ObjectiveTo prospective study the effectiveness and safety of multimodal analgesia (MA) in treatment of avascular necrosis of the femoral head with free vascularized fibular grafting (FVFG).MethodsSixty patients with avascular necrosis of the femoral head, who were scheduled to unilateral primary FVFG between February 2016 and December 2016 and met the selection criteria, were included in the study. All patients were allocated to two groups according to the method of random number table: MA group (n=30) and control group (n=30). There was no significant difference in gender, age, body mass index, side, duration and stage of avascular necrosis of the femoral head, preoperative visual analogue scale (VAS) scores under quiescent and active states, and range of motion (ROM) of hip flexion and abduction before operation (P>0.05). The patients in the MA group were treated with MA therapy, including oral administration of celecoxib before operation, local anesthetic wound infiltration during operation, and ice compression and oral administration of celecoxib after operation. The patients in control group were only treated with patient-controlled intravenous analgesia pump. The postoperative VAS scores under quiescent and active states, ROM of hip flexion and abduction, prescription of Tramadol and adverse reaction were recorded and compared.ResultsThe operations were completed successfully in both groups without obvious complications and adverse reaction. The Tramadol was used in 4 cases (13.3%) of MA group and in 11 cases (36.7%) of control group, but no significant difference was found between the two groups (χ2=4.356, P=0.072). The VAS scores under quiescent state at 6 and 24 hours postoperatively were significantly lower in MA group than in control group (P<0.05), while VAS scores under active state at 48 hours postoperatively and on the day of discharge were significantly lower in MA group than in control group (P<0.05). There was no significant difference in VAS score between two groups at other time points (P>0.05). The ROM of hip flexion in MA group was better than that in control group at 1 day postoperatively and the day of discharge (P<0.05), while no significant difference was found at 2 and 3 days postoperatively (P>0.05). The ROM of hip abduction in MA group was superior to the control group at 1, 2, and 3 days postoperatively and the day of discharge (P<0.05).ConclusionThe MA can effectively relieve the pain following FVFG and facilitate early functional exercises of the hip. The usage of opioids was also relatively fewer for MA protocol.
ObjectiveTo explore the effect of perioperative nutritional management on patients with spinal cord injury under the enhanced recovery after surgery (ERAS) theory.MethodsA total of 82 patients with spinal cord injury admitted to a tertiay hospital in Shanghai between August 2018 and May 2020 were selected by convenience sampling method. They were randomly divided into intervention group and control group, with 41 cases in each group. The patients in the control group received conventional orthopaedics elective surgery nutritional management, while the patients in the intervention group adopted perioperative nutritional management based on ERAS concept, including establishing a multidisciplinary nutritional management team, conducting admission and regular nutritional screenings, and then developing targeted nutritional interventions based on the screening results. Biochemical indexes of nutritional assessment, electrolyte indexes, nutrition-related complications and general inpatient indexes were observed and compared between the two groups.ResultsThere were statistically significant differences in albumin, prealbumin, total protein, hemoglobin, potassium, sodium, and chlorine between the two groups on the first day after surgery and one day before discharge (P<0.05). The incidences of hypoglycemia (2.4% vs. 19.5%) and total complications (19.5% vs. 61.0%) in the intervention group were lower than those in the control group, and the differences were statistically significant (P<0.05). The total hospital stay [(10.48±2.61) vs. (12.09±2.74) d], postoperative hospital stay [(5.57±2.35) vs. (7.55±3.01) d], and hospital expenses [(11.21±4.42)×104 vs. (14.73±5.51)×104 yuan] in the intervention group were less than those in the control group (P<0.01).ConclusionPerioperative nutritional management under the ERAS theory can effectively improve the nutritional status of patients with spinal cord injury, maintain electrolyte balance, reduce the incidence of complications, shorten the length of hospitalization, reduce the cost of hospitalization, and promote postoperative rehabilitation of patients.
Objective To explore the clinical application and effect of infrared thermal imager in blood flow monitoring after skin flap surgery by comparing with skin-contact thermometer. Methods Fifty patients who had undergone flap repair in the microsurgery ward of Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and October 2020 were enrolled. An infrared thermal imager (FLIR ONE Pro) and a skin-contact thermometer were applied to monitor the skin temperature change till 7 d after surgery. The time consumed of using infrared thermal imager and skin-contact thermometer by different nurses, the efficacy of flap temperature monitoring of the two devices, the temperatures at different time points by using the two devices, and the temperatures under different distances to the flaps by using infrared thermal imager were compared. Results Different nurses had no difference in operating either of the two devices (P>0.05). It took significantly less time to measure the temperature of the flap area with the infrared thermal imager than using skin-contact thermometer [(39.28±3.52) vs. (103.85±9.09) s, P<0.001]. The skin temperature measured by the infrared thermal imager was significantly higher than that by the skin-contact thermometer (P<0.001), and the skin temperature measured by the infrared thermal imager at a height of 30 cm was higher than that at a height of 50 cm (P=0.006), but the temperature change amplitudes were both stable. Conclusions Infrared thermal imager is superior to skin-contact thermometer in terms of temperature measurement time, ease of operation, and sensitivity to temperature changes after skin flap operations. The thermal image collected by infrared thermal imager can provide an important basis for the identification of flap vascular crisis. It is a visual and objective blood supply monitoring equipment.