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Giakas JA, Israel HA, Ali AH, Kaar SG. Does the addition of post-operative gabapentin reduce the use of narcotics after orthopedic surgery? PHYSICIAN SPORTSMED 2024; 52:283-290. [PMID: 37545473 DOI: 10.1080/00913847.2023.2246177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/27/2023] [Accepted: 08/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To evaluate the efficacy of post-operative gabapentin administration as an analgesic agent and its effect on narcotic use after orthopedic surgery in an outpatient sports medicine practice by comparing patients prior to and after initiating the routine use of gabapentin as part of a standardized post-operative pain medication regimen. We hypothesized that adding gabapentin to a multimodal post-operative pain regimen would decrease the number of requested pain medication refills and have no detrimental effect on Visual Analogue Scale and Single Assessment Numerical Evaluation scores at these early post-operative visits. METHODS All outpatient surgical patients, <90 years of age, undergoing outpatient orthopedic surgery by the study's senior author were included between 08/05/2021 and 02/22/2022. Patients were allowed 1 narcotic refill post-operatively and only in the first 3 weeks. The primary outcome was difference in percentage of patients who requested a narcotic refill within 3 weeks post-op. Two- and 6-week Visual Analogue Scale and Single Assessment Numerical Evaluation scores, and baseline health and demographic data. T-tests were run on continuous variables, Chi-Square or Fisher's Exact Test were run on dichotomous variables, and Mann-Whitney U test was run on all other categorical variables. Statistical significance was set at P < .05 for all tests. RESULTS There was a significant difference in narcotic refills at 3 weeks: 23 pre-gabapentin patients and 9 post-gabapentin patients (22.8% vs 9.0%, respectively: P = .006). There were no differences between 2- and 6-week Visual Analogue Scale and 2-week Single Assessment Numerical Evaluation scores. There was a significant difference in 6-week SANE between groups: mean difference = 6.4 (P = .027) though less than the established MCID. CONCLUSION Addition of gabapentin to a post-operative multimodal pain regimen reduced the use of narcotics after orthopedic sports medicine surgeries while also providing equivalent pain control.
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Affiliation(s)
- Julian A Giakas
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Heidi A Israel
- Department of Orthopedic Surgery, Division of Sports Medicine and Shoulder Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ashley H Ali
- Department of Orthopedic Surgery, Division of Sports Medicine and Shoulder Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Scott G Kaar
- Department of Orthopedic Surgery, Division of Sports Medicine and Shoulder Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
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2
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Sciard D, Xu K, Soulier A, Dufour G, Ursino M, Alberti C, Beaussier M. Postoperative analgesia after surgical repair of distal radius fracture: a randomized comparison between distal peripheral nerve blockade and surgical site infiltration. Minerva Anestesiol 2023; 89:876-883. [PMID: 36800809 DOI: 10.23736/s0375-9393.23.16956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Pain following open reduction and internal fixation of distal radius fracture (DRF) can be significant. This study compared the intensity of pain up to 48 hours after volar plating for DRF, associated to either an ultrasound guided distal nerve block (DNB) or surgical site infiltration (SSI). METHODS In this prospective single blind randomized study, 72 patients scheduled for DRF surgery under 1.5% lidocaine axillary block were allocated to receive, at the end of surgery, either an ultrasound-guided median and radial nerves block with ropivacaine 0.375% (DNB) performed by the anesthesiologist or a SSI with the same drug regimen, performed by the surgeon. Primary outcome was the duration between analgesic technique (H0) and pain reappearance (Numerical Rating Scale (NRS 0-10)>3). Secondary outcomes were the quality of analgesia, the quality of sleep, the magnitude of motor blockade, and the patient satisfaction. The study was built on a statistical hypothesis of equivalence. RESULTS Fifty-nine patients were included in the final per-protocol analysis (DNB=30, SSI=29). Time to reach NRS>3 was (in median [95%CI]) 267 min [155;727] and 164 min [120;181] respectively after DNB and SSI (difference=103 min [-22;594] - rejection of equivalence hypothesis). Pain intensity throughout the 48 hours, quality of sleep, opiate consumption, motor blockade and patient satisfaction was not significantly different between groups. CONCLUSIONS Although DNB provides a longer analgesia than SSI, both techniques gave comparable level of pain control during the first 48 hours after surgery, without any difference in the incidence of side effects or patient satisfaction.
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Affiliation(s)
- Didier Sciard
- Department of Anesthesiology, Montsouris Mutualist Institute, Paris, France
| | - Kailai Xu
- Department of Anesthesiology and Intensive Care, St Antoine Hospital, Hospitals of Paris, Paris, France
| | - Anne Soulier
- Department of Anesthesiology and Intensive Care, St Antoine Hospital, Hospitals of Paris, Paris, France
| | - Guillaume Dufour
- Department of Anesthesiology, Montsouris Mutualist Institute, Paris, France
| | - Moreno Ursino
- Unit of Clinical Epidemiology, Public Assistance, Hospitals of Paris, CHU Hôpital Robert Debré, Paris, France
- Inserm, Center of research of Cordeliers, Sorbonne University, University of Paris, Paris, France
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Public Assistance, Hospitals of Paris, CHU Hôpital Robert Debré, Paris, France
| | - Marc Beaussier
- Department of Anesthesiology, Montsouris Mutualist Institute, Paris, France -
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Krampe PT, Bendo AJP, Barros MIG, Bertolini GRF, Buzanello Azevedo MR. Cryotherapy in Knee Arthroplasty: Systematic Review and Meta-Analysis. Ther Hypothermia Temp Manag 2022. [DOI: 10.1089/ther.2022.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Priciane Tais Krampe
- Department of Physiotherapy, Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, Brazil
| | - Anna Julia Pereira Bendo
- Department of Physiotherapy, Universidade Estadual do Oeste do Paraná (Unioeste), Cascavel, Brazil
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Patient’s Preferred Type of Music: A Non-pharmacologic Postoperative Pain Relief. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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5
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Xie Z, Nie X, Pan L, Zhang N, Xue H. The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials. J Knee Surg 2021; 34:971-977. [PMID: 31952093 DOI: 10.1055/s-0039-3402795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43-2.67, p < 0.00001) and decreased duration of sensory block (MD = -26.82, 95% CI: -31.96 to -21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = -0.09; 95% CI: -1.89 to 1.70, p = 0.92), duration of motor block (MD = -59.76; 95% CI: -124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: -0.16 to 4.86, p = 0.07), first urination time (MD = -26.42, 95% CI: -57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: -25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.
