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McNaughton MA, Quinlan-Colwell A, Lyons MT, Arkin LC. Acute Perioperative Pain Management of the Orthopaedic Patient: Guidance for Operationalizing Evidence Into Practice. Orthop Nurs 2024; 43:10-22. [PMID: 38266259 DOI: 10.1097/nor.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Orthopaedic surgery often results in pain, with less than half of patients reporting adequate relief. Unrelieved acute pain occurring after surgery increases the risk of negative sequelae, including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain. Interventions that are individualized, evidence-informed, and applied within an ethical framework improve healthcare delivery for patients, clinicians, and healthcare organizations. Recommendations for using the principles of effective pain management from preoperative assessment through discharge are detailed, including recommendations for addressing barriers and challenges in applying these principles into clinical practice.
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Affiliation(s)
- Molly A McNaughton
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Ann Quinlan-Colwell
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Mary T Lyons
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
| | - Laura C Arkin
- Molly A. McNaughton, MAN, CNP-BC, PMGT-BC, AP-PMN, Nurse Practitioner, M Health Fairview Pain Management Center, Burnsville, MN
- Ann Quinlan-Colwell, PhD, APRN-CNS, PMGT-BC, AHNBC, Integrative Pain Management Educator and Consultant, AQC Integrative Pain Management Education & Consultation, Wilmington, NC
- Mary T. Lyons, MSN, APRN-CNS, AGCNS-BC, PMGT-BC, AP-PMN, Inpatient Palliative Care, Edward Hospital, Naperville, IL
- Laura C. Arkin, MSN, APRN-CNS, ONC, ONC-A, CCNS, FCNS, Director of Quality Services, Orlando Health Jewett Orthopedic Institute, Orlando, FL
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Usamah U, Sumartono C, Fitriati M, Wirabuana B, Tjokroprawiro BA. Comparative analysis of lumbar quadratus lumborum block and epidural block for analgesia in uterine surgery at Dr. Soetomo Hospital, Surabaya. J Med Life 2023; 16:1707-1713. [PMID: 38406774 PMCID: PMC10893563 DOI: 10.25122/jml-2023-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/13/2023] [Indexed: 02/27/2024] Open
Abstract
Over 80% of surgical patients experience postoperative pain, which, if inadequately managed, can lead to complications, prolonged rehabilitation, chronic pain, and decreased quality of life. Epidural block and quadratus lumborum block are techniques commonly used for postoperative pain management. This comparative analytic study aimed to analyze the differences in the analgesic effects of quadratus lumborum block and epidural block in uterine surgery at Dr. Soetomo General Hospital. The outcomes assessed were the numerical rating score (NRS) as a pain score and the administration of opioids as an adjuvant analgesic. Statistical analysis employed the Mann-Whitney test and Chi-square test. The study included 32 patients who underwent uterine surgery at Dr. Soetomo General Hospital and met the inclusion and exclusion criteria. Among the patients, 90.6% experienced mild pain, and 9.4% experienced moderate pain. Epidural blocks were performed in 50% of the patients, while quadratus lumborum blocks were performed in the other 50%. Additionally, 9.4% of the patients received opioids as adjuvant analgesics. The Mann-Whitney test revealed no significant difference in NRS between the epidural block and quadratus lumborum block groups (p-value>0.05). However, the Chi-square test indicated a significant difference in NRS between patients who received additional opioids as adjuvant analgesics and those who did not (p-value<0.00). There was no significant difference in NRS between patients who underwent epidural block and quadratus lumborum block as analgesic techniques.
