The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Kwong Yuen Chiu - One of the best experts on this subject based on the ideXlab platform.
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Silent compartment syndrome complicating total knee arthroplasty. Continuous Epidural Anesthesia masked the pain
The Journal of arthroplasty, 2000Co-Authors: Man Tang, Kwong Yuen ChiuAbstract:Posterior dislocation is an uncommon complication of total knee arthroplasty (TKA) using a posterior stabilized total knee prosthesis, and it usually results from flexion instability. Acute posterior dislocation of a posterior stabilized prosthesis complicated by compartment syndrome of the leg has not previously been reported in the literature. We report a 62-year-old woman with posterior dislocation of her posterior stabilized TKA when her knee was in extension. It was further complicated by compartment syndrome with severe muscle necrosis. The diagnosis of compartment syndrome was delayed, partly because of Continuous Epidural Anesthesia that completely abolished the pain and partly because of the low index of suspicion, as compartment syndrome is not well recognized as a possible complication of TKA. This case report strongly emphasizes that Continuous Epidural Anesthesia is contraindicated in the case of complicated TKA because important clinical cues to neurovascular complications could be masked.
Koichi Sairyo - One of the best experts on this subject based on the ideXlab platform.
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LOCAL INFILTRATEON OF ANALGESIA WITH Continuous Epidural Anesthesia AFTER TOTAL KNEE ARTHROPLASTY IMPROVED EARLY PHASE POSTOPERATIVE QUADRICEPS FUNCTION
Journal of Bone and Joint Surgery-british Volume, 2016Co-Authors: Daisuke Hamada, Takahiko Tsutsui, Tomohiro Goto, S. Kato, Keizo Wada, Koichi SairyoAbstract:Background Continuous Epidural Anesthesia or femoral nerve block has decreased postoperative pain after total knee arthroplasty to some extent. Although the established efficacy of these pain relief method, some adverse events such as hematoma or muscle weakness are still problematic. Intraoperative local infiltration of analgesia (LIA) has accepted as a promising pain control method after total knee arthroplasty. The safety and efficacy of LIA has been reported, although there are still limited evidence about the effect of LIA on quadriceps function and recovery of range of motion in early post-operative phase. The purpose of this study is to compare the quadriceps function and range of motion after TKA between the LIA with Continuous Epidural Anesthesia and Continuous Epidural Anesthesia alone. Methods Thirty patients with knee osteoarthritis who underwent primary TKA were included in this study. Patients who took anticoagulants were treated Continuous Epidural Anesthesia alone (n=11) and the other patients were treated with LIA with Continuous Epidural Anesthesia (n=19). A single surgeon at our department performed all surgeries. Surgical procedure and rehabilitation process was identical between two groups. Before the implantation, analgesic drugs consisting of 20 ml of 0.75 % ropivacaine and 6.6 mg of dexamethasone were injected into the peri-articular tissues. In each group, fentanyl Continuous Epidural patient-controlled analgesia (PCA) was also used during 48-h post-operative period. Knee flexion and extension angle were evaluated before surgery, post-op day 3, 7, 10 and 14. The quadriceps function was evaluated by quadriceps peak torque at 30° and 60° flexion using VIODEX. The peak torque was recorded preoperatively, day 14 and 3 month after surgery. The difference between two groups was analyzed by Mann Whitney U-test using Prism 6, a statistical software. Results LIA group showed better postoperative flexion angle until day 7 (Fig. 1). Then the discrepancy became smaller and came to the same degree at day14. The peak torque at 30° and 60° flex is higher in LIA group compared to Epidural Anesthesia alone. The LIA group showed less peak torque decrease at 2 weeks after surgery than Epidural Anesthesia alone group (Fig. 2, 3). No adverse events such as were observed in each group. Discussion This paper demonstrated that LIA in addition to the Continuous Epidural Anesthesia after TKA provides better quadriceps function and early recovery in knee range of motion. In this study we also used Continuous Epidural Anesthesia, thus this study can not evaluate the stand alone LIA effects on quadriceps function and range of motion recovery. Furthermore the patients were not randomly assigned in this study, this might be another limitation of this study. In conclusion, LIA provide better quadriceps function and early recovery of range of motion in addition to the pain relief. To view tables/figures, please contact authors directly.
Man Tang - One of the best experts on this subject based on the ideXlab platform.
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Silent compartment syndrome complicating total knee arthroplasty. Continuous Epidural Anesthesia masked the pain
The Journal of arthroplasty, 2000Co-Authors: Man Tang, Kwong Yuen ChiuAbstract:Posterior dislocation is an uncommon complication of total knee arthroplasty (TKA) using a posterior stabilized total knee prosthesis, and it usually results from flexion instability. Acute posterior dislocation of a posterior stabilized prosthesis complicated by compartment syndrome of the leg has not previously been reported in the literature. We report a 62-year-old woman with posterior dislocation of her posterior stabilized TKA when her knee was in extension. It was further complicated by compartment syndrome with severe muscle necrosis. The diagnosis of compartment syndrome was delayed, partly because of Continuous Epidural Anesthesia that completely abolished the pain and partly because of the low index of suspicion, as compartment syndrome is not well recognized as a possible complication of TKA. This case report strongly emphasizes that Continuous Epidural Anesthesia is contraindicated in the case of complicated TKA because important clinical cues to neurovascular complications could be masked.
