P169 Optimizing perioperative pain management in hemophilia patients undergoing total knee arthroplasty (TKA): exploring the role of regional anaesthesia (RA)
Bibliographic record
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Background and Aims Hemophilia is associated with spontaneous bleeding in muscle tissues and joints. Repeated hemarthrosis results in progressive joint cartilage damage, leading to hemophilic arthropathy. Joint pain remains a problem for many patients, necessitating orthopedic interventions. Perioperative pain management is challenging: NSAIDs are unsuitable for their impact on platelet activity; opioids are often ineffective for movement-related pain and can lead to significant side effects. RA presents an option for effective pain management, but its safety remains unclear. We report the perioperative management of 4 hemophilic patients undergoing elective TKA, performing peripheral nerve block in a safe manner. Methods 4 patients (age 41±12) underwent TKA; they all had severe hemophilia (3 type A, 1 type B). Tranexamic acid(1g) was administered via iv infusion 1 hour prior to surgery. FVIII/FVII was administered pre-induction and continued every 12h for 48h. After infusion, a single-shot US-guided femoral and sciatic nerve block was performed (levobupivacaine 0,375% 20ml + 20 ml respectively). General anesthesia was carried out; acetaminophen 1g, methadone 0,5 mg/kg and dexamethasone 4mg were administered. Postoperative opioid-sparing analgesia was successfully maintained with low-dose oral opioids(oxycodone/naloxone 5mg bid) for 48h, and acetaminophen. Results No major hemorrhagic complications occurred. No muscle and soft tissue bleeding after RA were reported. Adequate pain management enabled early physical rehabilitation. Conclusions The perioperative use of regional nerve blocks proved to be safe and effective for opioid-sparing analgesia in hemophilia patients undergoing TKA, enabling early physical rehabilitation. Our findings suggest that with appropriate clotting factor replacement, RA can be a viable option in this patient population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".