Introduction.
The United States and Canada are in the midst
of an epidemic of the use, misuse and overdose of opioids, and deaths
related to overdose. This is the direct result of overstatement
of the benefits and understatement of the risks of using opioids
by advocates and pharmaceutical companies. Massive amounts of prescription
opioids entered the community and were often diverted and misused.
Most other parts of the world achieve comparable pain relief using
fewer opioids. The misconceptions about opioids that created this epidemic are
finding their way around the world. There is particular evidence
of the increased prescription of strong opioids in Europe.
Despite the widespread use of opioids for pain control in post-operative joint arthroplasty patients, data regarding actual opioid consumption in opioid-naive patients during the recovery period are limited. We sought to determine postoperative opioid consumption for opioid-naïve patients undergoing total knee and hip arthroplasty (THA and TKA) procedures. The study cohort consisted of 55 patients (29 females, 26 males) who underwent either primary unilateral TKA (n=28) or THA (n=27). Prior to discharge, patients were provided with a medication log on which to track daily consumption of pain medicine. Patients were asked to provide details regarding the type of pain medication, quantity and frequency of use, and pain score at the time of use. Patients were contacted weekly by a member of the study team to monitor compliance. Specific opioid prescription information was acquired for each subject using their electronic medical record. Subjects returned the completed logs once they ceased opioid use post-operatively. Daily quantity was converted to daily Morphine Equivalent Dose (MED). Average daily, weekly, and total post-operative use was calculated for all opioid data variables. Descriptive statistics (mean, frequency, deviation) were used to analyze opioid data. All dependent variables were compared between TKA and THA patients using separate independent samples t-tests or Chi-square tests.Introduction
Methods
Pain management following surgery continues to challenge patients, physician-extenders, and surgeons. A recent survey of 300 patients following surgery found that 86% experienced pain following surgery with 75% describing moderate or severe pain. Pain management in 2017 has to better address patient's needs as Pain has become the “5th Vital Sign” and is used in many patient reported outcomes (for better or worse). Multimodal therapy has been defined as “Synchronous administration of ≥ 2 pharmacological agents or approaches, each with a distinct mechanism of action”. Mounting evidence supports the use of a multimodal approach to peri-operative pain management in all surgical subspecialties. A recent systematic review of intravenous ketamine showed a reduction total opioid consumption and an increase in the time to first analgesic dose needed across all studies. Gabapentin and pregabalin have both been shown to dramatically reduce the use of opioid consumption by 30%. We have worked with our anesthesia team and developed a multimodal analgesia program that includes ketorolac 10mg 3 tabs po qd × 3 days, then 10mg 2 tabs po × 2 days; gabapentin 300mg (<65 year old) or 100mg (>65 year old) 3 tabs po × 3 days; oxycodone 5mg po q 4–6 hours prn breakthrough pain and Tylenol 500mg 1–2 tabs po q 6 hours prn.
Knee osteoarthritis (KOA) is a frequent disease for which therapeutic possibilities are limited. In current recommendations, the first-line analgesic is acetaminophen. However, low efficacy of acetaminophen, frequently leads to the use of weak opioids (WO) despite their poor tolerance, especially in elderly patients. The primary objective was to compare the analgesic efficacy and safety of a new wearable transcutaneous electrical nerve stimulation (W-TENS) to weak opioids (WO) in the treatment of moderate to severe, nociceptive, chronic pain in knee osteoarthritis patients. ArthroTENS study is a phase 3, non-inferiority, multicentric, prospective, randomized, single-blinded for primary efficacy outcome, controlled, in 2-parallel groups, clinical study comparing W-TENS versus WO over a 3-month controlled period with an additional, optional, non-controlled, 3-month follow-up for patients in W-TENS group. The co-primary outcome was KOA pain intensity (PI) at month 3 and the number of adverse events (AEs) over 3 months.Introduction and Objective
Materials and Methods
The aim of this study was to perform a systematic review and bias evaluation of the current literature to create an overview of risk factors for re-revision following revision total knee arthroplasty (rTKA). A systematic search of MEDLINE and Embase was completed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The studies were required to include a population of index rTKAs. Primary or secondary outcomes had to be re-revision. The association between preoperative factors and the effect on the risk for re-revision was also required to be reported by the studies.Aims
Methods
To investigate treatment patterns and efficacy of postoperative strong opioids in patients who underwent total knee arthroplasty (TKA) in Korea A prospective, non-interventional study of 301 patients who underwent TKA and received strong opioids following patient controlled analgesia (PCA) was conducted by reviewing patient charts and diaries from 19 teaching hospitals. Clinical characteristics, strong opioid treatment patterns, efficacy of strong opioid on a scale of 0–10, and opioid-related adverse events (AEs) were investigated during hospitalization and at first outpatient visit. Safety analysis was conducted on 301 patients, and efficacy analysis was conducted on full analysis set (FAS) which consisted of all the patients who had at least 1 efficacy result among 301 patients.Purpose:
Methods:
The aim of this study was to characterize the relationship between pre- and postoperative opioid use among patients undergoing common elective orthopaedic procedures Pre- and postoperative opioid use were studied among patients from a national insurance database undergoing seven common orthopaedic procedures using univariate log-rank tests and multivariate Cox proportional hazards analyses.Aims
Patients and Methods
Ankle fractures are common orthopedic injuries, often requiring operative intervention to restore joint stability, improve alignment, and reduce the risk of post-traumatic ankle arthritis. However, ankle fracture surgeries (AFSs) are associated with significant postoperative pain, typically requiring postoperative
Orthopaedic surgeons prescribe more opioids than any other surgical speciality.