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Affiliation(s)
- Usamah Usamah
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Christrijogo Sumartono
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Mariza Fitriati
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
| | - Belindo Wirabuana
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Regional General Hospital, Surabaya, Indonesia
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Jennewine BR, Wing CW, Mihalko WM. Body Habitus Impact on Success of Cryoneurolysis for Postoperative Total Knee Arthroplasty Pain Control: A Retrospective Cohort Study. Arthroplast Today 2023; 22:101164. [PMID: 37521741 PMCID: PMC10382622 DOI: 10.1016/j.artd.2023.101164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/03/2023] [Accepted: 05/15/2023] [Indexed: 08/01/2023] Open
Abstract
Background Cryoneurolysis utilizes temperatures below -20°C for nonpermanent analgesia to control pain in total knee arthroplasty (TKA). There is concern that body habitus could limit pain control because of accuracy of cryoneurolysis to subcutaneous nerves. This study aimed to determine the relationship between body habitus and effectiveness of cryoneurolysis on postoperative pain control. Methods A retrospective chart review was performed on patients undergoing cryoneurolysis before primary TKA from 2017 to 2019. Included were 114 patients (58 control group and 56 treatment group). Cryoneurolysis patients were divided into 3 groups (small, medium, and large) based on the soft tissue to femoral diaphysis ratio of 7 cm proximal to superior pole of the patella. Postoperative outcome measures were morphine equivalents, numerical rating score for pain, range of motion, and Knee Injury and Osteoarthritis Outcome Score Joint Replacement. Results The small cryoneurolysis group showed decreased opioid consumption at the 2, 6, and 12 weeks compared with control group, with morphine equivalents significantly decreased at 2 weeks for small compared with medium groups (54.3 vs 142.9, P = .0097). Numerical rating score for pain decreased significantly between small and medium groups (3.4 vs 4.0, P = .012) and between medium and large groups (4.0 vs 2.4, P = .012). Range of motion increased at 12 weeks for small group compared with medium group (118 vs 112, P = .042). There were no differences in any outcome measure between small and large groups. Conclusions Body habitus does not appear to affect efficacy of cryoneurolysis in controlling postoperative pain following TKA. Cryoneurolysis remains a useful tool for multimodal pain management.
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Affiliation(s)
| | | | - William M. Mihalko
- Corresponding author. Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA. Tel.: +1 901 759 3273.
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Kim K, Biskupiak JE, Babin JL, Ilham S. Positive Association between Peri-Surgical Opioid Exposure and Post-Discharge Opioid-Related Outcomes. Healthcare (Basel) 2022; 11:healthcare11010115. [PMID: 36611576 PMCID: PMC9819163 DOI: 10.3390/healthcare11010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Multiple studies have investigated the epidemic of persistent opioid use as a common postsurgical complication. However, there exists a knowledge gap in the association between the level of opioid exposure in the peri-surgical setting and post-discharge adverse outcomes to patients and healthcare settings. We analyzed the association between peri-surgical opioid exposure use and post-discharge outcomes, including persistent postsurgical opioid prescription, opioid-related symptoms (ORS), and healthcare resource utilization (HCRU). Methods: A retrospective cohort study included patients undergoing cesarean delivery, hysterectomy, spine surgery, total hip arthroplasty, or total knee arthroplasty in an academic healthcare system between January 2015 and June 2018. Peri-surgical opioid exposure was converted into morphine milligram equivalents (MME), then grouped into two categories: high (>median MME of each surgery cohort) or low (≤median MME of each surgery cohort) MME groups. The rates of persistent opioid use 30 and 90 days after discharge were compared using logistic regression. Secondary outcomes, including ORS and HCRU during the 180-day follow-up, were descriptively compared between the high and low MME groups. Results: The odds ratios (95% CI) of high vs. low MME for persistent opioid use after 30 and 90 days of discharge were 1.38 (1.24−1.54) and 1.41 (1.24−1.61), respectively. The proportion of patients with one or more ORS diagnoses was greater among the high-MME group than the low-MME group (27.2% vs. 21.2%, p < 0.01). High vs. low MME was positively associated with the rate of inpatient admission, emergency department admissions, and outpatient visits. Conclusions: Greater peri-surgical opioid exposure correlates with a statistically and clinically significant increase in post-discharge adverse opioid-related outcomes. The study findings warrant intensive monitoring for patients receiving greater peri-surgical opioid exposure.
