Evaluation of the Efficacy of Liposomal Bupivacaine in Total Joint Arthroplasty

2019 ◽  
pp. 089719001987257
Author(s):  
Francis J. Zamora ◽  
Rani P. Madduri ◽  
Ashmi A. Philips ◽  
Nancy Miller ◽  
Mini Varghese
Keyword(s):  
Knee Arthroplasty ◽  
Pain Control ◽  
Standard Of Care ◽  
P Value ◽  
Opioid Use ◽  
Post Surgery ◽  
Likert Score ◽  
Average Pain ◽  
Hip And Knee Arthroplasty ◽  
The Difference

Background: Appropriate pain control is one of the cornerstones necessary to promote positive clinical outcomes. A new bupivacaine liposomal formulation was designed to extend its analgesic effect for up to 72-hours post-surgery, reportedly leading to significant opioid-sparing. Method: Retrospective and prospective chart review conducted in a 178-bed academic institution between January 2013 to December 2013 and August 2014 to November 2014, in 115 patients that receive hip and knee arthroplasty. The primary outcome was the measurement of average daily pain score on post-operative days 1 and 2. Secondary outcomes included length of stay, overall opioid use post-surgery and pain control satisfaction using Press-Ganey® scores. Results: The average pain scores in the HCl group were 4.64 and 4.38 (Likert score: 0-10) for POD 1 and POD 2, compared to 4.72 POD 1 and 4.2 POD 2 in the liposome group (POD 1: p = 0.413; POD 2: p = 0.303). The difference in LOS for knee arthroplasty was statistically significant [HCl group: 1.94 days (± 0.66) versus liposome group: 2.27 days (±0.77) p-value = 0.038)] favoring the standard of care. For hip arthroplasty or bilateral knee arthroplasty the differences in LOS were not statistically significant ( p = 0.052 and p = 0.484 respectively). 93% of the patients in the HCl group, pain was well controlled, versus 88.5% in the liposome group with similar oxycodone IR use among groups. Conclusion: Liposome bupivacaine did not offer a notable benefit compared to the HCl formulation in our study.

scholarly journals Opioid Use and Pain Control After Total Hip and Knee Arthroplasty in the US, 2014 to 2017

2020 ◽  
Vol 3 (7) ◽  
pp. e2011972
Author(s):  
Rahul Shah ◽  
Yong-Fang Kuo ◽  
Jordan Westra ◽  
Yu-Li Lin ◽  
Mukaila A. Raji
Keyword(s):  
Knee Arthroplasty ◽  
Pain Control ◽  
Opioid Use ◽  
Total Hip ◽  
The Us ◽  
Hip And Knee Arthroplasty

scholarly journals Trends and developments in hip and knee arthroplasty technology

2021 ◽  
Vol 8 ◽  
pp. 205566832095204
Author(s):  
Martin Marsh ◽  
Simon Newman
Keyword(s):  
Knee Arthroplasty ◽  
Standard Of Care ◽  
Hip Resurfacing ◽  
Implant Survival ◽  
Dual Mobility ◽  
Joint Replacements ◽  
Robotic Assisted Surgery ◽  
Hip And Knee Arthroplasty ◽  
Hip Stems ◽  
Hip And Knee Surgery

The developments in hip and knee arthroplasty over recent years have aimed to improve outcomes, reduce complications and improve implant survival. This review describes some of the most interesting trends and developments in this important and fast-moving field. Notable developments have included ceramic hip resurfacing, mini hip stems, cementless knee replacement and the wider adoption of the dual mobility articulation for hip arthroplasty. Advances in additive manufacturing and the surface modification of joint replacements offer increasing options for more challenging arthroplasty cases. Robotic assisted surgery is one of the most interesting developments in hip and knee surgery. The recent growth in the use of this technology is providing data that will help determine whether this approach should become the standard of care for hip and knee arthroplasty in the future.

scholarly journals A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

Cureus ◽  
2019 ◽  
Author(s):  
Christopher Roberts ◽  
Devon Foster ◽  
Glen G Shi ◽  
Elizabeth R Lesser ◽  
Michael G Heckman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Collaborative Approach ◽  
Opioid Use ◽  
Total Knee

Multimodal Analgesia Protocol after Head and Neck Surgery: Effect on Opioid Use and Pain Control

