Background and Purpose: Perioperative pain after total knee arthroplasty (TKA) is reported as severe in up to 60% of patients. Continuous femoral nerve blocks (CFNB) are a choice for major knee repair, but controversies remain about the need of supplemental sciatic nerve blocks (SNB) for better analgesia. Our aim is to assess the effect of the association of a SNB to a CFNB to reduce postoperative pain after TKA. Methods: A prospective randomized, single blinded, controlled study, on 50 patients undergoing TKA. Control group received a CFNB before general anesthesia; in the intervention group a single shot SNB was added after the CFNB was done. After the end of surgery all patients started a continuous local anesthetic infusion through the femoral catheter in the PACU (post-anesthesia care unit). Pain scores were measured in the PACU and at 12 h and 24 h postoperative using a visual analog scale (VAS). Results: VAS pain scores (mm) were lower and statistically significant for the intervention group up to 12 h postoperative: PACU admission mean VAS = 59.4 vs 30.2, P = 0.001; at 12 h mean VASr = 26.1 vs 9.2, P = 0.006; at 24 h mean VASr = 30.1 vs 32.7, P = 0.723. Conclusions: The association of a single shot SNB with a CFNB significantly reduces postoperative pain scores after TKA up to 12 h. At 24 h there are no differences between groups.

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Background Mediastinitis and endocarditis after cardiac surgery are serious complications that increase short and long term morbidity and mortality and also costs. Antibiotic prophylaxis aims to reduce the risk of surgical wound infection; however these infections occur in 0.4 to 4% of cardiac surgery procedures. Purpose To evaluate compliance with prophylactic antibiotic guidelines at Hospital Santa Cruz (HSC) Portugal in cardiac surgery. To assess the incidence of mediastinitis and endocarditis after cardiac surgery. Materials and methods A retrospective study was performed in 456 patients undergoing cardiac surgery (replacement/valve repair, coronary bypass graft (CABG) or both) by sternotomy, between January and December 2010. Data were collected from medical and pharmaceutical databases and other records available in the hospital. Results 456 patients were evaluated in this study, 74% male, with an average age of 68±12 years (range 22-90 years). Of these patients 45.6% underwent valve surgery (VS), 44.3% coronary artery bypass surgery (CABG) and 10.1% underwent both procedures. The prophylactic regimens used were cefazolin in monotherapy (45.8%), cefazolin + vancomycin (2.0%), vancomycin + gentamicin (52.2%), with an average duration of 1.5±0.8 days. The cefazolin monotherapy was used more frequently in CABG (42.8%) and vancomycin + gentamicin in VS (42.2%). The incidence of endocarditis and mediastinitis was 3.55%. Conclusions The prophylactic regimens used in cardiac surgery at HSC are in agreement with international and local guidelines. Given the high prevalence of MRSA in HSC, vancomycin and gentamicin were often used, as referred to in the literature. The incidence of postoperative endocarditis and mediastinitis is similar to that reported in several studies.

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