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AbstractText: Shoulder arthroplasty is the fastest growing joint replacement surgery in the United States, and optimal postoperative painmanagement is critical to optimize outcomes for these surgeries. Liposomal bupivacaine (LB) has gained popularity for its potential to provide extended postoperative pain relief with possibly fewer side effects. The goal of this study was to assess the impact of LB compared ...
However, it was reported that only one-quarter of orthopaedic and sports physicaltherapy abstracts presented at the CSM between 2000 and 2004 went ... systematic search was undertaken to locate full-text publications of orthopaedic and sports physicaltherapy abstracts presented at CSMs between 2005 and 2011 ... Conclusion The full-text publication rate for orthopaedic and sports physicaltherapy abstracts presented at recent CSMs has increased by over 50 ...
... efficiency and safety of liposomal bupivacaine infiltration and interscalene nerve block for paincontrol after total shoulder arthroplasty AbstractText: A systematic search was performed in Medline (1966 to May ... -0.207 to 0.157, P = .785) AbstractText: Liposomal bupivacaine infiltration provides equivalent postoperative paincontrol compared with interscalene nerve block following total shoulder arthroplasty.
BACKGROUND: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe. The purpose of this study was to quantify the number of narcotic pills taken by opioid-naïve patients undergoing outpatient foot and ankle surgeries with regional anesthesia.
METHODS: Eighty-four patients underwent outpatient foot and ankle surgeries under spinal blockade and long-acting popliteal blocks. Patients were given 40 or 60 narcotic pills, a 3-day supply of ibuprofen, deep vein thrombosis prophylaxis, and antiemetics. Patients received surveys at postoperative day (POD) 3, 7, 14, and 56 documenting if they were still taking narcotics, the quantity of pills consumed, whether refills were obtained, their pain level, and their reason for stopping opioids.
RESULTS: Patients consumed a mean of 22.5 pills, with a 95% confidence interval from 18 to 27 pills. Numerical Rating Scale pain scores started at 4 on POD 3 and decreased to 1.8 by POD 56. The percentage of patients still taking narcotics decreased from 55% on POD 3 to 2.8% by POD 56. Five new prescriptions were given during the study, with 3 being due to side effects from the original medication.
CONCLUSIONS: Patients receiving regional anesthesia for outpatient foot and ankle surgeries reported progressively lower pain scores with low narcotic use up to 56 days postoperatively. We suggest that providers consider prescribing 30 pills as the benchmark for this patient population.
LEVEL OF EVIDENCE: Level II, prospective comparative study.
AbstractText: To illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for painmanagement after total shoulder arthroplasty AbstractText: A systematic search was performed in Medline, PubMed, Embase, ScienceDirect and the Cochrane Library. Data on patients prepared for total shoulder arthroplasty in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved.
BACKGROUND: The synergistic effect of clonidine with bupivacaine, well established in peripheral nerve blocks, remains controversial in local field block for postoperative analgesia.
OBJECTIVE: To investigate the potential analgesic benefit of adding clonidine to bupivacaine during preincisional field block in posterior approaches for spine surgeries.
METHODS: Two hundred twenty-five patients were enrolled in this study and underwent lumbar spinal fusion (n = 80), lumbar laminectomy (n = 25), lumbar microdiscectomy (n = 94), or cervical laminectomy (n = 26). In each surgical subgroup, patients were randomly assigned in a double-blinded fashion to receive either 20 mL of 0.25% bupivacaine alone (control group, n = 109) or with 150 μg clonidine (clonidine group, n = 116) in the form of a preincisional field block. Outcome parameters included area under the curve of pain from postoperative day D0 to D8 and rescue morphine consumption from D0 to D3.
RESULTS: The area under the curve was reduced in the clonidine group, particularly in the microdiscectomy subgroup, and without reaching statistical significance in the cervical laminectomy subgroup. Total rescue morphine consumption was reduced in the clonidine group, particularly at D1-D2, a benefit that was exclusive to the lumbar stenosis and lumbar fusion subgroups. Field block with clonidine, surgical subgroup, and the presence of preoperative spinal pain were factors independently influencing postoperative wound pain in multivariate analysis.
CONCLUSION: The addition of clonidine to local preincisional field block with bupivacaine resulted in better and prolonged postoperative analgesia in posterior lumbar spine surgeries, an effect that was more pronounced in patients with no preoperative spinal pain.
... randomized controlled trials (RCT) AbstractText: A meta-analysis study of randomized controlled trials AbstractText: Postoperative recovery area AbstractText: Adult patients who have undergone lumbar spine surgery AbstractText: Patients received NSAIDs for paincontrol after lumbar spine surgery AbstractText: Standardized mean difference (SMD) and 95%CI were used to evaluate the visual ...
