Top Tweets for #MotorSparing

5 months ago

✨ From Doubt to Discovery ✨ 🎬 The Story Behind the Dual Subsartorial Block (DSB) #FromDoubtToDiscovery #DualSubsartorialBlock #DSB #RegionalAnesthesia #InnovationInMedicine #AnatomyDriven #MotorSparing #TKR #ERAS #ThinkingBeyondBorders #PatientCentricCare Every innovation begins with a question and sometimes, with the discomfort of knowing that “good enough” isn’t truly enough. This video captures my personal and scientific journey behind the Dual Subsartorial Block (DSB) - from an ordinary academic assignment to an anatomy-driven innovation that redefined postoperative analgesia for total knee replacement. It is a story of: 🧠 questioning accepted practices 🔍 respecting anatomy 🧪 validating ideas through science 🚶‍♂️ preserving movement while relieving pain ❤️ and keeping the patient at the center of every decision From cadaveric dissections and ultrasound anatomy to clinical trials and real-world outcomes, this is not just about a block - it’s about how innovation is born when curiosity meets persistence. 🎥 I hope this story resonates with clinicians, trainees, and anyone who believes that progress begins by asking why. ▶️ Watch here: https://t.co/A1wHVjOS3R

KartikBSonawane's tweet photo. ✨ From Doubt to Discovery ✨

🎬 The Story Behind the Dual Subsartorial Block (DSB)

#FromDoubtToDiscovery #DualSubsartorialBlock #DSB #RegionalAnesthesia
#InnovationInMedicine #AnatomyDriven #MotorSparing #TKR #ERAS
#ThinkingBeyondBorders #PatientCentricCare

Every innovation begins with a question and sometimes, with the discomfort of knowing that “good enough” isn’t truly enough.

This video captures my personal and scientific journey behind the Dual Subsartorial Block (DSB) - from an ordinary academic assignment to an anatomy-driven innovation that redefined postoperative analgesia for total knee replacement.

It is a story of:
🧠 questioning accepted practices
🔍 respecting anatomy
🧪 validating ideas through science
🚶‍♂️ preserving movement while relieving pain
❤️ and keeping the patient at the center of every decision

From cadaveric dissections and ultrasound anatomy to clinical trials and real-world outcomes, this is not just about a block - it’s about how innovation is born when curiosity meets persistence.

🎥 I hope this story resonates with clinicians, trainees, and anyone who believes that progress begins by asking why.

▶️ Watch here:
https://t.co/A1wHVjOS3R

693

Dr.Kartik Sonawane

@KartikBSonawane

11 months ago

Beyond Barriers: Publishing the First RCT on the Dual Subsartorial Block (DSB) #Research #ClinicalTrial #RCT #MedicalResearch #OpenAccess #AcademicPublishing #TKR #Orthopedics #KneeReplacement #TKA #JointReplacement #SurgeryInnovation #DualSubsartorialBlock #DSB #MotorSparing #OpioidFree #InnovationInAnesthesia My Stories from the Field: A. A Gold Medal Beginning The journey began in 2021 , when we launched our RCT evaluating the Dual Subsartorial Block (DSB) for total knee arthroplasty (TKA). By 2022, the study was complete and received the Gold Medal for Best Paper at the AOSRAPM–AORA International Conference in Mumbai. With such early recognition, we expected a smooth path to publication - but that wasn’t the case. B. Facing Journal Resistance Despite methodological rigor, transparent data-sharing, and clinical relevance, our manuscript encountered multiple rejections across fields: Orthopedic Journals (CoRR, KSSTA, JEOR, JOSR): Rejected for being too anesthesia-focused. Journal of Clinical Anesthesia (JCA): Returned the manuscript, suggesting motor-sparing should have been secondary. RAPM (BMJ): Raised methodological concerns around sample size and outcome hierarchy - even though our calculations were correct. Pain Practice (Wiley): Acknowledged novelty but flagged formatting and audience fit. Acta Anaesthesiologica Scandinavica: Deemed more suitable for a regional anesthesia–specific audience. Anesthesiology and IJA: While offering praise, required overly drastic edits to word count and figures. During each step, we refined methods, clarified assumptions, restructured visuals, and tightened language - but the rejections continued. C. Finally Published - After Four Years In 2025, after persistent revisions and alignment with COPY-editing requests, the manuscript was accepted by Cureus. Even there, we had to address figure formats, title refinement, registry details, and statistical clarity. But at long last, the RCT on DSB was published. D. Takeaway This journey underscores that even award-winning research can struggle to find a home - not due to poor science, but because of journal scope and formatting realities. It demonstrates that transparency, adaptation, and persistence are as critical as the innovation itself. Read more about the full RCT here: https://t.co/ewSvzdsX6l