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Affiliation(s)
- Zhiwei Xie
- Department of Hand-foot and Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaoying Nie
- Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Linlin Pan
- Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Na Zhang
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Huiqin Xue
- Department of Nursing, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
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6
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Villalba J, Molina-Corbacho M, García R, Martínez-Carreres L. Home-Based Intravenous Analgesia With an Elastomeric Pump After Medial Patellofemoral Ligament Repair: A Case Series. J Perianesth Nurs 2021; 36:690-694. [PMID: 34183257 DOI: 10.1016/j.jopan.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to show our experience using elastomeric pumps for postoperative pain relief after outpatient medial patellofemoral ligament (MPFL) reconstruction. DESIGN Prospective case series. METHODS Patients (N = 78) with recurrent patella dislocation who underwent MPFL repair using an autogenous semitendinosus tendon graft were included. After discharge, pain was controlled using intravenous analgesia infused by an elastomeric pump for 48 hours. Outcomes regarding pain, complications, overall satisfaction, and knee functionality were assessed. FINDINGS Early postoperative pain was mild in 53.8% of patients, and 30.8% patients had no pain at all. Twenty-four hours after surgery, 38.5% patients presented no pain, which increased to 53.8% at 72 hours. Nausea was experienced by 2.6% patients as was vomiting (7.7%) and drowsiness (2.6%). The mean score for patient satisfaction regarding the treatment was 90.2 (60.0-100.0). Moreover, postoperative knee functionality 12 months after the procedure proved to be statistically significantly superior (P <0.05). CONCLUSIONS Postoperative analgesia using an intravenous elastomeric pump allows performance of MPFL reconstruction as an outpatient procedure with satisfactory pain control, complication rates and patient satisfaction.
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Affiliation(s)
- Jordi Villalba
- Department of Orthopedic and Trauma Surgery. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Parc Taulí, 1. 08208 Sabadell, Spain.
| | - Matilde Molina-Corbacho
- Department of Orthopedic and Trauma Surgery. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Parc Taulí, 1. 08208 Sabadell, Spain
| | - Ramona García
- Department of Orthopedic and Trauma Surgery. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Parc Taulí, 1. 08208 Sabadell, Spain
| | - Laia Martínez-Carreres
- Department of Orthopedic and Trauma Surgery. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Parc Taulí, 1. 08208 Sabadell, Spain
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Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel) 2021; 9:333. [PMID: 33809571 PMCID: PMC8001960 DOI: 10.3390/healthcare9030333] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.
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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA
| | - Kara K. Brockhaus
- Department of Pharmacy, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
| | | | - Nicole Z. Spence
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA;
| | - Michelle M. Lucki
- Department of Orthopedics, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Michael J. Howkins
- Department of Addiction Medicine, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
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Waterman F, Cisternas M, Korrer S, Wilson A. Analysis of patient characteristics, health care costs by surgical venue, and opioid utilization for common orthopedic procedures in the United States. J Manag Care Spec Pharm 2021; 27:586-595. [PMID: 33576703 PMCID: PMC10394193 DOI: 10.18553/jmcp.2021.20343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Orthopedic surgery can be performed in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs), as well as in traditional inpatient venues. Patients who undergo orthopedic surgery may be prescribed opioids for the management of postsurgical pain. However, the association between surgery venue, postsurgical opioid use, and health care costs remains unclear. OBJECTIVE: To compare postsurgical opioid use and health care costs associated with 6 different orthopedic surgical procedures performed at inpatient, ASC, and HOPD venues. METHODS: Using the Optum Research Database, this retrospective study analyzed commercial health care claims from adult patients in the United States undergoing specific orthopedic procedures (total knee arthroplasty, partial knee arthroplasty, total hip arthroplasty, total shoulder arthroplasty, rotator cuff repair, and lumbar spinal fusion) between April 1, 2012, and December 31, 2017. The date of the first procedure in that period was the index date; continuous insurance coverage for 12 months before the index date (baseline period) to 6 months following the index date (postsurgical period, which includes the index date) was required. Opioid use and all-cause costs were measured in the postsurgical period. Baseline patient characteristics included demographics, Quan-Charlson Comorbidity Index, and opioid use. Multivariable analysis identified factors influencing postsurgical costs and persistent opioid use (defined as ≥ 1 opioid fill within 3 days after surgery [or discharge for inpatient stay] and ≥1 additional opioid fill during the postsurgical period at least 90 days after the index date). RESULTS: The sample included 126,172 patients (mean age, 58 years; 49% female). Overall, most procedures were performed at inpatient venues (68%), followed by HOPDs (18%) and ASCs (14%); the percentage of procedures performed at ASCs increased from 12% to 17% from 2012 to 2017. Patients whose procedures were performed at ASCs reported the lowest adjusted percentage of persistent opioid use following the procedure (18%) compared with those with procedures performed at HOPDs (24%) or inpatient venues (26%). Adjusted 30-day costs were 14% and 27% lower for patients with procedures in HOPDs and ASCs, respectively, compared with inpatient venues (P < 0.001 for both), and adjusted costs over the first 90 days were similar. CONCLUSIONS: All-cause costs on the day of surgery through 30 days after surgery for these 6 orthopedic procedures were significantly lower in HOPDs and ASCs compared with inpatient venues, even after adjustment for cohort, surgery year, demographic characteristics, baseline Quan-Charlson Comorbidity Index, and any opioid use within 90 days before the procedure. Additionally, patients undergoing orthopedic surgery at ASCs had the lowest adjusted percentage of persistent opioid use compared with those undergoing surgery at HOPDs or inpatient venues. Migration of certain orthopedic procedures from inpatient venues to HOPDs or ASCs may reduce health care costs and decrease the potential for persistent opioid use. DISCLOSURES: This study and editorial support for the preparation of this manuscript was funded by Pacira BioSciences, which contracted with Optum to conduct the study. Cisternas, Korrer, and Wilson are employees of Optum. Waterman was employed with Pacira BioSciences at the time of the study. Portions of this work were presented at AMCP Nexus 2019; October 29-November 1, 2019; National Harbor, MD.
