1st Annotated bibliography- OSTEOPOROSIS AND HYSTERECTOMY

Choi, G.H., Jung, J. Y., Lee, W.S. (2019). Increased risk of osteoporosis with hysterectomy: A longitudinal
study follow-up study using a national sample cohort. American Journal of Obstetrics and
Gynaecology.220(6). 573.e1-573.e13

In women who have had a hysterectomy, ovarian occlusion reduces estrogen production, which in turn
leads to a gradual loss of bone minerals as estrogen plays an important role in bone growth and
maturation. This study was conducted in Korea and data were collected from 9082 patients with
hysterectomy and 36,328 controls from the National Health Insurance Corporation. Patients were
matched for age, gender, income, location of residence and medical history. The incidence of
osteoporosis was found to be higher in the hysterectomy group (19% (1765/9082)) than in the control
group (14.2% (5168/36.328)), concluding that hysterectomy was directly related to osteoporosis. Sex
hormones such as estrogen and androgens play an important role in bone metabolism in adulthood,
and their deficiency after hysterectomy increases bone resorption and causes additional bone loss

Shamim, S., Lal, M., Shamim, R. (2018). Prevalence of osteoporosis in hysterectomised as compared to
non-hysterectomized women in 7th decade of life. International Journal of Reproduction, Contraception,
Obstetrics and Gynecology. 7(5). 1974-1978.

A descriptive study was conducted in 66 postmenopausal women over 70 years of age. Divided into two
groups. The first group consisted of 36 women who underwent spontaneous menopause and the
second group consisted of 30 women who underwent surgical menopause. A DEXA scan was used to
compare and examine the bone density of the two groups. Of the 30 women who underwent
hysterectomy, 24 (80%) had osteoporosis, 6 (20%) had osteopenia, and did not show normal bone
density, indicating a significant relationship between bone loss and hysterectomy. Among women who
did not undergo hysterectomy, 16 (44.44%) had osteopenia and 6 (16.66%) had normal bone density.
It has also been found that obesity and fertility rates are directly proportional to bone density. Greater
equity, greater bone density loss, and obesity contributed to the development of osteoporosis and
osteopenia.

2nd Annotated bibliography- PERIOPERATIVE ANALGESIA FOR ORTHOPEDIC

SURGERY

Bajwa, S., Jain, D., Anand, S., & Palta, S. (2021). Neural blocks at the helm of a paradigm shift in enhanced
recovery after surgery (ERAS). Indian journal of anaesthesia, 65(Suppl 3), S99–S103.
https://doi.org/10.4103/ija.ija_807_21

The greatest danger in major surgery is the inability to function in the form of pain, respiratory
complications, ileum, etc., which delays recovery and prolongs hospitalization. The concept of a
multimodal approach to recovery from surgery was first proposed by Danish surgeon Dr. Kehler later
evolved into Enhanced Recovery After Surgery protocol (ERAS). This is associated with a patient-
centric, evidence-based, multimodal, pooled approach to improving postoperative outcomes. ERAS
basically covers all elements of perioperative care, from pre-hospital to pre- and intra-operative care
to post-operative care. The basic principles of the ERAS protocol include optimized preoperative
patient preparation, counseling, nutrition, and avoidance of preoperative care. , Carbohydrate exposure
up to 2 hours preoperatively, standardized anesthesia and analgesia schemes, diminished stress
response to surgery and early mobilization. The analgesic pathway bundled with ERAS has been
successfully implemented with various orthopedic interventions such as knee and hip replacement to
ensure excellent prophylactic and postoperative opioid-saving analgesia. It is clear that there are clear
benefits to using multimodal analgesics, including ultrasound-guided nerve block technology, as part of
multimodal analgesia.

Bielka, K., Kuchyn, I., Tokar, I. et al. (2021). Psoas compartment block efficacy and safety for
perioperative analgesia in the elderly with proximal femur fractures: a randomized controlled study.
BMC Anesthesiol 21, 252

https://doi.org/10.1186/s12871-021-01473-9

90 patients were divided into 3 groups using randomized control trial. For patients in group 1
ultrasound-guided PCB with bupivacaine 0.125% 6–8 ml / h was administered. Intraoperative
anesthesia was administered with PCB and a sciatic nerve block. Postoperative analgesia encompassed
extended CPB with bupivacaine 0.125% 6–8 ml / h. In group 2 intraoperative spinal anaesthesia had
been performed. Group 3 patients underwent general sevoflurane inhalation anaesthesia with fentanyl
infusion for analgesia. All patients obtained paracetamol 3 g/day and dexketoprofen 75 mg/day all
through hospitalization. When required nalbuphine 5 mg SC was used for analgesia. Efficacy
consequences had been the ICU stay of hospitalization, number of patients who had extreme ache after
surgery, recurrent requirement of analgesia, sleep quality, postoperative mobilization time.
Perioperative PCBs in elderly patients with proximal femoral fractures may be an effective analgesic
technique because they reduce severe pain, the need for on-demand analgesia, and the number of
patients using opioids. PCBs also reduced the incidence of opioid-related nausea and vomiting
compared to general anesthesia and increase the number of patients mobilized on the first (sitting) and
second (standing) days after surgery.