Reachout Orthopedics - Issue 2

In contrast, Nasr [9] gave the first dose of duloxetine 60 mg 2 days before surgery in patients undergoing mastectomy and recorded lower pain scores in the duloxetine group compared to a control group at the study period. Although etoricoxib has been shown to have significant analgesic efficacy during pain at rest when compared to the control group in our results, there was no effect on pain score on movement. These results resembled those of Rawal et al . [35] where they evaluated the effect of etoricoxib (90 or 120 mg), versus ibuprofen (1800 mg) on postoperative pain following knee replacement and concluded that etoricoxib (90 and 120 mg) was significantly effective in reducing pain at rest and also reduced morphine consumption when compared to placebo with no significant effect on movement. Also Lierz et al . [23] used 120 mg of etoricoxib or placebo 1 h before induction of general anesthesia in knee arthroscopy surgery. They recorded similar results, showing reduction in pain only at rest and reduction in morphine consumption. Opioids are considered the drug of choice for management of postoperative pain but it is difficult to induce an optimum analgesia without significant side effects [36]. Therefore, we suggest in our study that short-term duloxetine treatment in combination with etoricoxib may be a good adjuvant for decreasing the need for opioids in order to alleviate postoperative pain without significant adverse effects. In our results there were 13 patients complaining of nausea and vomiting in the placebo group with significant difference when compared to D/E group. There were no incidences of other adverse effects, such as sedation, dizziness, somnolence, pursuits or headache. In this study we evaluate the acute post- operative pain not the chronic pain exam- ined in previous studies [8, 9, 37] because our study was on a group of patients complaining from chronic back ache with high incidence of postoperative failed back pain syndrome with multifactorial conditions which may affect up to 10 to 40% of patients [38]. Conclusion The present study demonstrates that the perioperative administration of the dulox- etine/etoricoxib combination reduces post- operative pain, beside the need for morphine at 24 and 48 h after lumbar spine surgery, and the opioid-related side effects more ef- fectively than either drug alone. Duloxetine/ etoricoxib combination may thus be a useful adjuvant to be used along with opioid as part of a multimodal analgesia in the acute post- surgical setting. Concerning limitations to our study, there are some to be applied. First it is not possible to prove that the combination of duloxetine and etoricoxib has more than just an additive effect because we did not make a full dose-response study nor associated ED50s. The second limitation of our study is that we evaluated a possible effect of duloxetine on acute postsurgical pain alone and not on the chronic one. Acknowledgments: We thank all member of anesthesi- ology department, faculty of medicine. Minia University, Egypt. Funding: This research received no specific grant from any funding agency in the public. Availability of data and materials: The data are available upon request to the corresponding author. Authors’ contributions: JZA preformed study design and conduction, data collection and analysis, and revising the manuscript. All authors read and approved the final manuscript. HSM preformed study design and conduction, data collection and analysis, preparation of the manuscript, and writing up of the first draft. Ethics approval and consent to participate: The study was approved by research ethics of Al- Minia University hospital, Faculty of medicine, Al- Minia University. The written informed consent was obtained from patients). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Publisher’s Note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and repro- duction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons. org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. References available on request Healthcare.India@springer.com Source: Attia, J.Z. & Mansour, H.S. BMC Anesthesiol (2017) 17: 162. https://doi.org/10.1186/s12871-017-0450-z. © The Author(s). 2017. The Gait Deviations of Ankylosing Spondylitis with Hip Involvement Objective: The aim of the study was to investigate the gait deviations of anky- losing spondylitis (AS) patients with hip involvement. Methods: Thirty-six subjects, including 18 AS patients with hip involvement (AS group) and 18 healthy people (control subjects, CS group), were enrolled in the study. Three-dimensional gait analysis of the AS group andCS groupwas performed. Kinematic parameters, kinetic parameters and surface electromyography (sEMG) during the gait cycle were measured. Results: The AS patients with hip involve- ment had a lower gait velocity, shorter step length and shorter stride length. In the hip angles, there was significantly de- creased flexion, excessive abduction and excessive external rotation; there was ex- cessive flexion in the knee and reduction in plantar flexion of the ankle. AS patients had increased forward trunk flexion, ex- cessive obliquity and restricted rotation of the trunk during the gait cycle. The hip moments of the AS group showed a signifi- cant reduction in flexion, abduction and external rotation during the gait cycle. The root mean square amplitude of the sEMG for the rectus femoris in the AS group was higher than that in the CS group. Conclusion: The gait deviations in AS pa- tients with hip involvement were described in this study. The gait analysis results dem- onstrated statistically significant altera- tions regarding the kinematic and kinetic gait parameters for the patients included in the sample. Coordination and balance were impaired by the disease. An efficient physical exercise plan can be formulated according to the results of gait analysis. Source: Zhang, G., Li, J., Xia, Z. et al . Clin Rheumatol (2019) 38: 1163. https://doi.org/10.1007/s10067-018- 4401-y. © International League of Associations for Rheumatology (ILAR) 2019. 17 reachOut Orthopedics