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Affiliation(s)
- Fanta Waterman
- Pacira BioSciences, Parsippany, NJ, and Serrette Brown Research and Consulting, Danbury, CT
| | | | | | - Annikka Wilson
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN
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Cipollaro L, Trucillo P, Bragazzi NL, Della Porta G, Reverchon E, Maffulli N. Liposomes for Intra-Articular Analgesic Drug Delivery in Orthopedics: State-of-Art and Future Perspectives. Insights from a Systematic Mini-Review of the Literature. ACTA ACUST UNITED AC 2020; 56:medicina56090423. [PMID: 32825518 PMCID: PMC7557801 DOI: 10.3390/medicina56090423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
Background and objectives: Liposomal structures are artificial vesicles composed of one or several lamellae of phospholipids which surround an inner aqueous core. Given the amphoteric nature of phospholipids, liposomes are promising systems for drug delivery. The present review provides an updated synthesis of the main techniques for the production of liposomes for orthopedic applications, focusing on the drawbacks of the conventional methods and on the advantages of high pressure techniques. Materials and Methods: Articles published in any language were systematically retrieved from two major electronic scholarly databases (PubMed/MEDLINE and Scopus) up to March 2020. Nine articles were retained based on the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. Results: Liposome vesicles decrease the rate of inflammatory reactions after local injections, and significantly enhance the clinical effectiveness of anti-inflammatory agents providing controlled drug release, reducing toxic side effects. Conclusions: This review presents an update on the improvement in musculoskeletal ailments using liposome treatment.
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Affiliation(s)
- Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy;
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy;
| | - Paolo Trucillo
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 84084 Salerno, Italy; (P.T.); (E.R.)
- Department of Chemical, Material and Industrial Production Engineering, University of Naples Federico II, Piazzale V. Tecchio, 80-80125 Napoli, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
| | - Giovanna Della Porta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy;
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 84084 Salerno, Italy; (P.T.); (E.R.)
| | - Ernesto Reverchon
- Department of Industrial Engineering, University of Salerno, Via Giovanni Paolo II, 84084 Salerno, Italy; (P.T.); (E.R.)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Via San Leonardo 1, 84131 Salerno, Italy;
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy;
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
- Correspondence:
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10
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Moutzouros V, Jildeh TR, Khalil LS, Schwartz K, Hasan L, Matar RN, Okoroha KR. A Multimodal Protocol to Diminish Pain Following Common Orthopedic Sports Procedures: Can We Eliminate Postoperative Opioids? Arthroscopy 2020; 36:2249-2257. [PMID: 32353620 DOI: 10.1016/j.arthro.2020.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether postsurgical pain, measured by the visual analog scale (VAS), following common orthopaedic sports procedures could be managed effectively with a nonopioid multimodal analgesic protocol. METHODS This prospective study evaluated a custom multimodal nonopioid pain protocol in patients undergoing common orthopaedic sports procedures by a single fellowship-trained orthopaedic sports surgeon from May 2018 to December 2018. Procedures included anterior cruciate ligament reconstruction, rotator cuff repair, arthroscopic partial meniscectomy, and labrum repair. The nonopioid pain protocol consisted of preoperative analgesics, intraoperative local infiltration analgesia, and a postoperative pain regimen. Patient pain was immediately reported after surgery and 1 week postoperatively using the VAS, whereas rescue opioids (oxycodone 5 mg) used were recorded using a prescription opioid journal. Statistical analysis of patient VAS scores, demographic correlations, and comparison between opioid rescue users versus nonusers was performed. RESULTS A total of 141 patients were included. One week following surgery, patients reported a mean VAS level of 3.2 ± 2.3 and required on average 2.6 ± 3.6 breakthrough oxycodone pills (8.6 ± 12.0 morphine equivalents). Forty-five percent of patients did not require any breakthrough prescription opioids and reported satisfaction with pain management. Patients who required opioids were more likely to have a history of anxiety/depression (44.2% vs 23.8%, P = .012) and reported greater pain scores as compared with nonusers (3.94 ± 2.5 vs 2.41 ± 1.75, P = .016). The most common side effect of the pain protocol was feeling drowsy (23.5%). All patients were satisfied with their pain management postoperatively. CONCLUSIONS A multimodal, nonopioid pain protocol was found to be effective in managing postoperative pain following common orthopedic sports procedures. Patients were found to have low levels of pain, require minimal rescue opioids, and had no severe side effects related to the protocol. These results suggest a nonopioid alternative to pain management following common orthopedic sports procedures. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Vasilios Moutzouros
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Toufic R Jildeh
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Lafi S Khalil
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Kaylin Schwartz
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Laith Hasan
- Tulane University Medical School, New Orleans, Louisiana
| | - Robert N Matar
- University of Cincinnati Medical Center, 222 Piedmont Ave, Cincinnati, Ohio, U.S.A
| | - Kelechi R Okoroha
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan.