KartikBSonawane's tweet photo. Beyond Barriers: Publishing the First RCT on the Dual Subsartorial Block (DSB)

#Research #ClinicalTrial #RCT #MedicalResearch #OpenAccess #AcademicPublishing #TKR
#Orthopedics #KneeReplacement #TKA #JointReplacement #SurgeryInnovation
#DualSubsartorialBlock #DSB #MotorSparing #OpioidFree #InnovationInAnesthesia

My Stories from the Field:

A. A Gold Medal Beginning

The journey began in 2021 , when we launched our RCT evaluating the Dual Subsartorial Block (DSB) for total knee arthroplasty (TKA).

By 2022, the study was complete and received the Gold Medal for Best Paper at the AOSRAPM–AORA International Conference in Mumbai. With such early recognition, we expected a smooth path to publication - but that wasn’t the case.

B. Facing Journal Resistance

Despite methodological rigor, transparent data-sharing, and clinical relevance, our manuscript encountered multiple rejections across fields:

Orthopedic Journals (CoRR, KSSTA, JEOR, JOSR):
Rejected for being too anesthesia-focused.

Journal of Clinical Anesthesia (JCA):
Returned the manuscript, suggesting motor-sparing should have been secondary.

RAPM (BMJ):
Raised methodological concerns around sample size and outcome hierarchy - even though our calculations were correct.

Pain Practice (Wiley):
Acknowledged novelty but flagged formatting and audience fit.

Acta Anaesthesiologica Scandinavica:
Deemed more suitable for a regional anesthesia–specific audience.

Anesthesiology and IJA:
While offering praise, required overly drastic edits to word count and figures.

During each step, we refined methods, clarified assumptions, restructured visuals, and tightened language - but the rejections continued.

C. Finally Published - After Four Years

In 2025, after persistent revisions and alignment with COPY-editing requests, the manuscript was accepted by Cureus.
Even there, we had to address figure formats, title refinement, registry details, and statistical clarity. But at long last, the RCT on DSB was published.

D. Takeaway

This journey underscores that even award-winning research can struggle to find a home - not due to poor science, but because of journal scope and formatting realities. It demonstrates that transparency, adaptation, and persistence are as critical as the innovation itself.

Read more about the full RCT here:

https://t.co/ewSvzdsX6l

Dr.Kartik Sonawane

@KartikBSonawane

11 months ago

🦴 Mobilizing for Success: Determinants of Functional Outcomes After Arthroplasty🚀 #Prehabilitation #PatientOptimization #ImplantDesign #Orthopedics #EarlyMobilization #ERAS #MotorSparing #RegionalAnesthesia #Rehabilitation #TipOfTheDay #MyRATips Tip of the Day: ▪️Arthroplasty is a restorative journey aimed at regaining mobility, independence, and quality of life. 🧠Psychological impact → Early mobilization builds confidence, reduces fear, and speeds rehab. 🏆Outcome success → Synergy of implant choice + pain control + early rehab = better ROM, less pain, improved QoL. 🔑 Key Factors Affecting Functional Outcomes 1️⃣ Preoperative Patient Status 🧍‍♂️Baseline mobility & strength – Prehabilitation and preserved quadriceps power predict faster recovery. ❤️Comorbidities – Diabetes, obesity, and cardiovascular diseases impair healing and delay rehabilitation. 🧠Psychological readiness – Anxiety, fear of pain, or depression reduce adherence to postoperative physiotherapy. 2️⃣ Intraoperative Considerations 🔧Implant positioning & soft-tissue handling – Accurate alignment, stable fixation, and minimal trauma ensure optimal biomechanics. ⏱️Reduced surgical time – Lowers tissue inflammation and perioperative morbidity. 🩸Hemodynamic stability – Prevents ischemia and aids tissue healing. 3️⃣ Implant Design and Functional Outcomes 🔩 Different implant designs influence biomechanics, proprioception, and muscle efficiency. ▪️Posterior-Stabilized (PS): Reliable rollback, stable flexion → good ROM. ▪️Cruciate-Retaining (CR): Preserves PCL for more physiologic kinematics → better proprioception. ▪️Ultra-Congruent / Medial Pivot: Mimic natural knee motion → smoother early gait and confidence. ▪️Unicompartmental (UKA): Preserves native ligaments → fastest recovery and near-normal function. 👉 Key Points: Even the best implant fails to deliver optimal outcomes if pain is uncontrolled and mobilization is delayed. 4️⃣ Postoperative Mobilization 🚶‍♀️ 💡 Same-day mobilization is non-negotiable. ✅ If mobilized immediately: ▪️Maintains soft tissue flexibility, preventing adhesions. ▪️Reduces fibrosis, stiffness, and long-term pain. ▪️Improves ROM & patient confidence. ▪️Enhances circulation, reduces DVT, & prevents pulmonary complications. ⚠️ If NOT mobilized promptly: ❌ Leads to fibrosis, capsular tightening, & muscle guarding. ❌ Inflammatory responses increase scarring & joint stiffness. ❌ Joint becomes more painful later, prolonging rehab. ❌ Poor ROM → compromised long-term outcomes. 5️⃣ RA: Why Motor-Sparing is Crucial 💉 Femoral Nerve Block (FNB) ✅ Provides excellent analgesia. ❌ Causes quadriceps weakness, delaying ambulation and increasing fall risk. ❌ Contradicts ERAS principles and worsens stiffness by preventing early mobilization. Motor-Sparing Alternatives 🎯 Preserve quadriceps strength, allowing same-day ambulation. 🚀 Provide analgesia comparable to FNB but with significantly lower fall rates. ✅ Align perfectly with fast-track/ERAS pathways. 6️⃣ Multimodal Pain Management 💊 🌿NSAIDs/COX-2 inhibitors – Target inflammation and swelling. 💡Acetaminophen – Steady background analgesia. 🧬Gabapentinoids & Duloxetine – Address neuropathic pain, preventing central sensitization and chronic postsurgical pain. 💉Low-dose ketamine – Useful opioid-sparing adjunct in select patients. 🏆 Take-Home Message 💡The functional outcome of arthroplasty is not defined by surgical replacement alone, but by a comprehensive rehabilitation strategy: 🚶Immediate mobilization is essential - preventing fibrosis, stiffness, and chronic pain while ensuring optimal ROM. 🔩Implant design sets the biomechanical foundation, but recovery depends on pain-free and confident mobilization. 💉Motor-sparing analgesia allows safe ambulation and avoids the pitfalls of femoral nerve block–induced weakness. 💊Multimodal pain control with neuropathic pain management ensures long-term comfort, protects rehabilitation progress, and prevents chronic pain syndromes. 🎯The journey of arthroplasty success begins with the scalpel, but is completed by pain control, early mobilization, & a patient-centered recovery pathway.🚀

KartikBSonawane's tweet photo. 🦴 Mobilizing for Success: Determinants of Functional Outcomes After Arthroplasty🚀

#Prehabilitation #PatientOptimization #ImplantDesign #Orthopedics #EarlyMobilization #ERAS #MotorSparing #RegionalAnesthesia #Rehabilitation #TipOfTheDay #MyRATips

Tip of the Day:

▪️Arthroplasty is a restorative journey aimed at regaining mobility, independence, and quality of life.
🧠Psychological impact → Early mobilization builds confidence, reduces fear, and speeds rehab.
🏆Outcome success → Synergy of implant choice + pain control + early rehab = better ROM, less pain, improved QoL.