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Affiliation(s)
- Kibum Kim
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL 60564, USA
- Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84112, USA
- Correspondence: ; Tel.: +1-312-413-0152; Fax: +1-312-996-2954
| | - Joseph E. Biskupiak
- Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84112, USA
- Pharmacotherapy Outcomes Research Center, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Jennifer L. Babin
- Department of Pharmacotherapy, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Sabrina Ilham
- Pharmacotherapy Outcomes Research Center, University of Utah Health, Salt Lake City, UT 84112, USA
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Galivanche AR, Zhu J, Mercier MR, McLean R, Wilhelm CV, Varthi AG, Grauer JN, Rubin LE. Admission NarxCare Narcotic Scores Are Associated With Increased Odds of Readmission and Prolonged Length of Hospital Stay After Primary Elective Total Knee Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202212000-00002. [PMID: 36732305 PMCID: PMC9726283 DOI: 10.5435/jaaosglobal-d-22-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The association of preoperative narcotic use with postoperative outcomes after primary elective total knee arthroplasty (TKA) has remained poorly characterized. The NarxCare platform analyzes patients' state Prescription Drug Monitoring Program records to assign numerical scores that approximate a patient's overall opioid usage. The present study investigated the utility of admission NarxCare narcotic scores in predicting the odds of adverse events (AEs) after primary elective TKA. METHODS Elective primary TKA patients performed at a single institution between October 2017 and May 2020 were evaluated. NarxCare narcotic scores at the time of admission, patient characteristics, 30-day AEs, readmissions, revision surgeries, and mortality were abstracted. Elective TKA patients were binned based on admission NarxCare narcotic scores. The odds of experiencing adverse outcomes were compared. RESULTS In total, 1136 patients met the criteria for inclusion in the study (Narx Score 0: n = 293 [25.8%], 1 to 99: n = 253 [22.3%], 100 to 299: n = 368 [32.4%], 300 to 499: n = 161 [14.2%], and 500+: n = 61 [5.37%]). By logistic regression, patients with higher admission narcotic scores tended to have a dose-dependent increase in the odds of prolonged length of hospital stay, readmission within 30 days, and aggregated AEs. DISCUSSION Admission narcotic scores may be used to predict readmission and to stratify TKA patients by risk of AEs.
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Affiliation(s)
- Anoop R. Galivanche
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Justin Zhu
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Michael R. Mercier
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Ryan McLean
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Christopher V. Wilhelm
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Arya G. Varthi
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N. Grauer
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Lee E. Rubin
- From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Chen LS, Zhang M, Chen P, Xiong XF, Liu PQ, Wang HB, Wang JJ, Shen J. The m 6A demethylase FTO promotes the osteogenesis of mesenchymal stem cells by downregulating PPARG. Acta Pharmacol Sin 2022; 43:1311-1323. [PMID: 34462564 PMCID: PMC9061799 DOI: 10.1038/s41401-021-00756-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/02/2021] [Indexed: 12/15/2022] Open
Abstract
N6-methyladenosine (m6A) is the most abundant posttranscriptional methylation modification that occurs in mRNA and modulates the fine-tuning of various biological processes in mammalian development and human diseases. In this study we investigated the role of m6A modification in the osteogenesis of mesenchymal stem cells (MSCs), and the possible mechanisms by which m6A modification regulated the processes of osteoporosis and bone necrosis. We performed systematic analysis of the differential gene signatures in patients with osteoporosis and bone necrosis and conducted m6A-RNA immunoprecipitation (m6A-RIP) sequencing to identify the potential regulatory genes involved in osteogenesis. We showed that fat mass and obesity (FTO), a primary m6A demethylase, was significantly downregulated in patients with osteoporosis and osteonecrosis. During the differentiation of human MSCs into osteoblasts, FTO was markedly upregulated. Both depletion of FTO and application of the FTO inhibitor FB23 or FB23-2 impaired osteogenic differentiation of human MSCs. Knockout of FTO in mice resulted in decreased bone mineral density and impaired bone formation. PPARG, a biomarker for osteoporosis, was identified as a critical downstream target of FTO. We further revealed that FTO mediated m6A demethylation in the 3'UTR of PPARG mRNA, and reduced PPARG mRNA stability in an YTHDF1-dependent manner. Overexpression of PPARG alleviated FTO-mediated osteogenic differentiation of MSCs, whereas knockdown of PPARG promoted FTO-induced expression of the osteoblast biomarkers ALPL and OPN during osteogenic differentiation. Taken together, this study demonstrates the functional significance of the FTO-PPARG axis in promoting the osteogenesis of human MSCs and sheds light on the role of m6A modification in mediating osteoporosis and osteonecrosis.