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11
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Lin C, Hwang S, Jiang P, Hsiung N. Effect of Music Therapy on Pain After Orthopedic Surgery—A Systematic Review and Meta‐Analysis. Pain Pract 2020; 20:422-436. [PMID: 31785131 DOI: 10.1111/papr.12864] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Shiow‐Li Hwang
- Department of Nursing Asia University Taichung Taiwan
- Department of Medical Research China Medical University Hospital China Medical University Taichung Taiwan
| | - Ping Jiang
- The First People's Hospital of Yunnan Province Kunming Yunnan China
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12
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Elsharkawy H, Saasouh W, Cho YJ, Soliman LM, Horn JL. The use of extended release bupivacaine with transversus abdominis plane and subcostal anterior quadratus lumborum catheters: A retrospective analysis of a novel technique. J Anaesthesiol Clin Pharmacol 2020; 36:110-114. [PMID: 32174670 PMCID: PMC7047671 DOI: 10.4103/joacp.joacp_358_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/26/2019] [Accepted: 05/21/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Liposomal bupivacaine (LB) is a formulation of local anesthetic that may exert analgesia over a prolonged period. Anecdotal use of LB suggests benefit and prolonged analgesia when used to supplement infiltration blocks. Our aim was to test the effect of a bolus of LB delivered through a nerve catheter in two types of interfascial plane blocks (transversus abdominis plane and anterior subcostal quadratus lumborum). The effect was evaluated through patient self-reporting of postsurgical pain up to 48 postoperative hours. Material and Methods Medical records of adult postoperative patients who received LB in a peripheral nerve catheter were followed retrospectively and analysed for pain scores and spread of dermatomal numbness over 48 h following the postoperative dose. A chart review of patients who qualified between June 2015 and March 2017 was performed, and clinical data were obtained from the institutional Perioperative Health Documentation System. Results Pain scores decreased following LB bolus, and all patients reported efficient block analgesia after bolus injection. Dermatomal numbness decreased gradually and was minimal by 48 h following bolus. Conclusion LB can be injected through a peripheral nerve catheter to prolong analgesia after catheter removal.
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Affiliation(s)
- Hesham Elsharkawy
- Case Western Reserve University, Cleveland, OH, USA.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - Wael Saasouh
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.,Department of Anaesthesiology, Detroit Medical Centre, Detroit, MI, USA
| | - Yoon Jeong Cho
- Department of General Anaesthesiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jean-Louis Horn
- Department of Anaesthesiology, Stanford University, Stanford, CA, USA
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13
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Ultrasound-guided popliteal sciatic nerve block: an effective alternative technique to control ischaemic severe rest pain during endovascular treatment of critical limb ischaemia. Pol J Radiol 2020; 84:e537-e541. [PMID: 32082452 PMCID: PMC7016492 DOI: 10.5114/pjr.2019.91271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/07/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose There are challenges with pain management related to a severely ischaemic limb. Although opioid-based treatment has been the cornerstone of pain relief, the use of these drugs should be limited because of their side effects in such vulnerable patients. We evaluated the utility and efficiency of sciatic nerve block as an alternative method to relieve severe rest pain during endovascular treatment of critical limb ischaemia. Material and methods We retrospectively investigated 10 patients who received ultrasound-guided popliteal sciatic nerve block for the relief of severe rest pain during endovascular treatment of critical limb ischaemia. The degree of pain relief was evaluated by using subjective criteria, from no relief of pain (= 1) to complete relief of pain (= 4). Details of endovascular treatment, time to perform the block, amount of local anaesthetics, duration of the block, need for supplemental analgesia, patient and operator satisfaction, and complications were recorded. Results All blocks were technically successful, and all of the patients had complete resolution of the pain within five minutes. The degree of pain relief was 3 in two patients and 4 in eight patients. All patients were satisfied with the block anaesthesia, and no patient required additional analgesia during this period. Operator satisfaction was very good in all cases. Complications secondary to block did not occur in any patient. Conclusions Ultrasound-guided popliteal sciatic nerve block provides effective pain control, which results in excellent patient and operator satisfaction during endovascular treatment of critical limb ischaemia with severe rest pain.
