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J Weckström

Publications and source records attributed to J Weckström.

5 recordsLinked to original sources
PubMed2005

Postoperative extradural analgesia with morphine and ropivacaine. A double-blind comparison between placebo and ropivacaine 10 mg/h or 16 mg/h.

BACKGROUND: Some controversy exists in the literature on the benefit of epidurals compared to patient-controlled intravenous analgesia (PCA). Also, the dose of ropivacaine for epidural analgesia when combined with morphine remains uncertain. The aim of this study was to compare the epidural vs. PCA technique and high-dose vs. low-dose ropivacaine combined with morphine during knee replacement surgery. METHODS: In this prospective, randomized, double-blind study, postoperative pain relief with a combination of epidural ropivacaine (Group L: 10 mg h-1, Group H: 16 mg h-1) and morphine (0.16 mg h-1) was evaluated in 30 patients. A placebo group (Group PL) of 15 patients having PCA morphine served as the control. Visual analog pain (VAS), morphine consumption, sensory and motor block and side-effects were recorded during 48 h. RESULTS: VAS scores at rest were significantly lower in Groups L and H compared to Group PL. On movement, Group H had lower VAS scores than Group PL during 3-27 h (P<0.05) and Group L during 4-9 h (P<0.05), while Group L had lower a VAS than Group PL during 9-18 h (P<0.05). Morphine consumption after 48 h was greater in Group PL (64.6+/-36.3 mg) vs. Group L (23.3+/-33.9 mg) (P<0.001) and Group H (4.3+/-9.6 mg) (P<0.0001). Mild motor block was seen in Group H in 20% and 14% patients at 24 h and 48 h, respectively, but time to mobilization was similar between the groups. Pruritus was more common in the ropivacaine groups (P<0.05). CONCLUSION: Lumbar epidural analgesia using a combination of ropivacaine (16 mg h-1) and morphine (0.16 mg h-1) provides superior analgesia compared to the PCA technique or ropivacaine (10 mg h-1) and morphine (0.16 mg h-1). Although this resulted in a mild motor block during the first 12 h, patient mobilization was similar in all groups.

Aged↗
PubMed2000

Tranexamic acid reduces blood loss in total hip replacement surgery.

UNLABELLED: Intraoperatively administered, tranexamic acid (TA) does not reduce bleeding in total hip replacement (THR). Therefore, its prophylactic use was attempted in the present study because this has been shown to be more effective in cardiac surgery. We investigated 40 patients undergoing THR in a prospective, randomized, double-blinded study. Twenty patients received TA given in two bolus doses of 10 mg/kg each, the first just before surgical incision and the second 3 h later. In addition, a continuous infusion of TA, 1.0 mg. kg(-1). h(-1) for 10 h, was given after the first bolus dose. The remaining 20 patients formed a control group. Both groups used preoperative autologous blood donation and intraoperative autotransfusion. Intraoperative bleeding was significantly less (P: = 0.001) in the TA group compared with the control group (630 +/- 220 mL vs 850 +/- 260 mL). Postoperative drainage bleeding was correspondingly less (P: = 0.001) (520 +/- 280 vs 920 +/- 410 mL). Up to 10 h postoperatively, plasma D-dimer concentration was halved in the TA group compared with the control group. One patient in each group had an ultrasound-verified late deep vein thrombosis. In conclusion, we found TA, administrated before surgical incision, to be efficient in reducing bleeding during THR. IMPLICATIONS: In a prospective, double-blinded study of 40 patients undergoing total hip replacement, the preoperative administration of tranexamic acid reduced bleeding by 35%, probably by decreasing induced fibrinolysis. Whether tranexamic acid therapy can replace predonation of autologous blood or intraoperative autotransfusion requires further study.

Aged↗
PubMed1996

Dislocations and the femoral head size in primary total hip arthroplasty.

The dislocation rate of 3197 Charnley prostheses with 22 mm head in which the surgery was done between 1979 and 1991 in 2 orthopaedic centers was compared with that of 2875 Lubinus prostheses with 32 mm head in which the surgery was done between 1980 to 1991 in 3 other centers. A 1-year followup showed an equal rate of dislocation (2.4%-2.5%) in the 2 groups and included 75% of the 201 dislocated hips. Almost all of the late dislocations occurred with the Charnley prosthesis, resulting in a total dislocation rate of 3.7% compared with 2.9% with the Lubinus prosthesis. Regardless of the type of prosthesis used, there was a higher risk of dislocation in patients with nonhealed hip fractures and in arthroplasties performed by less experienced surgeons. When these 2 variables were removed, the small femoral head was not associated with an increased risk of dislocation. However, there were 77 of 118 (65%) recurrent dislocations in the Charnley group, compared with 37 of 83 (45%) in the Lubinus group, and the relative risk of a dislocated hip arthroplasty becoming recurrent increased by 2.3 times if the small femoral head was used. The number of reoperations also were doubled in this group. Almost 4 times as many dislocations were documented within 2 weeks after surgery after any type of prosthesis inserted through a posterior approach compared with the transtrochanteric approach, but there was no increase in rate of recurrence or revision.

Aged↗
PubMed1983

Recurrences after initial dislocation of the shoulder. Results of a prospective study of treatment.

During the years 1978 and 1979, the results in 257 patients with a primary anterior dislocation of the shoulder were prospectively studied. The patients were less than forty years old and had been treated at twenty-seven Swedish hospitals. Thirty-two patients had a fracture of the greater tuberosity, but none of them reported having any further dislocations within two years after treatment, while 32 per cent of the patients without this fracture had a redislocation during the same period. The incidence of fractures of the greater tuberosity varied with the age of the patient; the highest rates were in the age groups of twelve to thirteen years and thirty-four to forty years (43 and 30 per cent, respectively), while in the age group of twenty to twenty-two years this injury was found in only 3 per cent of the patients. Chip fractures of the glenoid rim were found in 8 per cent of the patients, most of whom were in the older age groups. Impression fractures in the posterior part of the humeral head were demonstrated in 55 per cent of the patients and were not associated with a significantly higher rate of recurrence of dislocation. One hundred and twelve patients used an immobilization device for three to four weeks, while 104 patients began to use the shoulder as early and as freely as possible. At the two-year follow-up the groups showed an equal rate of recurrence of dislocation. In the age group of twenty-two years or younger nearly 50 per cent of the patients had one or more recurrences, regardless of treatment. In the two older age groups (twenty-three to twenty-nine and thirty to forty years old), the incidence of recurrence was 25 per cent or less.

Adolescent↗