Shoulder Osteoarthritis

Cuff Tear Arthropathy

Massive Rotator Cuff Tear

Pre-Operative Interscalene block: 3-5mL of 0.5% bupivacaine plus 10mL Exparel (1-2 mg of midazolam and/or 50-100 mcg of fentanyl IV for sedation)

Interscalene regional block

Local infiltration injection intraoperatively prior to closing during the procedure. A standardized dose of 100 mL of infiltration will be utilized according to the following formula. The mixture will be injected into the deltoid and pectoralis major muscles and fasciae, and subcutaneous tissues using an 18-guage needle.
Total dose 100mL
Ropivacaine 0.5% 40mL Epinephrine 1mg/mL 0.1mL Ketorolac 30mg/mL 1mL Morphine 10mg/mL 0.5mL Normal saline 0.9% 58.4mL

Local infiltration analgesia

University of Missouri

Local Infiltration Analgesia Vs. Interscalene Block in Total Shoulder Arthorplasty

Local Infiltration Analgesia Vs. Interscalene Block in Total Shoulder Arthorplasty: A Randomized Controlled Trial

Following surgery, the patient's pain level will be recorded in a visual analog scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, 2 days and daily until 7 days, and then at 14 days.

The patient's daily opiate consumption during the first 7 days following surgery and the toal accumulated amount of opiate consumption by 2 weeks postop will also be recorded, quantified and converted to morphine equivalents units (MEU) for standardization

Postoperative complications (medical, nerve injury, dislocation, hematoma, and wound complications)

Intraoperative complications (fracture, vascular injury, and anesthesia-related),

Individual participant data (IPD) will be shared with other members of the research team.

H. Mike Kim

ASSOCIATE PROFESSOR OF CLINICAL ORTHOPAEDIC SURGERY

University of Missouri-Columbia

Patients will be randomized prior to their scheduled surgery date by our research team using a randomization protocol developed by our department biostatistics team. The surgeons and anesthesiologists will be blinded about the group assignment until the day before surgery. The group assignment will be sealed in an envelope and delivered to the surgeon.

During 3 weeks (9 sessions; three sessions/wk), subject will performed 60 min walking at spontaneous walking speed in hypoxic (continuous hypoxic training, CHT; simulated altitude of 3000 m) condition in a single‐blind fashion.

During 3 weeks (9 sessions; three sessions/wk), subject will performed 60 min walking at spontaneous walking speed in normoxic (continuous normoxic training; CNT) condition in a single‐blind fashion.

Obesity

During 3 weeks (9 sessions; three sessions/wk), subject will performed 60 min walking at spontaneous walking speed in normoxic (continuous normoxic training; CNT) or hypoxic (continuous hypoxic training, CHT; simulated altitude of 3000 m) condition in a single‐blind fashion. Both CNT and CHT sessions will be performed in an hypoxic chamber (ATS Altitude, Sydney, Australia) built in our laboratory at an altitude of 380 m (Lausanne, Switzerland). In order to blind subjects to altitude, the system will also run for normoxic training groups with a normoxic airflow into the chamber.

Training

Institute of Sport Sciences of the University of Lausanne

Hypoxic Training in Obese Patients

Changes in Body Composition, Metabolic and Mechanical Responses to Hypoxic Walking Training in Obese Patients

All subjects will undergo dual-energy X-ray absorptiometry (DEXA) and bio‐impedance for measurements of body composition.

The subjects will be then asked to complete five 6 min level walking trials on the instrumented treadmill at five equally spaced speeds (0.55, 0.83, 1.11, 1.38 and 1.66 m/s), in randomized order. They will be allowed to establish their own preferred stride rate combination for each condition and will be given 5 min of rest between walking trials. During the walking trials, oxygen uptake (V˙O 2), carbon dioxide (CO2) output (V˙C O2) and ventilation (V˙ E) will be measured breath‐by‐breath (OxyconPro, Jaeger, Germany) and the volume and gases calibrations will be checked before each trial. Oxygen uptake values from the last 2 min will be averaged and normalized to body mass (V˙O 2, mlO2∙kg-1∙min-1). This value minus resting V'O2 was then divided by walking speed to obtain the net energy cost of walking (mlO2∙kg-1∙m-1).

During steady metabolic state (i.e., the last 2 min of walking for each speed), the mechanical external (Wext) and internal (Wint) work changes of 20 consecutive walking steps will be determined with an instrumented treadmill (H‐P‐COSMOS Treadmill MCU2 EPROM 2.31), consisting of a treadmill mounted on four 3‐D force sensors, following the methods described in detail by Cavagna (Cavagna 1975) and Willems et al. (1995).

Total mechanical work and efficiency. The total mass‐specific muscular work per distance travelled (Wtot) will be calculated as the sum of Wext and Wint. The mechanical efficiency will be computed as the ratio between Wtot and net energy cost of walking.

The blood samples were drawn at rest before (session 1) and after (session 12) the training program during fasting to determine total cholesterol (TC), high‐density lipoprotein (HDL), low‐density lipoprotein (LDL) and triglycerides (TG), leptin, total adiponectin, resistin, retinol‐binding protein 4 (RBP4), plasma glucose and insulin concentrations (this measure is a composite).

osteoarthritis/hypoxia

Local Infiltration Analgesia Vs. Interscalene Block in Total Shoulder Arthorplasty

Hypoxic Training in Obese Patients

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