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Affiliation(s)
- Liu-shan Chen
- grid.411847.f0000 0004 1804 4300Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006 China
| | - Meng Zhang
- grid.414011.10000 0004 1808 090XDepartment of Orthopedics, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, 450003 China
| | - Peng Chen
- grid.411866.c0000 0000 8848 7685The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405 China
| | - Xiao-feng Xiong
- grid.12981.330000 0001 2360 039XDepartment of Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006 China
| | - Pei-qing Liu
- grid.12981.330000 0001 2360 039XDepartment of Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006 China
| | - Hai-bin Wang
- grid.411866.c0000 0000 8848 7685The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510405 China
| | - Jun-jian Wang
- grid.12981.330000 0001 2360 039XDepartment of Laboratory of New Drug Design and Evaluation, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, 510006 China
| | - Juan Shen
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006, China.
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Wang F, Li H, Mu Q, Shan L, Kang Y, Yang S, Chang HC, Su KP, Liu Y. Association of Acute Postoperative Pain and Cigarette Smoking With Cerebrospinal Fluid Levels of Beta-Endorphin and Substance P. Front Mol Neurosci 2022; 14:755799. [PMID: 35177964 PMCID: PMC8845024 DOI: 10.3389/fnmol.2021.755799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Cigarette smoking is associated with postoperative pain perception, which might be mediated by beta-endorphin and substance P. These effects on postoperative pain perception have never been investigated in human cerebrospinal fluid (CSF), which reflects biochemical alterations in the brain. Therefore, we investigated the associations among cigarette smoking, postoperative pain, and levels of beta-endorphin and substance P in human CSF. Methods: We recruited 160 Chinese men (80 active smokers and 80 nonsmokers) who underwent lumbar puncture before anterior cruciate ligament reconstruction, and 5-ml CSF samples were collected. Pain visual analog scale (VAS) scores, post-anesthetic recovery duration (PARD), and smoking variables were obtained. CSF levels of beta-endorphin and substance P were measured. Results: Compared to non-smokers, active smokers had significantly higher pain VAS (2.40 ± 0.67 vs. 1.70 ± 0.86, p < 0.001) and PARD scores (9.13 ± 2.11 vs. 7.27 ± 1.35, p = 0.001), lower CSF beta-endorphin (33.76 ± 1.77 vs. 35.66 ± 2.20, p = 0.001) and higher CSF substance P (2,124.46 ± 217.34 vs. 1,817.65 ± 302.14, p < 0.001) levels. Pain VAS scores correlated with PARD in active smokers (r = 0.443, p = 0.001). Conclusions: Cigarette smoking is associated with increased postoperative pain intensity, shown by delayed pain perception, higher pain VAS scores, and lower beta-endorphin and higher substance P levels in the CSF of active smokers. The more extended postoperative pain perception is delayed, the more pain intensity increases.
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Affiliation(s)
- Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
- Key Laboratory of Psychosomatic Medicine, Inner Mongolia Medical University, Huhhot, China
| | - Hui Li
- Department of Biomedical Engineering, College of Engineering, Peking University, Beijing, China
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qingshuang Mu
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ligang Shan
- Key Laboratory of Psychosomatic Medicine, Inner Mongolia Medical University, Huhhot, China
- Department of Anesthesiology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yimin Kang
- Key Laboratory of Psychosomatic Medicine, Inner Mongolia Medical University, Huhhot, China
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China
| | - Shizhuo Yang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Hui-Chih Chang
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
- *Correspondence: Yanlong Liu Kuan-Pin Su
| | - Yanlong Liu
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Yanlong Liu Kuan-Pin Su
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Li Z, Zhuang Z, Hong Z, Chen L, He W, Wei Q. Avascular necrosis after femoral neck fracture in children and adolescents: poor prognosis and risk factors. INTERNATIONAL ORTHOPAEDICS 2021; 45:2899-2907. [PMID: 34549321 DOI: 10.1007/s00264-021-05210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Avascular necrosis (AVN) after femoral neck fracture (FNF) is a rare and severe paediatric condition, but only few studies described its prognosis and risk factors. The present study aimed to evaluate the outcomes and independent factors for poor prognosis of AVN after FNF in children and adolescents. METHOD This retrospective study included children and adolescents with AVN after FNF who received conservative treatment (CT group) or non-vascularized bone grafting (NVBG group) between 2000 and 2018. The primary outcomes were the risk of hip arthritis (Tönnis grade) and hip deformity risk (Stulberg classification). All patients were followed for at least two years to assess AVN progression. RESULTS Study included 81 patients. In the CT group, 23/43 patients (53.4%) developed hip arthritis, and 24/43 patients (55.8%) showed hip deformity. In the NVBG group, 23/38 patients (60.5%) developed hip arthritis, and 34/38 patients (89.5%) had a hip deformity. The multivariable analysis indicated that NVBG surgery had no significant effect on the outcomes. Post-treatment femoral head collapse (P = 0.05, OR = 3.80, 95% CI = 1.01-14.29) and post-treatment hip subluxation (P = 0.01, OR = 2.85, 95% CI = 2.31-129.56) were independent risk factors for severe hip arthritis. Post-treatment femoral head collapse (P < 0.01, OR = 7.64, 95% CI = 3.23-18.04) and pre-treatment hip subluxation (P = 0.02, OR = 7.33, 95% CI = 1.44-37.41) were independent risk factors for severe hip deformity. CONCLUSION Neither CT nor NVBG have demonstrated superiority regarding long-term outcomes in patients with AVN after FNF. Upon the disease progression to severe collapse with subluxation and severe arthritis, further hip preservation attempts could be futile.
