1.
The mid-term and long-term effects of tourniquet use in total knee arthroplasty: systematic review
Rafaqat W, Kumar S, Ahmad T, Qarnain Z, Khan KS, Lakdawala RH
Journal of experimental orthopaedics. 2022;9(1):42
Abstract
PURPOSE A tourniquet is routinely used during total knee arthroplasty (TKA) to reduce intra-operative hemorrhage, though surgery without a tourniquet is becoming popular. To address concerns about the effect of blood at cement interfaces on long-term implant stability, we conducted a systematic review among patients undergoing total knee arthroplasty to determine if TKA with a tourniquet, compared to TKA without a tourniquet or with reduced tourniquet duration, is associated with better mid-term and long-term implant stability. METHODS A literature search was conducted without language restriction in PubMed, Cochrane database and Web of Science from conception to 17th March, 2021. Prospective cohorts, randomized and observational, that compared tourniquet use with a control group, followed patients for 3 months or more and reported outcomes concerning implant stability, limb function, pain and inflammation. Article selection, quality assessment according to the Revised Cochrane risk assessment scale and Newcastle Ottawa Scale, and data extraction were conducted in duplicate. PROSPERO CRD42020179020. RESULTS The search yielded 4868 articles, from which 16 randomized controlled trials (RCT) and four prospective cohort studies, evaluating outcomes of 1884 knees, were included. Eleven RCTs were evaluated to be low overall risk of bias, five RCTs had some concerns and four cohort studies were good quality. Few studies showed benefits of tourniquet use in mid-term implant stability (1/6), pain (1/11) and limb inflammation (1/5), and long-term implant stability (1/1). One study reported a significantly improved range of motion (1/14) while another reported significantly reduced quadriceps strength (1/6) in the tourniquet group. The remaining studies reported non-significant effect of tourniquet use. CONCLUSION Although few studies indicated benefits of tourniquet use in mid-term pain, limb inflammation, implant loosening and function, and long-term implant loosening, the majority of studies report no significant advantage of tourniquet use in total knee arthroplasty.
2.
Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: a randomized controlled study
Kumar S, Singh S, Singh P, Singh SK
Central European Journal of Urology. 2016;69((2)):190-7.
Abstract
INTRODUCTION To compare the outcomes of tubeless day care PNL using hemostatic seal in the access tract versus standard PNL. MATERIAL AND METHODS It was a prospective randomized controlled study. Cases were randomized to either the day care group with hemostatic seal (DCS) or the control group where patients were admitted and a nephrostomy tube was placed at the conclusion of surgery. RESULTS A total of 180 cases were screened and out of these, 113 were included in the final analysis. The stone clearance rates were comparable in both the groups. The mean drop in hemoglobin was significantly lower in DCS group than the control group (1.05 +/-0.68 vs. 1.30 +/-0.58 gm/dl, p = 0.038).Mean postoperative pain score, analgesic requirement (paracetamol) and duration of hospital stay were also significantly lower in the DCS group (3.79 +/-1.23 vs. 6.12 +/-0.96, 1.48 +/-0.50 vs. 4.09 +/-1.11 grams and 0.48 +/-0.26 vs. 4.74 +/-1.53 days respectively; p <0.05). The incidence of urine leakage through the access tract site was significantly lower in the DCS subgroup when compared to the controls (3.6% vs. 21.1%, p <0.05). Cases in the DCS group resumed their normal activities in a significantly shorter time (8.05 +/-3.05 vs.18.42 +/-4.42 days; p <0.05). Higher proportion of cases in the DCS group got re-admitted, although it was not a statistically significant number (7.1% vs. 1.8%; p = 0.21). CONCLUSIONS Tubeless day care PNL with composite hemostatic tract seal is considered safe. It resulted in a significant reduction of blood loss and analgesic requirement with significantly reduced hospital stay, nephrostomy tube site morbidity and time required to resume normal activity when compared to the standard PNL. However, patients must be compliant with the given instructions and should have access to a health care facility, as few of them may need re-admission.
3.
Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft
Malik VK, Kumar S
Saudi Medical Journal. 2010;31((12):):1326-30.
Abstract
OBJECTIVE To evaluate whether use of fibrin glue instead of sutures for the treatment of recurrent pterygium with conjunctival auto-graft (CAG) further decreases its recurrence. METHODS A prospective, clinical open trial of 50 eyes of 50 patients with recurrent pterygium, who were randomly assigned to either, pterygium excision and CAG with fibrin glue (Group 1) or with 6 interrupted sutures (Group 2), was carried out from January 2009 to July 2010 at the outpatient department of Subharti Medical College, Meerut, North India. Both groups had 25 patients each. The groups were compared with regards to the surgical time taken, development of recurrence, postoperative symptoms (irritation, watering, and redness), and complications. RESULTS Recurrence was seen in one (4%) eye in group I, and 3 (12%) eyes in group II after 9-13 months of follow up. The difference between the 2 groups was not statistically significant. The surgical time was significantly reduced, and postoperative inflammation and complications were less in group I. Postoperative symptoms were significantly more in group II patients. CONCLUSION While conjunctival autograft with sutures for management of recurrent pterygium appears to be a safe and feasible modality, fibrin glue fixation of the autograft is a more viable option in terms of surgical ease, less time consuming, less postoperative complications, and less recurrence.
4.
Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations
Sharma A, Kaur R, Kumar S, Gupta P, Pandav S, Patnaik B, Gupta A
Ophthalmology. 2003;110((2):):291-8.
Abstract
OBJECTIVE To compare the efficacy of fibrin glue and N-butyl-2-cyanoacrylate in corneal perforations. DESIGN Randomized, controlled clinical trial. PARTICIPANTS Forty-one patients (41 eyes) with corneal perforations up to 3 mm in diameter with a positive Seidel's test were randomly assigned to two groups (1 and 2). INTERVENTION Group 1 comprised 19 eyes treated with fibrin glue, and group 2 comprised 22 eyes treated with N-butyl-2-cyanoacrylate. MAIN OUTCOME MEASURES Number of eyes with successful healing, time required for healing, status of corneal vascularization, and complications were compared in the two groups. Power calculation was performed at alpha = 0. 05. RESULTS Fifteen (79%) eyes had successful healing of corneal perforation in group 1, compared with 19 (86%) eyes in group 2 (P > 0. 05) at 3 months' follow-up. The power to detect a difference between the two groups was 10%. Corneal perforation healed within 6 weeks in 12 (63%) eyes in group 1 and 7 (31. 8%) eyes in group 2 (P < 0. 05). Reapplication of glue was required in six (31. 5%) eyes in group 1 and seven (31. 4%) eyes in group 2 during the first 3 months of follow-up. The mean number of applications per eye was 1. 37 in group 1 and 1. 36 in group 2. An increase in deep corneal vascularization was observed in 2 (10. 5%) eyes in group 1 and 10 (45. 5%) eyes in group 2 (P < 0. 05). Giant papillary conjunctivitis occurred in one (5%) eye in group 1 and eight (36. 4%) eyes in group 2 (P < 0. 05). CONCLUSIONS Fibrin glue and cyanoacrylate tissue adhesive are both effective in the closure of corneal perforations up to 3 mm in diameter. Fibrin glue provides faster healing and induces significantly less corneal vascularization, but it requires a significantly longer time for adhesive plug formation.