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Background: It is important to promote early ambulation postoperatively but there are many factors that can hinder the possibility of walking after surgery. Studies have been done to research the benefits related to early ambulation postoperatively but few are focused on patients that have rheumatoid arthritis (RA). We retrospectively investigated the incidence and predictors of the inability to start walking on the first postoperative day (POD) after rheumatoid toe arthroplasty.Methods: RA patients who underwent toe arthroplasty at an academic teaching hospital were retrospectively reviewed. We divided patients into the two groups: possible group, who were able to walk on the first day postoperatively and impossible group, who were unable to walk on the first day postoperatively. The primary outcome was odds ratio (OR) with a 95% confidence interval (CI) between various patient factors and the impossible group with logistic regression analysis. The post hoc analysis for association between anesthesia methods and postoperative outcome was carried out.Results: A total of 300 patients were included and divided into two groups: possible group (n = 191) and impossible group (n = 109). The incidence of postoperative nausea and vomiting (PONV) before rehabilitation was significantly associated with the infeasibility of walking rehabilitation on the first POD [OR = 2.43, 95% CI 1.22-4.14, P = 0.003]. The number of rescue analgesics administered before rehabilitation and the supplementation of peripheral nerve block (PNB) was also associated with the infeasibility of walking rehabilitation on the first POD [OR = 1.29, 95% CI 1.04-1.59, P = 0.003], [OR = 0.41, 95% CI 0.20-0.79, P = 0.010], respectively. In the post hoc analysis, incidence of PONV was highly associated with postoperative intravenous continuous opioid (48.7%, P < 0.0001) compared to regional analgesia; PNB (11.3 %) and epidural (26.7%).Conclusions: In our study, the incidence of PONV and inadequate postoperative pain management hindered early rehabilitation. Adding PNB to general anesthesia had an advantage for postoperative rehabilitation and decreased PONV after rheumatoid toe surgery.

Materials and Methods:Sixteen PGY-1 anesthesia residents without USguided TAP block experience were randomized into two groups: the control group (C group) and the pork belly (PB group), each of eight. The training course consisted of two modules: a knowledge module and a second practice module. PowerPoint slides and videos were used to show (1) mechanism of sonography, (2) anatomy and sonoanatomy of TAP block, (3) and skills of hydro-dissection and image optimization in the knowledge module in both groups. In practice module, a blue phantom was used for practicing hand-eye coordination in the C group. In the PB group, a 20cm×30cm pork belly was used for practicing hand-eye coordination and hydrodissection. The practice module would not end until all trainees reached a mastery level. Skills of hand-eye coordination and hydro-dissection were tested respectively in a 20cm×30cm pork belly in both groups. Rates of mastery of hand-eye coordination and hydro-dissection were compared between the two groups using chi-square test. A P< 0.05 was considered as statistically significant.

Introduction: Previous studies explored the benefits related to early ambulation postoperatively, but few focused on patients with rheumatoid arthritis (RA). We retrospectively evaluated the incidence and predictors of the inability to begin walking on the first postoperative day (POD) after toe arthroplasty for rheumatoid arthritis. Methods: RA patients who underwent toe arthroplasty at one hospital were retrospectively reviewed. A total of 300 patients were included and divided into two groups: possible group (n = 191), who were able to walk on the first POD, and impossible group (n = 109), who were unable to walk on the first POD. Data were analyzed using odds ratios (OR) with 95% confidence intervals (CI) between various patient factors and the impossible group with logistic regression analysis. Results: The incidence of postoperative nausea and vomiting before rehabilitation was significantly associated with the infeasibility of walking rehabilitation on the first POD [OR = 2.43, 95% CI 1.22-4.14, P = 0.003]. The number of rescue analgesics administered before rehabilitation and the supplementation of peripheral nerve block was also associated with the infeasibility of walking rehabilitation on the first POD [OR = 1.29, 95% CI 1.04-1.59, P = 0.003; OR = 0.41, 95% CI 0.20-0.79, P = 0.010, respectively]. Conclusion:The incidence of postoperative nausea and vomiting and inadequate postoperative pain management hindered early rehabilitation. Adding peripheral nerve block to general anesthesia had an advantage for postoperative rehabilitation after toe arthroplasty for rheumatoid arthritis.