Kazuhiko Tsuruya - One of the best experts on this subject based on the ideXlab platform.
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bacterial meningitis and multiple abscess formation in the iliopsoas erector spinae and vastus lateralis muscle in a maintenance hemodialysis patient treated with Continuous Epidural Anesthesia for herpes zoster related pain control a case report and
Renal Replacement Therapy, 2018Co-Authors: Shunsuke Yamada, Toshiro Maeda, Noriko Nakamura, Kosuke Masutani, Takanari Kitazono, Narihito Tatsumoto, Kazuhiko TsuruyaAbstract:Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients. A 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with Continuous Epidural Anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient. Treatment with sensitive antibiotics and timely open surgical drainage is necessary to cure catheter-related meningitis and secondary deep muscle abscesses in hemodialysis patients. Our case also suggests that Epidural Anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus.
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Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with Continuous Epidural Anesthesia for herpes zoster-related pain control: a case report
Renal Replacement Therapy, 2018Co-Authors: Shunsuke Yamada, Toshiro Maeda, Noriko Nakamura, Kosuke Masutani, Takanari Kitazono, Narihito Tatsumoto, Kazuhiko TsuruyaAbstract:Background Infection is the second leading cause of mortality in patients who undergo maintenance hemodialysis. In this population, impairment in both cellular and humoral immunity contributes to the increased incidence of infection and infection-related hospitalization. However, these artificial devices occasionally enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients. Case presentation A 54-year-old male undergoing maintenance hemodialysis was hospitalized because of the acute onset pain in the back and bilateral legs and declining consciousness which started at 7 days after the treatment of herpes zoster-related neuralgia with Continuous Epidural Anesthesia. Physical examination revealed purulent discharge from the insertion site of the catheter. Serum biochemical tests showed increased inflammatory response and malnutrition. Magnetic resonance imaging revealed meningitis and multiple abscesses in the iliopsoas, erector spinae, gluteus medius, and vastus lateralis muscles, where conventional antibiotic treatment often fails to cure. Staphylococcus aureus was detected in the cerebrospinal fluid. Combination of intravenous antibiotics treatment and aggressive open surgical drainage of the muscle abscesses finally cured meningitis and multiple deep muscle abscesses in this patient. Conclusions Treatment with sensitive antibiotics and timely open surgical drainage is necessary to cure catheter-related meningitis and secondary deep muscle abscesses in hemodialysis patients. Our case also suggests that Epidural Anesthesia may not be a good therapeutic option for herpes zoster because patients with herpes zoster are immunologically more compromised during and shortly after reactivation of varicella zoster virus.
Muneaki Shimada - One of the best experts on this subject based on the ideXlab platform.
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A Clinical Comparison of Continuous Sciatic Nerve Block and Epidural Anesthesia for Postoperative Pain Control in Patients with Fracture of the Foot
Masui. The Japanese journal of anesthesiology, 2015Co-Authors: Yoshimune Osaka, Naho Shimada, Ikue Saito, Yuuki Kozono, Takeshi Ando, Rie Saito, Muneaki ShimadaAbstract:Abstract Epidural analgesia provides good pain relief for patients with fracture of the foot Ultrasound-guided peripheral nerve block offers safety and efficacy without affecting the leg. We compared the Continuous sciatic nerve block with the Continuous Epidural Anesthesia regarding postoperative pain after the open reduction and internal fixation (ORIF) of the ankle fracture or calcaneal bone fracture. Fifteen patients were included in the Epidural group (group E), and 17 patients in the sciatic nerve block group (group S). The postoperative pain scores were significantly lower in group S 3 hours and 12 hours after the procedure, and tended to be lower in other periods. Perioperative periods were uneventful in both groups. Continuous sciatic nerve block developed good postoperative analgesia in ORIF of ankle fracture or calcaneal bone fracture compared with Continuous Epidural Anesthesia.
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A Clinical Comparison of Continuous Sciatic Nerve Block and Epidural Anesthesia for Postoperative Pain Control in Patients with Fracture of the Foot
Masui. The Japanese journal of anesthesiology, 2015Co-Authors: Yoshimune Osaka, Naho Shimada, Ikue Saito, Takeshi Ando, Rie Saito, Yuki Kozono, Muneaki ShimadaAbstract:BACKGROUND Epidural analgesia provides good pain relief for patients with fracture of the foot Ultrasound-guided peripheral nerve block offers safety and efficacy without affecting the leg. METHODS We compared the Continuous sciatic nerve block with the Continuous Epidural Anesthesia regarding postoperative pain after the open reduction and internal fixation (ORIF) of the ankle fracture or calcaneal bone fracture. RESULTS Fifteen patients were included in the Epidural group (group E), and 17 patients in the sciatic nerve block group (group S). The postoperative pain scores were significantly lower in group S 3 hours and 12 hours after the procedure, and tended to be lower in other periods. Perioperative periods were uneventful in both groups. CONCLUSIONS Continuous sciatic nerve block developed good postoperative analgesia in ORIF of ankle fracture or calcaneal bone fracture compared with Continuous Epidural Anesthesia.