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Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The patient is normally investigated supine with the legs spaced apart and the leg to be investigated externally rotated (Fig. 9.53a). The femoral artery is imaged in the transverse plane (Fig. 9.53b) to allow the operator to establish the course of the vessels and to locate the position of the femoral bifurcation. Imaging protocols may vary, but a common approach is to scan the vessels with the probe in the longitudinal plane from the groin to the adductor canal in mid-thigh, with assessment of the common, deep and superficial femoral arteries (Fig. 9.53c).
Acute postoperative pain management with percutaneous peripheral nerve stimulation: the SPRINT neuromodulation system
Published in Expert Review of Medical Devices, 2021
Rodney A. Gabriel, Brian M. Ilfeld
Anterior Cruciate Ligament Reconstruction. The use of ultrasound-guided percutaneous PNS has also been described in a small feasibility study for patients undergoing anterior cruciate ligament reconstruction[13]. Like the previous feasibility trials described, patients were randomized to receive either sham or active stimulation for 5 minutes, then crossover the next 5 minutes, followed by 30 minutes of active stimulation. Ten patients were recruited and received PNS to the femoral nerve, which was placed days before surgery. During the initial 5-minute treatment period, those who received active stimulation had a 7% decrease in pain over that time period, while those in the sham group experienced a 4% increase in pain (potentially because of the unblocked sciatic nerve contributing to the apparent inadequate analgesia). Those who initially received sham had an 11% decrease in pain during the crossover treatment. Postoperatively, 80% of patients required additional continuous adductor canal nerve block for rescue analgesia during the first 2 days after surgery. After that, both pain scores and opioid use were minimal.
Revision of total knee arthroplasty with the use of patient-specific instruments: an alternative surgical technique
Published in Expert Review of Medical Devices, 2020
Vicente J. León-Muñoz, Andrea Parrinello, Mirian López-López, Francisco Martínez-Martínez, Fernando Santonja-Medina
No changes were made to the postoperative protocol, following the clinical pathway and care program for elective total knee replacement at the authors’ institution. Tranexamic acid was used in all cases and administered at an intravenous dose of 15 mg/kg before the deflation of the tourniquet. Patients received a first dose of prophylactic antibiotics just prior to induction, and a second one after the deflation of the tourniquet. All patients received prophylaxis against deep vein thrombosis. Postoperatively, a combined ultrasound-guided femoral and sciatic nerve block or an adductor canal block was performed for analgesia. If necessary, intravenous analgesics were administered. Compressive bandages (with wool and crepe) were applied and remained in place until the second postoperative day. Wound drains were used for 2 days for all patients. Direct full weight bearing was allowed in all cases. As per our hospital’s standard procedure, transfusion criteria were a postoperative hemoglobin (Hb) level of < 8 g/dl or the presence of symptoms of tissue hypoperfusion with values higher than 8.