Medical Trust Hospital

The posterolateral corner (PLC) of the knee is a key anatomical structure which provides varus and rotational stability to the knee joint. Injuries to the PLC pose a great challenge for orthopedic surgeons due to their complex nature. PLC injuries rarely occur in isolation, with up to 95% being associated with ligament tears. Surgical reconstruction is indicated in Grade III injuries, defined clinically as >10 ​mm lateral opening on varus stress and >10° external rotation on the dial test, supported by MRI magnetic resonance imaging findings. Several techniques have been described for PLC reconstruction; however, the classic anatomic reconstruction described by LaPrade remains the gold standard, traditionally performed using an Achilles tendon allograft. In this video technique, we describe a modified LaPrade technique using peroneus longus and hamstring tendon autografts for PLC and posterior cruciate ligament (PCL) reconstruction, respectively, in a patient having tibia nail in situ for Type IIIb open fracture shaft of tibia. The peroneus longus tendon is fashioned into a Y-shaped construct and must be at least 250 ​mm long to perform this technique. The graft passage and fixation sequence are the reverse of the LaPrade technique. This method ensures anatomic fixation, independent tensioning, and secure fixation of each segment, thereby restoring the normal biomechanics of the knee.

There is limited evidence to suggest that routine testing of serum electrolytes, blood urea, and serum creatinine in low-risk patients significantly improves surgical outcomes or reduces complications. This study aimed to evaluate the need of these investigations in patients of American Society of Anesthesiologists physical status (ASA-PS) I and II scheduled to undergo elective surgeries of minor and intermediate risk.

We conducted a prospective, observational study at a tertiary care hospital, involving 1166 patients aged 18–60 years with ASA-PS grades I and II, undergoing elective minor and intermediate-risk surgeries. Comprehensive preoperative evaluation included documentation of demographic data, medical history, medications, pre- and postoperative values of blood urea, serum creatinine, and serum electrolytes. The study design incorporated assessment of changes in anesthetic management, including ordering of repeat tests, specialist referrals, and surgery postponements or cancelations. Postoperative complications related to electrolyte disturbances were monitored. Statistical analysis included Chi-squared test for categorical variables and dependent t-test for comparing pre- and postoperative changes in biochemical parameters. Data was entered in Excel and analyzed using Statistical Package for the Social Sciences (IBM, Bangalore, India) version 23.

A total of 148 (12.69%) patients underwent repeat tests preoperatively; none of them experienced any postponements/cancelations or changes in anesthetic management. Statistically significant changes were observed in blood urea, serum creatinine, and serum electrolyte values across all anesthesia types and comorbidities (P < 0.05). However, these changes remained within clinically acceptable limits and did not necessitate alterations in patient management. Notably, only 0.26% of patients required postoperative repeat tests, and no patients needed referral to superspecialty care.

Our study provides substantial evidence indicating that routine preoperative assessment of blood urea, serum creatinine, and serum electrolytes may not be necessary for ASA-PS I and II patients undergoing elective minor and intermediate-risk surgeries.

Rebound pain (RP) is a distressing, yet not much explored, entity. This study aimed to evaluate and compare how adjuvants like dexamethasone and dexmedetomidine added to 0.5% ropivacaine for peripheral nerve block (PNB) can impact RP.

In this randomized, double-blinded study, 72 patients posted for elective upper limb surgeries under brachial plexus block were randomly divided into three groups of 24 each. Group A received 28 ml 0.5% ropivacaine +2 ml normal saline, Group B received 28 ml 0.5% ropivacaine + 8 mg dexamethasone (2 ml), and Group C received 28 ml 0.5% ropivacaine +50 µg dexmedetomidine (2 ml). The incidence and onset of RP, as well as the duration of sensory and motor block, were compared between the groups. The distribution of variables was compared using appropriate statistical tests.

On postoperative days 1 and 2, the RP incidence was significantly lower in the dexmedetomidine group (12.5%, 16.67%) and dexamethasone group (25%, 20.83%), compared to the control group (54.17%, 58.33%) (P = 0.006 and 0.003 respectively). Patients in the dexmedetomidine group had a significantly delayed onset of RP (P = 0.0475). The motor and sensory block duration was prolonged in both, the dexmedetomidine group (410.83 ± 116.17 min, 442.5 ± 116.4 min) and dexamethasone group (375 ± 90.7 min, 418.54 ± 97.84 min) compared to the control group (321.25 ± 69.85 min, 358.33 ± 75.9 min). There was no significant difference between the two adjuvants in prolongation of sensory (P value 0.676) and motor blockade (P value 0.390).

The incidence of RP is significantly reduced when dexmedetomidine and dexamethasone are added as adjuvants to 0.5% ropivacaine in upper limb PNBs, with dexmedetomidine being superior in this regard.