The consolidation of the acromioclavicular (AC) and coracoclavicular (CC) ligament complex after arthroscopically assisted stabilization of acute acromioclavicular joint (ACJ) separation is still under consideration.Fifty-five consecutive patients after arthroscopically assisted double-CC-bundle stabilization within 14 days after acute high-grade ACJ separation were studied prospectively. All patients were clinically analysed preoperatively (FU0) and post-operatively (FU1 = 6 ...
BACKGROUND: Surgical treatment of patients with atlantoaxial instability caused by pathologic changes of the skull base and craniovertebral junction combined with anterior compression of the brain stem is still associated with substantial technical difficulties and remains a matter of debate. Currently, anterior stabilization of the atlantoaxial junction is a promising approach that allows for the resection of the pathologic lesion of the skull base and craniovertebral junction with subsequent stabilization of C1-C2 or C1-C3 in 1 stage.
METHODS: In this article, we present 5 clinical cases in which transoral decompression and anterior stabilization of the C1-C2 (4 cases) and C1-C3 (1 case of anteroposterior stabilization) segments with custom-made fixation systems was used to treat various pathologic conditions of the craniovertebral junction.
RESULTS: In all cases, complete removal of the pathologic lesion and decompression of the upper cervical spinal cord as well as reliable stabilization of the upper spinal segments were achieved. Some degree of movement in the cervical spine was preserved in all patients due to unfixed C0-C1 and C3-C7 segments in 4 cases and C0-C1 and C4-C7 in 1 case. Implant migration or instability was not observed in any of the cases. The follow-up period was from 1 to 4 years after surgery.
CONCLUSIONS: The first experience of anterior fixation using individually manufactured C1-C2 and C1-C3 systems demonstrated their effectiveness. This approach can be safely used as an alternative or in combination with standard posterior stabilization methods. An innovative surgical technology developed and implemented in our surgical practice allows for optimization of the surgical technique, reduces the number of perioperative complications, eliminates movement restrictions in the cervical spine, improves motor activity, and makes earlier patient rehabilitation possible.
... optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery AbstractText: To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33-53weeks of recovery; and d) percent ...
Muscular and Skeletal Diseases (7) Osteolysis (4), Foot Ulcer (2), Peripheral Nervous System Diseases (1), more mentions
The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery. METHODS Patients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and ...
PURPOSE: Even if medial patellofemoral ligament (MPFL) reconstruction is a proven method, complications such as implant loosening, patella fractures, recurrent luxations, knee pain or knee stiffness are frequently described. Besides a correct tunnel positioning and implant-specific complications, this might be caused by difficulties with an appropriate graft tensioning. The study presented here is a necessary first step in exploring our technique of a double-limbed, hardware-free MPFL reconstruction, which provides another way to test and adjust the graft tension before permanent fastening.
METHODS: Thirty consecutive patients (m/f = 18/12) with recurrent dislocations were evaluated after a mean follow-up of 24 months. Patients who had additional procedures such as a trochleoplasties, tibial tubercle transfers and derotational osteotomies were not included. Besides a standardized clinical examination, different scorings and possible complications were evaluated.
RESULTS: The mean Kujala score improved significantly from 57 ± 15 to 92 ± 10. The Lysholm and IKDC score increased significantly from 59 ± 11 to 95 ± 6 and from 49 ± 9 to 89 ± 9, respectively. No patient reported a re-dislocation, subluxation or showed a positive apprehension. A total of 23 patients were engaged in regular physical activities. All but one, who lost interest, returned to the same sports. Because some did not follow our recommendation to return to sports after a rehab of at least 10-12 weeks, the period for a return was relatively short (median of 12 weeks, range 3-25 weeks). Four patients reported a moderate anterior knee pain only occurring after increased loads such as longer runs or workouts. One of these showed a slight flexion deficit of less than 20°. A severe motion deficit or stiffness was not noticed.
CONCLUSIONS: Even if a larger, clinical outcome study is needed to ensure the efficacy and safety of our method, it seems to provide a good clinical outcome, a correspondingly high satisfaction and a low incidence of complications. The possibility to adjust graft tension might help in minimizing complications caused by difficulties with an appropriate graft tension.
LEVEL OF EVIDENCE: IV.
... improved from 50 points preoperatively to 75 points postoperatively (p = 0.0003. The WOSI-score significantly improved from 37% preoperatively to 66% postoperatively (p = 0.0001. Revision surgery commonly was required for screw removal AbstractText: The early clinical results of this arthroscopic bone block augmentation and capsular repair are promising AbstractText: IV Keyword: Bone block stabilization. Keyword: Capsule repair. Keyword: Glenoid erosion.