🔑 Key Factors Affecting Functional Outcomes

1️⃣ Preoperative Patient Status

🧍‍♂️Baseline mobility & strength – Prehabilitation and preserved quadriceps power predict faster recovery.
❤️Comorbidities – Diabetes, obesity, and cardiovascular diseases impair healing and delay rehabilitation.
🧠Psychological readiness – Anxiety, fear of pain, or depression reduce adherence to postoperative physiotherapy.

2️⃣ Intraoperative Considerations

🔧Implant positioning & soft-tissue handling – Accurate alignment, stable fixation, and minimal trauma ensure optimal biomechanics.
⏱️Reduced surgical time – Lowers tissue inflammation and perioperative morbidity.
🩸Hemodynamic stability – Prevents ischemia and aids tissue healing.

3️⃣ Implant Design and Functional Outcomes 🔩

Different implant designs influence biomechanics, proprioception, and muscle efficiency.

▪️Posterior-Stabilized (PS): Reliable rollback, stable flexion → good ROM.
▪️Cruciate-Retaining (CR): Preserves PCL for more physiologic kinematics → better proprioception.
▪️Ultra-Congruent / Medial Pivot: Mimic natural knee motion → smoother early gait and confidence.
▪️Unicompartmental (UKA): Preserves native ligaments → fastest recovery and near-normal function.
👉 Key Points: Even the best implant fails to deliver optimal outcomes if pain is uncontrolled and mobilization is delayed.

4️⃣ Postoperative Mobilization 🚶‍♀️

💡 Same-day mobilization is non-negotiable.

✅ If mobilized immediately:
▪️Maintains soft tissue flexibility, preventing adhesions.
▪️Reduces fibrosis, stiffness, and long-term pain.
▪️Improves ROM & patient confidence.
▪️Enhances circulation, reduces DVT, & prevents pulmonary complications.

⚠️ If NOT mobilized promptly:
❌ Leads to fibrosis, capsular tightening, & muscle guarding.
❌ Inflammatory responses increase scarring & joint stiffness.
❌ Joint becomes more painful later, prolonging rehab.
❌ Poor ROM → compromised long-term outcomes.

5️⃣ RA: Why Motor-Sparing is Crucial 💉

Femoral Nerve Block (FNB)
✅ Provides excellent analgesia.
❌ Causes quadriceps weakness, delaying ambulation and increasing fall risk.
❌ Contradicts ERAS principles and worsens stiffness by preventing early mobilization.

Motor-Sparing Alternatives
🎯 Preserve quadriceps strength, allowing same-day ambulation.
🚀 Provide analgesia comparable to FNB but with significantly lower fall rates.
✅ Align perfectly with fast-track/ERAS pathways.

6️⃣ Multimodal Pain Management 💊

🌿NSAIDs/COX-2 inhibitors – Target inflammation and swelling.
💡Acetaminophen – Steady background analgesia.
🧬Gabapentinoids & Duloxetine – Address neuropathic pain, preventing central sensitization and chronic postsurgical pain.
💉Low-dose ketamine – Useful opioid-sparing adjunct in select patients.

🏆 Take-Home Message

💡The functional outcome of arthroplasty is not defined by surgical replacement alone, but by a comprehensive rehabilitation strategy:
🚶Immediate mobilization is essential - preventing fibrosis, stiffness, and chronic pain while ensuring optimal ROM.
🔩Implant design sets the biomechanical foundation, but recovery depends on pain-free and confident mobilization.
💉Motor-sparing analgesia allows safe ambulation and avoids the pitfalls of femoral nerve block–induced weakness.
💊Multimodal pain control with neuropathic pain management ensures long-term comfort, protects rehabilitation progress, and prevents chronic pain syndromes.

🎯The journey of arthroplasty success begins with the scalpel, but is completed by pain control, early mobilization, & a patient-centered recovery pathway.🚀

865

Raj Gupta, MD, FASRA @dr_rajgupta

over 5 years ago

Moving towards #MotorSparing #blocks for #THA #TKA. Anything that restricts mobilization is bad. @SretroPMD @jattarab @garyschwartzmd @KalagaraHari #ASRAFall20 #ASRAWorldWide2020

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