Orthopaedic surgeons prescribe more opioids than any other surgical speciality.
Hallux valgus surgery can result in moderate to severe post-operative pain requiring the use of
Purpose. Previous studies have demonstrated pronounced reduction of sleep quality following major surgery, which may affect postoperative pain and early recovery. This prospective, randomized, controlled trial was designed to evaluate the effect of zolpidem on sleep quality in fast-track total knee arthroplasty (TKA). Methods. 180 patients who underwent primary TKA were enrolled in this study and randomized 1:1 to receive either zolpidem (Group A) or placebo (Group B) for 6 days. VAS pain scores (rest, ambulation, flexion, and night), range of motion (ROM),
More than half of patients with neck of femur (NOF) fractures report their pain as severe to very severe in the first 24hrs.
Background.
Despite the widespread success of total hip arthroplasty (THA), postoperative pain management remains a concern.
Introduction. Analgesic drugs are often prescribed to patients with low back pain (LBP). Recommendations for non-invasive pharmacological management of LBP from recent clinical practice guidelines were compared with each other and with the best available evidence on drug efficacy. Methods. Guideline recommendations concerning opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antidepressants, anticonvulsants and muscle relaxants from national primary care guidelines published within the last 3 years were included in this review. For each pharmacotherapy, the most recent systematic review was included as the best available evidence on drug efficacy and common adverse effects were summarized. Results. Eight recent national clinical practice guidelines were included in this review (from Australia, Belgium, Canada, Denmark, The Netherlands, UK and US). Guidelines are universally moving away from pharmacotherapy due to the limited efficacy and the risk of adverse effects. NSAIDs have replaced paracetamol as the first choice analgesics for LBP in many guidelines.
Introduction. Despite evidence-based recommendations opioids and benzodiazepines are commonly prescribed to treat osteoarthritis. This study aims to quantify the prevalence of opioid and benzodiazepine prescriptions given for the primary diagnosis of osteoarthritis across a large healthcare system. Additionally, we aim to characterize risk factors for drug misuse, abuse, and diversion. Methods. We conducted a descriptive analysis of adult patient encounters with a primary diagnosis of osteoarthritis during a one-year time period from Jan –Dec 2016 at a large, healthcare system. Demographic data, prescription data, patient-specific prescription drug use risk criteria were collected. Descriptive analysis was conducted to characterize the population of arthritis patients who received prescription opioids. The rate of controlled substance prescribing was calculated for the population as a whole and among subgroups (age, facility type, and patient risk profile). Results. During the one-year time frame, our system had 45,341 outpatient encounters with a primary diagnosis of osteoarthritis. Almost a third of these encounters resulted in a prescription for an opioid or benzodiazepine (n = 7,375; 31.9%). The majority of patients were between ages 18 and 64 (57.1%), with 42.9% patients >65. While 38.8% were prescribed in an acute care setting (ED or Urgent Care), the majority were in outpatient clinics (58.8%) with 36.2 % of outpatient encounters originating from orthopaedic clinics. 14.3% of those who received a prescription had a risk factor for prescription misuse, the most prevalent being “early refill” (7.0%). Conclusion.
Introduction.
Introduction. Multimodal pain management strategies are now commonplace in perioperative management of total knee arthroplasty (TKA), although controversy remains regarding the role of adductor canal blocks (ACB) in this algorithm. Proposed benefits include theoretical decreased role of perioperative narcotic pain medication, improved function with physical therapy postoperatively, shorter duration of hospital stay and improved patient satisfaction. Those opposed cite increased cost and risk of complications including inadvertent motor blockade. The purpose of this study was to independently evaluate the effect of adductor canal block on short-term post-operative outcomes including (1) length of stay (LOS), (2) post-operative narcotic utilization, and (3) function with physical therapy in the era of modern TKA. Methods. Our institutional database was utilized to retrospectively identify a cohort of consecutive patients from January 2014-January 2018 who had undergone unilateral primary TKA with a single surgeon utilizing a preoperative single-shot ACB in addition to a standardized multimodal pain regimen versus those that only received the same multimodal pain regimen (no-ACB). The primary reason that a patient did not receive a preoperative block was lack of availability of the block team The time period of interest was selected based on the implementation of our current pain protocols. The multimodal pain regimen consists of: preoperative Tylenol, a periarticular injection intraoperatively including 0.5% Marcaine and Toradol, IV Toradol postoperatively, Percocet, Celebrex and IV