Opioid Disposal in Patients Undergoing Total Joint Replacement Utilizing a Carbon-Based Home Medication Disposal Pouch

Objective: To evaluate the efficacy and safety of patient-controlled analgesia through prolonged epidural analgesia after joint replacement of the lower extremities. Material and methods. We analyzed the postoperative period of 213 elderly and senile patients who were operated on for degenerative-dystrophic and traumatic injuries of the joints of the lower extremities. All patients underwent total joint replacement (164 - THA and 49 - TKA). The age of patients is from 65 to 90 years (average age was 78 ± 8 years) with a physical status of ASA 3 and above. All examined patients were divided into 2 groups. 63 patients comprised the main group, which in the postoperative period underwent patient-controlled analgesia (PCA) through prolonged epidural analgesia. The control group consisted of 150 patients, for the anesthesia of which in the postoperative period only standard systemic multimodal analgesia was used Conclusion. Patient-controlled analgesia is an alternative to traditional analgesic regimens. This method should be one of the main methods after surgical anesthesia for joint replacement of the lower limb in elderly and senile patients.

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Book ReviewComplications of Total Joint Replacement

New England Journal of Medicine ◽

10.1056/nejm198611203152125 ◽

1986 ◽

Vol 315 (21) ◽

pp. 1362-1362

Author(s):

Joseph P. Iannotti

Keyword(s):

Joint Replacement ◽

Total Joint Replacement

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COVID-19 (SARS-CoV-2) lymphocyte responses are associated with inflammatory biomarkers in total joint replacement surgery candidates pre-operatively

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02563-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Marco S. Caicedo ◽

Vianey Flores ◽

Alicia Padilla ◽

Samelko Lauryn ◽

Joshua J. Jacobs ◽

...

Keyword(s):

Joint Replacement ◽

Total Joint Replacement ◽

Cross Reactivity ◽

Inflammatory Biomarkers ◽

Nucleocapsid Proteins ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Operative Planning ◽

Lymphocyte Responses ◽

Reactive Lymphocytes

Abstract Background Recent studies indicate that, in addition to antibody production, lymphocyte responses to SARS-CoV-2 may play an important role in protective immunity to COVID-19 and a percentage of the general population may exhibit lymphocyte memory due to unknown/asymptomatic exposure to SARS-CoV-2 or cross-reactivity to other more common coronaviruses pre-vaccination. Total joint replacement (TJR) candidates returning to elective surgeries (median age 68 years) may exhibit similar lymphocyte and/or antibody protection to COVID-19 prior to vaccination Methods In this retrospective study, we analyzed antibody titters, lymphocyte memory, and inflammatory biomarkers specific for the Spike and Nucleocapsid proteins of the SARS-CoV-2 virus in a cohort of n=73 returning TJR candidates (knees and/or hips) pre-operatively. Results Peripheral blood serum of TJR candidate patients exhibited a positivity rate of 18.4% and 4% for IgG antibodies specific for SARS-CoV-2 nucleocapsid and spike proteins, respectively. 13.5% of TJR candidates exhibited positive lymphocyte reactivity (SI > 2) to the SARS-CoV-2 nucleocapsid protein and 38% to the spike protein. SARS-CoV-2 reactive lymphocytes exhibited a higher production of inflammatory biomarkers (i.e., IL-1β, IL-6, TNFα, and IL-1RA) compared to non-reactive lymphocytes. Conclusions A percentage of TJR candidates returning for elective surgeries exhibit pre-vaccination positive SARS-CoV-2 antibodies and T cell memory responses with associated pro-inflammatory biomarkers. This is an important parameter for understanding immunity, risk profiles, and may aid pre-operative planning. Trial registration Retrospectively registered.

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