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Affiliation(s)
- Ziqi Li
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China
| | - Zhikun Zhuang
- Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou, 362000, Fujian, China
| | - Zhinan Hong
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China
| | - Leilei Chen
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China
| | - Wei He
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China.
| | - Qiushi Wei
- Department of Joint Diseases, Traumatology & Orthopedics Institute of Guangzhou University of Chinese Medicine, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, Guangdong, China.
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Berkowitz RD, Steinfeld R, Sah AP, Anupindi VR, Shah D, DeKoven M, Coyle K, McCallum SW, Mack R, Coyle E, Freyer A, Du W, Black LK. Economic Impact of Preoperative Meloxicam IV Administration in Total Knee Arthroplasty: A Randomized Trial Sub-Study. J Pain Palliat Care Pharmacother 2021; 35:150-162. [PMID: 34280067 DOI: 10.1080/15360288.2021.1883789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We evaluated the economic impact associated with preoperative meloxicam IV 30 mg vs placebo administration among adult total knee arthroplasty (TKA) recipients enrolled in Phase IIIB NCT03434275 trial. Data on total hospital costs and length of stay (LOS) obtained from the trial were compared between meloxicam IV 30 mg and placebo groups. Patients in the meloxicam IV 30 mg vs placebo group (n = 93 vs 88) incurred an adjusted $2,266 (95% CI: -$1,035, $5,116; p = 0.1689) lower total hospital costs and an adjusted 8.6% (95% confidence interval [CI]: -2.0%, 18.1%; p = 0.1082) shorter LOS. While statistically non-significant, based on 95% CIs, the results from this sub-study may suggest a favorable impact associated with meloxicam IV 30 mg on hospital costs and LOS.
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Affiliation(s)
- Richard D Berkowitz
- Richard D. Berkowitz, MD, FAAOS is with University Orthopedic and Joint Replacement Center, University Hospital, Tamarac, FL
| | - Richard Steinfeld
- Richard Steinfeld, MD is with Orthopedic Center of Vero Beach, Vero Beach, FL
| | - Alexander P Sah
- Alexander P. Sah, MD, FAAOS is with Institute for Joint Restoration, Washington Hospital, Fremont, CA
| | - Vamshi Ruthwik Anupindi
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Drishti Shah
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Mitch DeKoven
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Katharine Coyle
- Vamshi Ruthwik Anupindi, MS, Drishti Shah, MS, PhD, Mitch DeKoven, MHSA, and Katharine Coyle, BA are with IQVIA, Falls Church, VA
| | - Stewart W McCallum
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Randall Mack
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Erin Coyle
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Alex Freyer
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
| | - Wei Du
- Wei Du, PhD is with Clinical Statistics Consulting, Blue Bell, PA
| | - Libby K Black
- Stewart W. McCallum, MD FACS, Randall Mack, BS, Erin Coyle, BA, BSN, Alex Freyer, PharmD, and Libby K. Black, PharmD are with Baudax Bio, Inc., formerly part of Recro Pharma, Inc, Malvern, PA
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10