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14
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Suksompong S, von Bormann S, von Bormann B. Regional Catheters for Postoperative Pain Control: Review and Observational Data. Anesth Pain Med 2020; 10:e99745. [PMID: 32337170 PMCID: PMC7158241 DOI: 10.5812/aapm.99745] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Context Perioperative analgesia is an essential but frequently underrated component of medical care. The purpose of this work is to describe the actual situation of surgical patients focusing on effective pain control by discarding prejudice against ‘aggressive’ measures. Evidence Acquisition This is a narrative review about continuous regional pain therapy with catheters in the postoperative period. Included are the most-relevant literature as well as own experiences. Results As evidenced by an abundance of studies, continuous regional/neuraxial blocks are the most effective approach for relief of severe postoperative pain. Catheters have to be placed in adequate anatomical positions and meticulously maintained as long as they remain in situ. Peripheral catheters in interscalene, femoral, and sciatic positions are effective in patients with surgery of upper and lower limbs. Epidural catheters are effective in abdominal and thoracic surgery, birth pain, and artery occlusive disease, whereas paravertebral analgesia may be beneficial in patients with unilateral approach of the truncus. However, failure rates are high, especially for epidural catheter analgesia. Unfortunately, many reports lack a comprehensive description of catheter application, management, failure rates and complications and thus cannot be compared with each other. Conclusions Effective control of postoperative pain is possible by the application of regional/neuraxial catheters, measures requiring dedication, skill, effort, and funds. Standard operating procedures contribute to minimizing complications and adverse side effects. Nevertheless, these methods are still not widely accepted by therapists, although more than 50% of postoperative patients suffer from ‘moderate, severe or worst’ pain.
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Affiliation(s)
| | | | - Benno von Bormann
- Institute of Medicine, Suranaree University of Technology, Korat, Thailand
- Corresponding Author: Institute of Medicine, Suranaree University of Technology, 111 Maha Witthayalai Rd, Nakhon Ratchasima 30000, Thailand. Tel: +66(0)918825723,
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15
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Sharpe KP, Berkowitz R, Tyndall WA, Boyer D, McCallum SW, Mack RJ, Du W. Safety, Tolerability, and Effect on Opioid Use of Meloxicam IV Following Orthopedic Surgery. J Pain Res 2020; 13:221-229. [PMID: 32021411 PMCID: PMC6982445 DOI: 10.2147/jpr.s216219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/21/2019] [Indexed: 12/12/2022] Open
Abstract
Objective A Phase 3 randomized multicenter, double-blind, placebo-controlled trial (NCT02720692) compared once-daily intravenous (IV) meloxicam 30 mg to placebo, when added to the standard of care pain management regimens, in adults with moderate-to-severe pain following major elective surgery and concluded that meloxicam IV had a safety profile similar to placebo and reduced opioid consumption. Methods In this post hoc subgroup analysis of orthopedic surgery subjects, 379 subjects received meloxicam IV 30 mg or IV-administered placebo every 24 hrs for ≤7 doses. Safety was assessed via AEs, laboratory tests, vital signs, and ECG, with an emphasis on specific AEs, including injection site reactions, bleeding, cardiovascular, hepatic, renal, thrombotic, and wound healing events. Daily opioid consumption was assessed during treatment. Results Among meloxicam IV-treated subjects, 64.7% experienced ≥1 AE versus 68.8% of placebo-treated subjects. Investigators assessed most AEs to be mild or moderate in intensity and unrelated to treatment. Total opioid consumption (36.8 mg versus 50.3 mg IV morphine equivalent dose; P=0.0081) and opioid consumption during time points 0‒24, 24‒48, 0‒48, and 0‒72 hrs were statistically significantly lower in the meloxicam IV group. Conclusion Meloxicam IV demonstrated no significant differences in the number and frequency of AEs versus placebo in subjects following orthopedic surgery. Opioid consumption was reduced in the meloxicam IV group versus placebo. Trial registration ClinicalTrials.gov (Identifier: NCT02720692).
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Affiliation(s)
| | | | | | - David Boyer
- Shoals Clinical Research Associates, LLC, Florence, SC, USA
| | | | | | - Wei Du
- Clinical Statistics Consulting, Blue Bell, PA, USA
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16
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Recovery and discharge criteria after ambulatory anesthesia: can we improve them? Curr Opin Anaesthesiol 2019; 32:698-702. [DOI: 10.1097/aco.0000000000000784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Hauritz RW, Hannig KE, Balocco AL, Peeters G, Hadzic A, Børglum J, Bendtsen TF. Peripheral nerve catheters: A critical review of the efficacy. Best Pract Res Clin Anaesthesiol 2019; 33:325-339. [PMID: 31785718 DOI: 10.1016/j.bpa.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
Continuous peripheral nerve blocks are commonly used for postoperative analgesia after surgery. However, catheter failure may occur due to either primary (incorrect insertion) or secondary reasons (displacement, obstruction, disconnection). Catheter failure results in unanticipated pain, need for opioid use, and risk of readmission or delay in hospital discharge. This review aimed to assess definition and frequency of catheter failure, and discuss the alternatives to prolong duration of single-shot nerve blocks. A literature search was performed on peripheral catheters reporting failure as the main outcome measure. Thirty-three studies met the selection criteria, comprising 2711 catheters. Literature review suggests that peripheral nerve catheters have clinically significant failure rate when the assessment is performed using an objective (imaging) method. Subjective methods of assessment (without imaging) may underestimate the incidence of catheter failure.
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Affiliation(s)
- Rasmus W Hauritz
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Kjartan E Hannig
- Department of Anesthesia and Intensive Care Medicine, Kolding Hospital, Denmark
| | - Angela Lucia Balocco
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Gwendolyne Peeters
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | - Jens Børglum
- Department of Anesthesia and Intensive Care Medicine, Zealand University Hospital, Denmark
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18
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Župčić M, Dedić D, Graf Župčić S, Đuzel V, Šimurina T, Šakić L, Grubješić I, Šutić I, Šutić I, Korušić A. THE ROLE OF PARAVERTEBRAL BLOCKS IN AMBULATORY SURGERY: REVIEW OF THE LITERATURE. Acta Clin Croat 2019; 58:43-47. [PMID: 31741558 PMCID: PMC6813485 DOI: 10.20471/acc.2019.58.s1.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.
