Woo Suk Lee

Continuous epidural analgesia versus continuous intravenous analgesia with peri-articular infiltration following total knee arthroplasty in geriatric patients

BACKGROUND Postoperative continuous intravenous analgesia may not provide effective postoperative analgesia following total knee arthroplasty. This study was conducted to determine if combined continuous intravenous analgesia and peri-articular infiltration provided a better quality of analgesia following total knee arthroplasty than epidural analgesia. METHODS A prospective, double-blind study involving 50 patients who had undergone total knee arthroplasty was conducted. Patients were divided into control group and an experimental group. Patients in the control group (n = 25) received peri-articular infiltration with 47 mL normal saline prior to closure of the wound and postoperative epidural analgesia for 48 hours. Patients in the experimental group (n = 25) received a mixture of peri-articular infiltration of 16 mL of 0.75% ropivacaine, 6 mg morphine, 0.2 mg of epinephrine and 25 mL normal saline prior to closure of the wound and postoperative continuous intravenous analgesia for 48 hours. The analgesic efficacy was then evaluated using the verbal numeric rating scale at 1, 2, 6, 12, 24, and 48 hours postoperatively. The side effects and the dosage of rescue analgesics were then recorded. RESULTS The experimental group showed a significantly higher pain score than the control group 2 and, 6 hours postoperatively at rest and 2 hours postoperatively following passive knee movement (P < 0.05). In addition, the rescue analgesic requirement was higher for the experimental group during the first 24 hours following surgery than for the control group (P < 0.05). CONCLUSIONS We found that combined continuous intravenous analgesia and peri-articular infiltration of a mixture of ropivacaine and, morphine injected into the peri-articular tissue provided minimal benefits for pain control during the early postoperative period when compared to epidural analgesia after total knee arthroplasty.

Subacute Epiphyseal Osteomyelitis in a Child -A Case Report-

Primary subacute osteomyelitis is an infection of the bone that continues for several weeks without anyacute infectious manifestations such as fever, local pain and swelling. A diagnosis is often delayed because of the slow onset, the subtle radiological changes and the absence of infectious clinical and laboratory manifestations. Primary subacute osteomyelitis in 35%of primary osteomyelitis cases, almost developed in the metaphysis, but there is no report of subacute epiphyseal osteomyelitis in Korea. We report a case of primary subacute epiphyseal osteomyelitis in the distal femur which was treated conservatively with a satisfactory outcome.