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Berkowitz RD, Steinfeld R, Sah AP, Mack RJ, McCallum SW, Du W, Black LK, Freyer A, Coyle E. Safety and Efficacy of Perioperative Intravenous Meloxicam for Moderate-to-Severe Pain Management in Total Knee Arthroplasty: A Randomized Clinical Trial. PAIN MEDICINE 2021; 22:1261-1271. [PMID: 33502533 PMCID: PMC8185557 DOI: 10.1093/pm/pnab016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To evaluate the effect of perioperative meloxicam IV 30 mg on opioid consumption in primary total knee arthroplasty (TKA). Design Multicenter, randomized, double-blind, placebo-controlled trial. Subjects In total, 181 adults undergoing elective primary TKA. Methods Subjects received meloxicam 30 mg or placebo via an IV bolus every 24 hours, the first dose administered prior to surgery as part of a multimodal pain management protocol. The primary efficacy parameter was total opioid use from end of surgery through 24 hours. Results Meloxicam IV was associated with less opioid use versus placebo during the 24 hours after surgery (18.9 ± 1.32 vs 27.7 ± 1.37 mg IV morphine equivalent dose; P < 0.001) and was superior to placebo on secondary endpoints, including summed pain intensity (first dose to 24 hours postdosing, first dose to first assisted ambulation, and first dose to discharge) and opioid use (48–72 hrs., 0–48 hrs., 0–72 hrs., hour 0 to end of treatment, and the first 24 hours after discharge). Adverse events (AEs) were reported for 69.9% and 92.0% of the meloxicam IV and placebo groups, respectively; the most common AEs were nausea (40% vs. 59%), vomiting (16% vs 22%), hypotension (14% vs 15%), pruritus (15% vs 11%), and constipation (11% vs 13%). Conclusions Perioperative meloxicam IV 30 mg as part of a multimodal analgesic regimen for elective primary TKA reduced opioid consumption in the 24-hour period after surgery versus placebo and was associated with a lower incidence of AEs typically associated with opioid use.
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Affiliation(s)
| | | | - Alexander P Sah
- Institute for Joint Restoration & Research, Fremont, California, USA
| | | | | | - Wei Du
- Clinical Statistics Consulting, Blue Bell, Pennsylvania, USA
| | | | | | - Erin Coyle
- Baudax Bio Inc., Malvern, Pennsylvania, USA
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11
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Willinger ML, Heimroth J, Sodhi N, Garbarino LJ, Gold PA, Rasquinha V, Danoff JR, Boraiah S. Management of Refractory Pain After Total Joint Replacement. Curr Pain Headache Rep 2021; 25:42. [PMID: 33864533 DOI: 10.1007/s11916-021-00956-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Chronic pain after total joint replacement (TJA), specifically total knee replacement (TKA), is becoming more of a burden on patients, physicians, and the healthcare system as the number of joint replacements performed increases year after year. The management of this type of pain is critical, and therefore, understanding the various modalities physicians can use to help patients with refractory pain after TJA is essential. RECENT FINDINGS The modalities by which chronic pain can be successfully managed include genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). Meta-analyses and case reports have demonstrated the effectiveness of these treatment options in improving pain and functional outcomes in patients with chronic pain after TKA. The purpose of this paper is to review and synthesize the current literature investigating the different ways that refractory pain is managed after TJA, with the goal being to provide treatment recommendations for providers treating these patients.
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Affiliation(s)
- Max L Willinger
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, Queens, NY, 11040, USA
| | - Jamie Heimroth
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, Queens, NY, 11040, USA
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, Queens, NY, 11040, USA
| | - Luke J Garbarino
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, Queens, NY, 11040, USA
| | - Peter A Gold
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, Queens, NY, 11040, USA.