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Affiliation(s)
| | - David Dedić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Sandra Graf Župčić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Viktor Đuzel
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Tatjana Šimurina
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Livija Šakić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Igor Grubješić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Ingrid Šutić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Ivana Šutić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
| | - Andjelko Korušić
- 1Clinical Hospital Centre Rijeka, Clinic of Anesthesiology and Intensive Care Medicine, Rijeka, Croatia; 2University of Rijeka, Faculty of Medicine, Department of Physiology and Immunology, Rijeka, Croatia; 3J. J. Strossmayer University, Faculty of Medicine, Osijek, Croatia; 4Clinical Hospital Dubrava, Clinic of Anaesthesiology, Reanimatology and Intensive Care Medicine, Zagreb, Croatia; 5Clinical Hospital Centre Rijeka, Clinic of Neurology, Rijeka, Croatia; 6Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom; 7General Hospital Zadar, Department of Anesthesiology and Intensive Care Medicine, Zadar, Croatia; 8Department of Health Studies University of Zadar, Zadar,Croatia; 9Department of Anaesthesiology, Reanimatology and Intensive Medicine, University Hospital "Sveti Duh", Zagreb, Croatia; 10University of Rijeka, Faculty of Medicine, Department of Family medicine, Rijeka, Croatia
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Benigni L, Lafuente P, Viscasillas J. Clinical comparison of two techniques of brachial plexus block for forelimb surgery in dogs. Vet J 2019; 244:23-27. [PMID: 30825890 DOI: 10.1016/j.tvjl.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/09/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
The objective of this study was to compare two different local anaesthesia techniques for intraoperative analgesia in dogs undergoing surgical procedures distal to the mid humeral diaphysis. Thirty-two dogs were divided into two groups: the US group received an ultrasound-guided brachial plexus block at the level of the first rib and the N group received a neurostimulation-guided paravertebral brachial plexus block. Ropivacaine 0.75% at 1.5mg/kg was injected in each case. Dogs were monitored during the surgical procedure, and rescue analgesia was administered whenever the heart rate, respiratory rate or blood pressure increased more than 20% from the basal values. Success rate was defined as no need for rescue analgesia during surgery and complete blockade of the operated leg evaluated just after anaesthesia recovery. Complications were also recorded. Data was analysed using Fisher exact and Mann/Whitney tests. Success rate was observed in 14/16 (87%) dogs and in 12/16 (75%) dogs in the US and N groups, respectively (P=0.65). Complications recorded were hypotension in three cases (US group, n=1; N group, n=2) and Horner's syndrome in three cases (US group, n=1; N group, n=2; P=0.65). Both techniques were found to provide good level of analgesia that allowed performing the orthopaedic procedures from the mid humeral diaphysis and distal in the limb, without the need for further analgesia.
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Affiliation(s)
- L Benigni
- The Royal Veterinary College, North Mymms, Hartfield, Hertfordshire AL9 7TA, United Kingdom
| | - P Lafuente
- The Royal Veterinary College, North Mymms, Hartfield, Hertfordshire AL9 7TA, United Kingdom
| | - J Viscasillas
- The Royal Veterinary College, North Mymms, Hartfield, Hertfordshire AL9 7TA, United Kingdom.
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Prajapati R, Larsen SW, Yaghmur A. Citrem–phosphatidylcholine nano-self-assemblies: solubilization of bupivacaine and its role in triggering a colloidal transition from vesicles to cubosomes and hexosomes. Phys Chem Chem Phys 2019; 21:15142-15150. [DOI: 10.1039/c9cp01878f] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In concentration- and lipid composition-dependent manners, bupivacaine triggers lamellar–nonlamellar phase transitions in citrem/soy phosphatidylcholine nanodispersions.
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Affiliation(s)
- Rama Prajapati
- Department of Pharmacy, Faculty of Health and Medical Sciences
- University of Copenhagen
- DK-2100 Copenhagen Ø
- Denmark
| | - Susan Weng Larsen
- Department of Pharmacy, Faculty of Health and Medical Sciences
- University of Copenhagen
- DK-2100 Copenhagen Ø
- Denmark
| | - Anan Yaghmur
- Department of Pharmacy, Faculty of Health and Medical Sciences
- University of Copenhagen
- DK-2100 Copenhagen Ø
- Denmark
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21
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Crisologo PA, Monson EK, Atway SA. Gabapentin as an Adjunct to Standard Postoperative Pain Management Protocol in Lower Extremity Surgery. J Foot Ankle Surg 2018; 57:781-784. [PMID: 29748103 DOI: 10.1053/j.jfas.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Indexed: 02/03/2023]
Abstract
Postoperative pain is a problem that plagues physicians and has since the dawn of the surgical arts. Many interventions are available and used as the standard such as preoperative local anesthetic blocks, opiates, both oral and intravenous, and nonsteroidal antiinflammatory drugs. Although the temptation often exists to increase the postoperative opiate dose, opiate abuse is an increasing problem. This abuse has fueled the search for nonopiate pain adjuncts. Gabapentinoids have been shown to both decrease postoperative pain and, secondarily, decrease opiate dependence. This is a growing field in medical research, although it is relatively lacking in the specialty of lower extremity orthopedic surgery. A PubMed query was performed for related articles, which found only 8 related to lower extremity orthopedic surgery, and of these, none addressed the foot or ankle. Studies involving chronic pain, nonorthopedic surgery, orthopedic procedures proximal to and including the hip, studies involving only pregabalin, and studies regarding cancer pain were excluded. The results from our literature review are encouraging regarding the addition of gabapentin as a regular, perioperative adjunctive pain medication because all studied reported data evaluating preoperative administration have shown a statistically significant reduction in postoperative pain and opiate consumption.
