Purpose Local iniltration analgesia (LIA) has attracted growing interest in recent years. To prolong the positive efects of LIA, a continuous intraarticular perfusion has been introduced in total knee arthroplasty with good clinical results. The purpose of the present study was to evaluate if similar results can be obtained with the use of a continuous periarticular perfusion in unicondylar knee arthroplasty (UKA). Methods 50 consecutively selected patients undergoing UKA received either a single-shot LIA (control group; n = 25) or single-shot LIA combined with a continuous postoperative periarticular perfusion for 2 postoperative days (intervention group, n = 25). VAS (visual analogue scale) for pain, pain medication consumption and range of lexion were recorded postoperatively for 6 days. The catheter was removed after 2 days. Results Only minor advantages of using a continuous periarticular catheter could be shown. Patients in the intervention group showed signiicant lower VAS scores on day 1 and required signiicant less pain medication on day 6. Further, there was a signiicant diference in the range of lexion on day 3, on which patients of the intervention group were able to bend the knee joint on average by 12° more than patients of the control group. On the other days, any signiicant diferences between the two groups were not observed. Conclusion In summary, the present study could not identify any superiority of a periarticular catheter over single-shot LIA in UKA. Because of additional costs and the potential risk of infection, the conclusion of this study is to not recommend adding a periarticular catheter to the single-shot LIA in UKA. Level of evidenceII Keywords UKA • Unicondylar knee arthroplasty • LIA • Local iniltration analgesia • Perioperative pain management • Total knee replacement Abbreviations UKA Unicondylar knee arthroplasty LIA Local iniltration analgesia VAS Visual analogue scale ROM Range of motion LMWHs Low-molecular-weight heparins * Malin Meier

Aims and Objectives: Local infiltration analgesia (LIA) is meanwhile worldwide established and scientifically proven in perioperative treatment of TKA. Single-shot is the mostly used option. However, after the local analgesia has subsided, at the latest after the day of surgery, the pain is usually present and affects rapid mobilization and rehabilitation. Long-acting medications for LIA have not proved to be effective and there are barely data on intra-articular continuous analgesia. We present a randomized controlled trial which compares the LIA with and without additional continuous analgesia using an intraarticular catheter. Materials and Methods: 50 patients with TKA were randomized and included in the study. All patients received the same implant system without patellar resurfacing, without tourniquet or drains. The operation was performed by the same surgeon and postoperative treatment was identical. Both groups received a general anesthesia with laryngeal mask. A group of 25 patients received a single-shot LIA containing 150 ml bupivacaine (0.2%) and morphine (20 mg). The other group, also 25 patients, received the same single-shot LIA and an intraarticular catheter (350 ml) for 3 days with continuous infiltration (8ml/h) of bupivacaine (0.2%) and morphine (20 mg per 200 ml bupivacaine) . The following parameters were recorded preoperatively and postoperatively: VAS, additionally analgetics / opioids. Also included were complications such as infections, postoperative falls and DVT. Results: The average operating time was 46 min. There were no complications or reinterventions. The results were not significantly different during the first day, but for day 2 to 4 VAS was significantly better and additional analgetics / opioids were significantly less (p <0.05) in the group with additional catheters. On days 5 and 6, the results again were comparable. Conclusion: There was a superiority of the additional intra-articular catheter for some days in the perioperative treatment of TKA.

The 2008 European Football Championship 2008 (Euro 08) is the largest sporting event ever organized in Switzerland. One million visitors came to the city of Berne during the event and the local airport in Bern/Belp registered 261 extra flights. For each football game there were 33,000 fans in the stadium and 100,000 fans in the public viewing zones.The ambulance corps and the Department of Emergency Medicine (ED) at Inselspital, University Hospital Berne, were responsible for basic medical care and emergency medical management. Injuries and illnesses were analyzed by a standardized score (NACA score). The preparation strategy as well as costs and patient numbers are presented in detail.A total of 30 additional ambulance vehicles were used, 4,723 additional working days (one-third medical professionals) were accumulated, 662 ambulance calls were registered and 240 persons needed medical care (62% Swiss, 28% Dutch and 10% other nationalities). Among those needing treatment 51 were treated in 1 of the 4 city hospitals. No injuries with NACA grades VI and VII occurred (NACA I: 4, NACA II: 17, NACA III: 16, NACA IV: 10 and NACA V: 4 patients). The city of Berne compensated the Inselspital Bern with a total of 112,603 Euros for extra medical care costs. The largest amount was spent on security measures (50,300 Euros) and medical staff (medical doctors 22,600 Euros, nurses 29,000 Euros). Because of the poor weather and the exemplary behavior of the fans, the course of events was rather peaceful.

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