| | - Vijay Rasquinha
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, Queens, NY, 11040, USA
| | - Jonathan R Danoff
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Sreevathsa Boraiah
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY, USA
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12
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Robotic Total Knee Arthroplasty vs Conventional Total Knee Arthroplasty: A Nationwide Database Study. Arthroplast Today 2020; 6:1001-1008.e3. [PMID: 33385042 PMCID: PMC7772451 DOI: 10.1016/j.artd.2020.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 09/29/2020] [Indexed: 12/19/2022] Open
Abstract
Background As robot-assisted equipment is continuously being used in orthopaedic surgery, the past few decades have seen an increase in the usage of robotics for total knee arthroplasty (TKA). Thus, the purpose of the present study is to investigate the differences between robotic TKA and nonrobotic TKA on perioperative and postoperative complications and opioid consumption. Methods An administrative database was queried from 2010 to Q2 of 2017 for primary TKAs performed via robot-assisted surgery vs non-robot-assisted surgery. Systemic and joint complications and average morphine milligram equivalents were collected and compared with statistical analysis. Results Patients in the nonrobotic TKA cohort had higher levels of prosthetic revision at 1-year after discharge (P < .05) and higher levels of manipulation under anesthesia at 90 days and 1-year after discharge (P < .05). Furthermore, those in the nonrobotic TKA cohort had increased occurrences of deep vein thrombosis, altered mental status, pulmonary embolism, anemia, acute renal failure, cerebrovascular event, pneumonia, respiratory failure, and urinary tract infection during the inpatient hospital stay (all P < .05) and at 90 days after discharge (all P < .05). All of these categories remained statistically increased at the 90-days postdischarge date, except pneumonia and stroke. Patients in the nonrobotic TKA cohort had higher levels of average morphine milligram equivalents consumption at all time periods measured (P < .001). Conclusions In the present study, the use of robotics for TKA found lower revision rates, lower incidences of manipulation under anesthesia, decreased occurrence of systemic complications, and lower opiate consumption for postoperative pain management. Future studies should look to further examine the long-term outcomes for patients undergoing robot-assisted TKA. Level of Evidence Level III.
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13
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Song J, Qiao Y, Zhou Q, Zhang X. Fascia iliaca compartment block for analgesia in total hip replacement: A randomized controlled study protocol. Medicine (Baltimore) 2020; 99:e22158. [PMID: 32925776 PMCID: PMC7489678 DOI: 10.1097/md.0000000000022158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Pain management after the total joint arthroplasty is still challenging, but worthy of attention, because good pain management can improve the outcomes of patient. It is still controversial whether fascia iliaca compartment block (FICB) can effectively decrease the opioid consumption and pain after total hip replacement (THR) owing to the number of published investigations is small. The purpose of this present study is to assess the efficacy and safety of FICB for postoperative analgesia after THR. METHODS This is a single center, placebo-controlled randomized trial which is performed in accordance with the SPIRIT Checklist for randomized studies. It was authorized via the Chifeng Municipal Hospital institutional review committee (H2020-19-8). 100 patients undergoing THR will be included in this study. Patients are randomly divided into 2 groups: FICB group or Non-FICB group, FICB with 5mgmL of epinephrine and 40 mL of ropivacaine 0.2%. Primary outcomes are pain score at different time point. Visual analog scale is used to assess the pain (10: the maximum possible pain and 0: absent pain). The secondary outcomes are the postoperative complications, length of hospital stay and total consumption of opioid. All the needed analyses are implemented through utilizing SPSS for Windows Version 15.0. RESULTS Figure 1 will show the primary and secondary outcomes. CONCLUSION This trial can provide an evidence for the use of FICB for analgesia after THR.
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Affiliation(s)
| | - Yan Qiao
- Department of neurology, Chifeng Municipal Hospital, Inner Mongolia, China
| | - Qi Zhou
- Department of Anesthesiology
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14
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Katakam A, Karhade AV, Schwab JH, Chen AF, Bedair HS. Development and validation of machine learning algorithms for postoperative opioid prescriptions after TKA. J Orthop 2020; 22:95-99. [PMID: 32300270 DOI: 10.1016/j.jor.2020.03.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Abstract
Objective The aims of this study were to develop machine learning algorithms for preoperative prediction of prolonged opioid prescriptions after TKA and to identify variables that can predict the probability of this adverse outcome. Methods Five algorithms were developed for prediction of prolonged postoperative opioid prescriptions. Results The stochastic gradient boosting (SGB) model had the best performance. Age, history of preoperative opioid use, marital status, diagnosis of diabetes, and several preoperative medications were predictive of prolonged postoperative opioid prescriptions. Conclusion The SGB algorithm developed could help improve preoperative identification of TKA patients at risk for prolonged postoperative opioid prescriptions.
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Affiliation(s)
- Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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