The Anesthesiology Department at the Fairfield Medical Center, of Lancaster, Ohio, has started using an innovative technique for post-operative pain control called an ultrasound guided continuous peripheral nerve block for Total Joint Replacement Unit patients.

This technique combines a continuous infusion of local anesthetic through small catheters with a disposable delivery pump, called the On-Q pain pump.It has no electronics or moving parts, making it easy for caregivers and patients to use without worry.

The pump is worn in a small pouch by the patient and can be used for days of pain relief following surgery. Patients reported they thought they would be in a lot more pain post-surgery than they actually were.

The change experts have seen in their patients' pain relief after a joint replacement surgery with this new type of therapy is substantial. With this form of pain relief, patients take significantly less narcotics which means they also have far fewer narcotic-associated side effects.  These undesirable effects include nausea, vomiting, confusion, grogginess, etc.

Patients who choose to have their anesthesiologist place these nerve blocks tend to recover faster, respond more favorably and, in some cases, go home much quicker.  The concept is similar to epidurals, which have been used for decades in labor and delivery.

With these type of peripheral nerve blocks, instead of placing a catheter in the patient's lower back, it is placed near specific nerves affected by the planned surgery and only a local anesthetic is used. An ultrasound machine provides an image to guide the placement of the pain pump catheter. This allows doctors to place the catheter very close to the nerves numbing the area, significantly lessening the pain.

The nerve block is placed before surgery and used to treat the pain for the following days patients recover from surgery as well as during physical therapy.

With this new technology, patients seem to be getting better results from physical therapy, which is an important step to recovery and getting back to the normal day-to-day lifestyle to which people are accustom.

Most patients are discharged about two days after surgery. When the medication in the pump is gone, the catheter is simply removed.   Patients are pleased, because they do not need to use as much pain medication as they have after other operations in the past.

By easing the pain and reducing the side effects associated with larger amounts of narcotics, this new pain control system has a myriad of significant benefits. 

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Article written by staff at lancastereaglegazette.com and adapted for the purposes of this newsletter.

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Ultrasound elastography can be a sensitive means of diagnosing rotator cuff tears in patients with painful shoulders, according to research from Alfa Scan Radiology Center in Giza, Egypt.  "Detection of tissue softening by elastography might predict tendonitis at an early stage before MRI, as the examination can be done, unlike MRI, guided by the pain location," said Dr. Naglaa Abdel Razek.

The research team sought to assess real-time ultrasound elastography for evaluating the supraspinatus tendon, studying 20 healthy volunteers and 40 patients presenting with shoulder pain. Elastography was performed using an EUB-7500 ultrasound system and electronic-array transducers of 7.5 and/or 13 MHz. 

Tendon parts were evaluated by a semiquantitative score of different colors representing stiff tissue (blue) to softer tissue (green, yellow, and red).  In B-mode scanning, reviewers examined tendon insertion and the midportion and musculotendinous junction for tendon thickening, focal intratendinous abnormal high echogenicity, interruption of fibers, calcification, paratenonitis, and bursitis, according to Razek.

The elastography findings were then compared with the B-mode results, and for 20 patients, elastography was also compared with MRI findings. Arthroscopy was performed only when elastography was positive and MRI had a negative finding, Razek said.

In the 20 healthy volunteers, elastography showed blue color throughout the tendon, which is consistent with stiff normal tendon tissue and normal findings at grayscale, Razek said. In the patients with partial tears, elastography showed intratendinous color alterations (green, yellow, and red) not reaching the bursal or articular aspects. Patients with full tears showed color alterations reaching the bursal or articular surfaces.

The differences in tendon stiffness between the healthy volunteers and the patients were statistically significant (p < 0.0001). The elastography and MRI findings also showed good correlation (p < 0.001), Razek said.

In addition, elastography was able to diagnose tendinitis and mild synovial effusion in four cases (10%) that had false-negative findings on MRI. Elastography changed the diagnosis of partial tear into complete tear in two cases (5%), Razek said.

"The sensitivity and negative predictive value has been increased from 95% to 97% and from 87% to 93% by adding elastography to the conventional ultrasound technique," she said.

Elastography can also be used as an easy reproducible follow-up method to monitor treatment, Razek noted.  "Elastography is suggested as a complementary study to conventional high-resolution ultrasound for diagnosis of rotator cuff tendon tears in patients with painful shoulder," she concluded.

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Article written by staff at auntminnie.com and adapted for the purposes of this newsletter.

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