for 72 h. The authors hypothesized that an expedited care pathway, with 24 h of hospital admission and ambulatory brachial plexus analgesia and continuous passive motion at home, results in equivalent elbow range of motion (ROM) 2 weeks after surgery compared with standard 72-h hospital admission.

Methods: A randomized, single-blinded study was conducted after obtaining approval from the research ethics board.

Point-of-care ultrasound defines gastric content and changes the anesthetic management of elective surgical patients who have not followed fasting instructions: a prospective case series.

Purpose: Pulmonary aspiration of gastric contents is a major cause of anesthesia morbidity and mortality. Point-of-care gastric ultrasound provides information regarding the type and volume of gastric content. The hypothesis of this prospective cohort study was that the addition of point-of-care gastric ultrasound to standard patient assessment results in changes in anesthetic management in at least 30% of elective surgical patients who do not follow fasting instructions.

Neurological Complications Related to Elective Orthopedic Surgery: Part 2: Common Hip and Knee Procedures.

Unlabelled: Many anesthesiologists may not be familiar with the rate of surgical neurological complications of the hip and knee procedures for which they are providing local anesthetic-based anesthesia and/or analgesia. Part 2 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common hip and knee procedures, including arthroscopic hip and knee surgery and total hip and knee replacement.

What's New: As the popularity of regional anesthesia continues to increase with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective hip and knee procedures.

Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures.

Unlabelled: Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low.

Comparing the DN4 tool with the IASP grading system for chronic neuropathic pain screening after breast tumor resection with and without paravertebral blocks: a prospective 6-month validation study.

Investigating protective strategies against chronic neuropathic pain (CNP) after breast cancer surgery entails using valid screening tools. The DN4 (Douleur Neuropathique en 4 questions) is 1 tool that offers important research advantages. This prospective 6-month follow-up study seeks to validate the DN4 and assess its responsiveness in screening for CNP that satisfies the International Association for the Study of Pain (IASP) definition and fulfills its grading system criteria after breast tumor resection with and without paravertebral blocks (PVBs).

Novice performance of ultrasound-guided needling skills: effect of a needle guidance system.

Background And Objectives: Ultrasound-guided needle placement is a widely used technical skill that can be challenging to learn. The SonixGPS is a novel ultrasound needle-tracking system that has the potential to improve performance over traditional ultrasound systems. The objective of our study was to determine if the use of the SonixGPS ultrasound system improves performance of novice practitioners in ultrasound-guided needle placement compared with conventional ultrasound in the out-of-plane approach on a simulation model.

Infection related to ultrasound-guided single-injection peripheral nerve blockade: a decade of experience at toronto Western hospital.

The use of ultrasound guidance has revolutionized regional anesthesia practice. Ultrasound equipment disinfection techniques vary between institutions. To date, there are no large data set publications or evidence-based guidelines that describe risk-reduction techniques for infectious complications related to the use of ultrasound guidance for peripheral nerve blockade.

A valid and reliable assessment tool for remote simulation-based ultrasound-guided regional anesthesia.

Background And Objectives: The purpose of this study was to establish construct and concurrent validity and interrater reliability of an assessment tool for ultrasound-guided regional anesthesia (UGRA) performance on a high-fidelity simulation model.

Methods: Twenty participants were evaluated using a Checklist and Global Rating Scale designed for assessing any UGRA block. The participants performed an ultrasound-guided supraclavicular brachial plexus block on both a patient and a simulator.

The analgesic effects of proximal, distal, or no sciatic nerve block on posterior knee pain after total knee arthroplasty: a double-blind placebo-controlled randomized trial.

Background: The analgesic efficacy of sciatic nerve block (SNB) after total knee arthroplasty (TKA) is unclear. Proximal and distal SNB are each reported to provide posterior knee analgesia, whereas others suggest that posterior knee pain is not important after TKA. This prospective, randomized, double-blind, parallel-arm, placebo-controlled trial examined whether proximal or distal SNB provides superior analgesia in the posterior knee compared with no SNB after TKA.