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Affiliation(s)
- P Andrew Crisologo
- Fellow, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Erik K Monson
- Director and Assistant Professor, Podiatric Medicine and Surgery Residency Program, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Said A Atway
- Assistant Professor, Podiatric Medicine and Surgery Residency Program, The Ohio State University Wexner Medical Center, Columbus, OH
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22
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Outpatient total knee arthroplasty: Readmission and complication rates on day 30 in 61 patients. Orthop Traumatol Surg Res 2018; 104:967-970. [PMID: 30179723 DOI: 10.1016/j.otsr.2018.07.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/15/2018] [Accepted: 07/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) on an outpatient basis is controversial due to concerns about patient safety. In France, only 1.1% of TKAs performed in 2017 were outpatient procedures. Nevertheless, recent advances in the multi-modal and multidisciplinary management of TKA patients combined with optimisation of the various components of perioperative care are increasing the use of outpatient TKA. However, studies on outcomes remain scarce. The primary objective of this work was to compare readmission rates within 30 days after TKA between patients managed as outpatients and as inpatients. The secondary objectives were to compare complication rates and patient satisfaction between the two groups. HYPOTHESIS After outpatient TKA, the day-30 rates of readmission and complications are similar to those seen after inpatient TKA. MATERIAL AND METHODS A retrospective single-centre study of consecutive patients who underwent TKA between April 2014 and July 2017 was performed. Readmissions, complications, and patient satisfaction were collected. RESULTS Of 574 patients, 61 were selected to undergo outpatient TKA and 513 had inpatient TKA. The day-30 readmission rate was 2/61 (3.3%) in the outpatient group and 25/513 (4.9%) in the inpatient group. The overall complication rate was 8% in the outpatients and 7.2% in the inpatients. The satisfaction rate was high in the outpatient group, with 80% very satisfied and 20% satisfied patients. CONCLUSION When performed in appropriately selected patients, outpatient TKA is not associated with a higher readmission rate compared to inpatient TKA. LEVEL OF EVIDENCE IV, retrospective comparative study.
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Moon SY, Kim JE, Kwon OJ, Kim AR, Kim DH, Kim JH, Hwang HS, Yang C. A novel taping therapy for pain after arthroscopic shoulder surgery: study protocol for a randomised controlled pilot trial. Trials 2018; 19:518. [PMID: 30249298 PMCID: PMC6154883 DOI: 10.1186/s13063-018-2866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the number of arthroscopic shoulder surgeries has increased given that the intervention is minimally invasive. However, postoperative pain is one of the most common symptoms of patients who undergo arthroscopic surgery. Although pharmacological treatments and brachial plexus blocks for reducing pain are currently used, the adherence rate of interventions is low, and adverse effects often occur. Chimsband, made up of silver and optic fibres, is a novel taping therapy that stimulates patients' acupoints and is expected to relieve pain with few adverse effects. The aim of this study is to explore the effectiveness of Chimsband to relieve pain following arthroscopic shoulder surgery. METHODS/DESIGN This is a randomised, parallel, controlled, exploratory clinical trial. Thirty participants who undergo arthroscopic shoulder surgery will be randomly allocated to an intervention or a control group. Both groups will receive 10 sessions of interferential current therapy within a period of 2 weeks, while the intervention group will additionally receive taping therapy after undergoing physical therapy. Two follow-up visits will be scheduled after the last treatment session. The primary outcome variable will be the difference in the visual analogue scale (VAS) scores between baseline and first follow-up evaluation after the end of 10 treatment sessions. The secondary outcomes will be VAS at the end of the second week, shoulder pain and disability index, range of motion, VAS while sleeping, questionnaire of blood stasis pattern identification at two follow-up visits, and number of bands used per visit. Outcomes will be evaluated at baseline, 2 weeks from visit 1 (+ within 6 days) after commencement, and at 4 weeks from visit 1 (+ within 6 days) follow-up. DISCUSSION This study will be the first clinical trial to explore the effect and safety of Chimsband on postoperative shoulder pain. It would provide clinical evidence to conduct further taping therapy studies for relieving musculoskeletal pain. TRIAL REGISTRATION Korean Clinical Trial Registry, KCT0002355 . Registered on 13 June 2017.
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Affiliation(s)
- Sun-Young Moon
- Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea.,Korean Medicine Life Science, University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Jung-Eun Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - O-Jin Kwon
- Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Ae-Ran Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Da-Heui Kim
- Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Jae-Hong Kim
- Department of Acupuncture & Moxibustion, DongShin University Gwangju Oriental Hospital, Gwangju, Republic of Korea
| | - Hwa Soo Hwang
- Chims-Saengvit Oriental Medicine Clinic, Seoul, Republic of Korea
| | - Changsop Yang
- Clinical Research Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon, Republic of Korea.
