The Efficacy of Multimodal High-Volume Wound Infiltration in Primary Total Knee Replacement in Facilitating Immediate Post-Operative Pain Relief and Attainment of Early Rehabilitation Milestones.

The efficacy of multimodal high-volume wound infiltration in primary total knee replacement in facilitating immediate post-operative pain relief and attainment of early rehabilitation milestones.

Eur J Orthop Surg Traumatol. 2013 May 21;
Banerjee P

Inadequate pain relief after lower limb joint replacement surgery has been a well-recognised limiting factor affecting post-operative mobilisation and length of hospital stay. Multimodal local wound infiltration with local anaesthetics, adrenaline and non-steroidal anti-inflammatory agents can lower the opiate intake, reduce the length of stay and enhance early mobilisation in knee replacement patients. A retrospective review of 64 patients undergoing primary total knee replacement was undertaken. Thirty-two patients (cases) had their wounds infiltrated with ropivacaine, adrenaline and ketorolac by the operating surgeon, intraoperatively. Subsequently, a 19G wound catheter placed into the knee joint. They received two further top-up doses of the same combination at 10 and 20 h post-operatively. This group was compared with a control group of 32 patients who did not receive any local infiltration. Both groups were comparable in terms of BMI and age. Post-operative opiate drug consumption in first 48 h after surgery, length of hospital stays and time taken to mobilise after surgery were recorded. There was significant reduction in opiate consumption in the treatment group with an average consumption of 49.35 mg of morphine compared to 71.48 mg in the control group (p = 0.004). The median length of hospital stay was significantly reduced from 5 days in the control group to 4 days in the treatment group (p = 0.03). The patients in the treatment group mobilised around 19 h earlier (p = 0.001). No major post-operative complications were encountered in either group. Wound infiltration is an effective and safe technique that promotes early rehabilitation and discharge of patients following primary total knee replacement. HubMed – rehab


Multimodal interactions in typically and atypically developing children: natural versus artificial environments.

Cogn Process. 2013 May 21;
Giannopulu I

This review addresses the central role played by multimodal interactions in neurocognitive development. We first analyzed our studies of multimodal verbal and nonverbal cognition and emotional interactions within neuronal, that is, natural environments in typically developing children. We then tried to relate them to the topic of creating artificial environments using mobile toy robots to neurorehabilitate severely autistic children. By doing so, both neural/natural and artificial environments are considered as the basis of neuronal organization and reorganization. The common thread underlying the thinking behind this approach revolves around the brain’s intrinsic properties: neuroplasticity and the fact that the brain is neurodynamic. In our approach, neural organization and reorganization using natural or artificial environments aspires to bring computational perspectives into cognitive developmental neuroscience. HubMed – rehab


Percutaneous A1 pulley release by the tip of a 20-g hypodermic needle before open surgical procedure in trigger finger management.

Tech Hand Up Extrem Surg. 2013 Jun; 17(2): 112-5
Mishra SR, Gaur AK, Choudhary MM, Ramesh J

The objective of the study was to assess the safety, the efficacy, and the result of percutaneous A1 pulley release, using the tip of a 20-G hypodermic needle; the study included 17 patients with 27 trigger digits (18 grade IIIA, 8 grade IIIB, and 1 grade IV). All the patients were assessed by the total range of motion of the affected digit, the visual analog scale score, and the Disability of Arm Shoulder Hand score, before and after the procedure and during the follow-up at 2, 6, 12, and 24 weeks, and then every 3 months, and the improvement was assessed by one sample t test. Sixteen patients with 26 trigger digits (95.4%) showed complete relief of symptoms with no recurrence and a statistically significant improvement in the range of motion, the visual analog scale score, and the Disability of Arm Shoulder Hand score with a P-value <0.0001, which concludes that the procedure is safe, effective, and highly successful with good results and lower complications, comparable to those reported in papers on open release for grade III and IV trigger fingers. HubMed – rehab


Testicular sperm retrieval and intra cytoplasmic sperm injection provide favorable outcome in spinal cord injury patients, failing conservative reproductive treatment.

Spinal Cord. 2013 May 21;
Raviv G, Madgar I, Elizur S, Zeilig G, Levron J

Study design:Retrospective cohort analysis.Objectives:The objective of this study was to determine the in vitro fertilization (IVF) outcome after testicular sperm extraction (TESE) in a group of spinal cord injury (SCI) male patients not compatible with conservative fertility treatment.Setting:University-affiliated medical center.Methods:Thirty two SCI patients (C2 to L2) were referred to IVF after repeated trials of electroejaculation (EEJ) or penile vibratory stimulation (PVS), and full andrological evaluation. Testicular sperm aspiration (TESA) was the method of choice for sperm extraction. Open TESE was performed only after a negative TESA attempt. Clinical pregnancy and live birth rates were determined.Results:A total of 106 testicular procedures were performed. Sperm was found in 95 cycles (89.6%). The average metaphase II (MII) oocyte number was 11.0±4.2, an average of 5.1±2.3 oocytes became normally fertilized after Intra Cytoplasmic Sperm Injection (ICSI) (fertilization rate 57.1%). On average, 2.7±1.2 embryos were replaced. The clinical pregnancy rate was 32/106 (30.2%) per cycle and 19/32 (59.3%) per couple. Live birth rate was 62.5% (20/32).Conclusions:TESA/E and IVF can provide excellent prognosis for SCI patients that cannot be treated by EEJ or PVS.Spinal Cord advance online publication, 21 May 2013; doi:10.1038/sc.2013.44. HubMed – rehab