A comparison of regional and general anaesthesia for total replacement of the hip or knee
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We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included. We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) -0.19; 95% confidence interval (CI) -0.33 to -0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80). Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement.Keywords:
Regional anaesthesia
Background Guidelines recommend warfarin prophylaxis to prevent venous thromboembolism after joint replacement surgery. This study describes variations in International Normalized Ratio (INR) and patterns of concomitant drug use in patients with total hip and total knee replacement receiving warfarin perioperatively. Methods Health records were analyzed from patients who underwent total hip replacement or total knee replacement between January 1, 2000 and October 31, 2009, had warfarin 30 days before or up to 15 days after surgery, were older than 18 years at initiation, and were enrolled in a health plan for 30 days before and up to 90 days after initiation. Results The mean ages of patients having total hip replacement and total knee replacement were 68 and 70 years, respectively. During days 5-90 after initiation, INR readings for 47% of patients having total hip replacement and 53% of patients having total knee replacement were outside the American College of Chest Physicians (ACCP) recommended range, 2.0–3.0. Ten percent of patients with total hip replacement and 9% with total knee replacement developed venous thromboembolism, and 3% and 2% had a bleeding event, respectively. Patients who had values below ACCP-recommended INR had an increased risk of venous thromboembolism among the total knee replacement population but not the total hip replacement population. In patients with ≥1 INR, 65% were prescribed concomitant drugs which increase INR, 2% were prescribed drugs which increase or decrease INR, 24% were prescribed drugs which increase INR and decrease INR, and 10% were prescribed concomitant drugs with no effect on INR or had no concomitant drugs. Conclusions Approximately 50% of patients receiving low-dose warfarin perioperatively had INR below ACCP-recommended levels and increased risk of venous thromboembolism. Concomitant use of drugs potentially interacting with warfarin was common after total hip replacement or total knee replacement surgery.
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Nurses care for patients before, during, and after hip replacement—one of the most common joint surgeries along with knee replacement. Here's what you need to know to provide your patients with the best possible care.
Joint replacement
Total joint replacement
Total Knee Replacement
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Total Knee Replacement
Enoxaparin sodium
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Hip Fracture
Total Knee Replacement
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Rivaroxaban is a highly potent direct factor Xa inhibitor that is pending FDA approval for the indication of venous thromboembolism (VTE) prophylaxis in patients undergoing total knee replacement or total hip replacement surgery.
Total Knee Replacement
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Study on outcome of cemented total hip replacement by posterolateral approach to hip - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.012, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg
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Abstract Background Single‐entry models (SEM) improve wait times for hip and knee replacement, but little is known whether prioritization implemented in SEM can help meet the benchmarks for consolation/surgery. This study aimed to determine the impact of prioritization on receiving consultation and surgery within the benchmarks. Methods This is a retrospective cohort study for which two administration databases were linked. Logistic regression was used to investigate the impact of prioritization on receiving consultations and surgery within the benchmarks of 90 and 182 days, respectively, adjusting for patients’ characteristics and preference for surgeon. Results 1,967 patients were included in this study. The odds ratios of having consultation within 90 days for hip replacement patients in priorities 1 and 2 (high priority) were 57.24 (CI: 23.16–141.47) and 14.63 (CI: 6.44–33.25), respectively, compared with those in priority 3. For knee replacement, patients with higher priority were more likely to have consultation within 90 days. Although priority levels were not related to having surgery within 182 days for knee replacement, hip replacement patients with priority 1 (CI: 0.2–0.75) and 2 (CI: 0.16–0.54) were less likely to have surgery within 182 days, compared with those with priority 3. Conclusion Patients with high priority levels were more likely to have consultation within 90 days for hip and knee replacements. SEM may not help have surgery within 182 days. Prioritization has no impact on receiving surgery within 182 days for knee replacement, but hip replacement patients with high priority were less likely to have surgery within 182 days.
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Hip surgery
Knee surgery
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Regional anaesthesia is now a well recognized and accepted technique in the practice of paediatric anaesthesia. It may be used in conjunction with general anaesthesia or as an alternative to general anaesthesia, for example, in high-risk infants. This technique offers excellent postoperative pain relief. However, age-dependent and clinical differences must be recognized for safety.
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We conducted a postal survey of 221 anaesthetists in the Oxford region to determine their views and actual clinical practice regarding regional anaesthesia in adult patients undergoing limb surgery, when a combined regional and general anaesthetic was planned. Of the 162 respondents (73.3%), 142 (87.6%) regularly practised regional blocks for limb surgery in adult patients. For all the regional anaesthetic techniques in question, more anaesthetists felt it was safer to perform these blocks before induction of general anaesthesia than after induction. However, their actual practice varied markedly from their views, with more anaesthetists performing these blocks after general anaesthesia. Overall, trainees performed blocks before induction of general anaesthesia more often than consultants (p = 0.047).
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