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Liu SE, Irwin MG. Regional anaesthesia for orthopaedic procedures. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2018. [DOI: 10.1016/j.mpaic.2018.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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An Enhanced Recovery after Surgery Pathway for Microvascular Breast Reconstruction Is Safe and Effective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1634. [PMID: 29464164 PMCID: PMC5811294 DOI: 10.1097/gox.0000000000001634] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/16/2017] [Indexed: 01/22/2023]
Abstract
Supplemental Digital Content is available in the text. Background: The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods: Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation. There were 3 groups of women in this cohort study: (1) traditional historical control; (2) transition group with partial implementation; and (3) ERAS. Narcotic use, patient-reported pain scores, antiemetic use, time to regular diet, time to first walk, hospital length of stay, and 30-day postoperative complications were compared between the groups. Results: After implementation of the pathway, the use of parenteral narcotics was reduced by 88% (traditional, 112 mg; transition, 58 mg; ERAS, 13 mg; P < 0.0001), with no consequent increase in patient-reported pain. Patients in the ERAS cohort used less antiemetics (7.0, 5.3, 2.2 doses, P < 0.0001), returned to normal diet 19 hours earlier (46, 39, 27 hours, P < 0.0001), and walked 25 hours sooner (75, 70, 50 hours, P < 0.0001). Overall, hospital length of stay was reduced by 2 days in the ERAS cohort (6.6, 5.6, 4.8 days, P < 0.0001), without an increase in rates of major complications (9.5%, 10.1%, 8.3%, P = 0.9). Conclusions: A clinical care pathway in microsurgical breast reconstruction using the ERAS Society guideline promotes successful early recovery.
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Hulet C, Rochcongar G, Court C. Developments in ambulatory surgery in orthopedics in France in 2016. Orthop Traumatol Surg Res 2017; 103:S83-S90. [PMID: 28057478 DOI: 10.1016/j.otsr.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription.
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Affiliation(s)
- C Hulet
- Département de chirurgie orthopédique et traumatologique, niveau 11, Inserm U1075 COMETE « mobilité : attention, orientation & chronobiologie », université de Caen Basse-Normandie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - G Rochcongar
- Département de chirurgie orthopédique et traumatologique, niveau 11, Inserm U1075 COMETE « mobilité : attention, orientation & chronobiologie », université de Caen Basse-Normandie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - C Court
- Orthopédie TRaumatologie, hôpital Kremlin-Bicêtre, hôpitaux universitaires Paris Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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Galois L, Serwier JM, Arashvand AD. Surgery of the hallux valgus in an ambulatory setting: a liability risk? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:545-548. [PMID: 28078468 DOI: 10.1007/s00590-017-1901-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization. MATERIALS AND METHODS The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002-2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer's database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire. RESULTS We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19-64) in ambulatory patients (AG group) in comparison with 49.5 years (19-73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p = 0.002) and scarfs osteotomies in the HG group (p = 0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p = 0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p = 0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p = 0.084). DISCUSSION AND CONCLUSION No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures except for insufficient results. Hallux valgus 1-day surgery does not seem to expose surgeons to higher medicolegal problems than classical hospitalization. Nevertheless, a specific consent form for ambulatory patients is required to limit claims regarding information.
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Affiliation(s)
- L Galois
- Orthopedic and Trauma Surgery Department, Central Hospital, University Hospital of Nancy, 29 Av.de Lattre de Tassigny, 54035, Nancy Cedex, France.
| | - J-M Serwier
- Orthopedic and Trauma Surgery Department, University Hospital of Mons-Hainaut, Av. Baudouin de Constantinople, 7000, Mons, Belgium
| | - A D Arashvand
- Orthopedic and Trauma Surgery Department, University Hospital of Mons-Hainaut, Av. Baudouin de Constantinople, 7000, Mons, Belgium
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Shulman BS, Marcano AI, Davidovitch RI, Karia R, Egol KA. Nature's wrath-The effect of weather on pain following orthopaedic trauma. Injury 2016; 47:1841-6. [PMID: 27318614 DOI: 10.1016/j.injury.2016.05.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/29/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite frequent complaints by orthopaedic trauma patients, to our knowledge there is no data regarding weather's effect on pain and function following acute and chronic fracture. The aim of our study was to investigate the influence of daily weather conditions on patient reported pain and functional status. METHODS We retrospectively examined prospectively collected data from 2369 separate outpatient visits of patients recovering from operative management of acute tibial plateau fractures, acute distal radius fractures, and chronic fracture nonunions. Pain and functional status were assessed using a visual analogue scale (VAS) and the DASH and SMFA functional indexes. For each visit date, the mean temperature, difference between mean temperature and expected temperature, dew point, mean humidity, amount of rain, amount of snow, and barometric pressure were recorded. Statistical analysis was run to search for associations between weather data and patient reported pain and function. RESULTS Low barometric pressure was associated with increased pain across all patient visits (p=0.007) and for patients at 1-year follow-up only (p=0.005). At 1-year follow-up, high temperature (p=0.021) and high humidity (p=0.030) were also associated with increased pain. No significant association was noted between weather data and patient reported functional status at any follow-up interval. CONCLUSIONS Patient complaints of weather influencing pain after orthopaedic trauma are valid. While pain in the immediate postoperative period is most likely dominated by incisional and soft tissue injuries, as time progresses barometric pressure, temperature, and humidity impact patient pain levels. Affirming and counseling that pain may vary based on changing weather conditions can help manage patient expectations and improve satisfaction.
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Affiliation(s)
- Brandon S Shulman
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Alejandro I Marcano
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
| | - Roy I Davidovitch
- Center for Musculoskeletal Care, 33 East 38th Street, New York, NY 10016, USA.
| | - Raj Karia
- NYU Langone Medical Center, 380 2nd Ave. Suite 606, New York, NY 10010, USA.
| | - Kenneth A Egol
- NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
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Abstract
OBJECTIVE The aim of this article is to provide an overview of peripheral nerve blocks, the use of peripheral nerve block within and outside interventional radiology, and the complications of peripheral nerve block. CONCLUSION Interventional radiologists are often responsible for sedation and pain management in the majority of interventional radiology procedures. Peripheral nerve block is increasingly being used in interventional radiology.
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