2019 ◽  
Vol 161 (3) ◽  
pp. 424-430 ◽  
Author(s):  
Eugenie Du ◽  
Zainab Farzal ◽  
Elizabeth Stephenson ◽  
April Tanner ◽  
Katherine Adams ◽  
...  
Keyword(s):  
Head And Neck ◽  
Pain Control ◽  
Neck Surgery ◽  
Multimodal Analgesia ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Protocol Implementation ◽  
Pain Scores ◽  
Before And After ◽  
Average Pain

Objective To assess the effect that implementation of a multimodal analgesic plan has on opioid requirements and pain control in head and neck (H&N) surgery patients. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods An institutional review board (IRB)–approved quality improvement initiative was undertaken to implement a multimodal analgesic protocol for all admitted H&N surgery patients starting November 2017. Postprotocol data from January to May 2018 were compared to preprotocol data from May to October 2017. Data were obtained from the electronic health records as well as through preoperative and postoperative surveys. Average pain scores and opioid use in morphine milligram equivalents (MMEs) before and after protocol implementation were compared. Results In total, 139 postprotocol patients were compared to 89 preprotocol patients. The adjusted MMEs in the first 24 hours after surgery decreased significantly from 93.7 mg to 58.6 mg ( P = .026) with protocol implementation. When averaged over the length of stay (MME/hospital day), the change was no longer statistically significant (57.9 vs 46.8 mg, P = .211). The average pain score immediately after surgery and on day of discharge did not change with protocol implementation. Conclusion Implementation of a multimodal analgesia plan reduced opioid use immediately after surgery but not over the course of hospitalization without any change in reported pain scores. This study shows that multimodal opioid-sparing analgesia after H&N surgery is feasible. Future studies are needed further refine the optimal analgesic strategy for H&N patients and assess the long-term efficacy, safety, and cost of such regimens.

scholarly journals Outcome of fat injection in treatment of retracted scars

2019 ◽  
Vol 6 (9) ◽  
pp. 3195
Author(s):  
Fobin Varghese ◽  
Ajayakumar Kochunarayanan ◽  
Aneesh Joseph ◽  
Kalesh Sadasivan
Keyword(s):  
Normal Skin ◽  
Functional Results ◽  
Fat Grafting ◽  
P Value ◽  
Fat Injection ◽  
Post Surgery ◽  
Scar Assessment ◽  
The Difference ◽  
One Year ◽  
Different Origins

Background: Fat grafting was developed in recent years with refinement mainly based on Coleman technique. The method consists of taking fat removed by liposuction under low pressure, fat processing and then placement of fat on the treated area.Methods: Patients who presented with depressed or retracted scars were considered. 12 patients were selected for the study as one year. Patients were given fat injection by Coleman’s technique and were evaluated at 1, 3 and 6 months. Patient and observer scar assessment score (POSAS) was used for evaluation.Results: The present study infers that there is a significant decrease in POSAS score on both the patient and observer side after fat injection for retracted scars. The overall patient score decreased from 5.75 (±0.866 SD) pre-operatively to 3.17 (±1.115 SD) post-operatively with a p value of less than 0.005. The difference between the scores is 2.58 which are comparable to other studies. The overall observer score decreased from 4.25 (±1.422 SD) pre-operatively to 2.58 (±0.996) post-operatively with a p value of less than 0.005. The difference between the scores is 1.67 which is comparable to other studies.Conclusions: Autologous fat grafting seems to be a promising and effective therapeutic approach for scars with different origins such as trauma, burns, post-surgery. In general, we can affirm that treated areas regain characteristics similar to normal skin, which are clinically perceptible, leading not only to aesthetic but also functional results. 

CLINICAL AND DIAGNOSTIC SIGNIFICANCE OF THE ANATOMICAL SHORT LEG

Vestnik ◽  
2021 ◽  
pp. 356-359
Author(s):  
У.А. Абдуразаков ◽  
В.И. Нечаев ◽  
А.У. Абдуразаков
Keyword(s):  
Chronic Pain ◽  
Knee Arthroplasty ◽  
Pharmacological Treatment ◽  
Pain Syndrome ◽  
Chronic Pain Syndrome ◽  
Leg Length ◽  
Diagnostic Significance ◽  
Hip And Knee Arthroplasty ◽  
The Difference

В статье изучены клинические и диагностические значимости анатомической короткой ноги у 150 пациентов с деформацией стоп, патологией крупных суставов нижних конечностей, а у 24 пациентов было произведено эндопротезирование тазобедренных и коленных суставов. Они страдали хроническими болевыми синдромами, принимали консервативное лечение без эффекта. У всех наблюдавшихся при обследовании выявили наличие разницы в длине ног в 10 и более мм, соответственно перекоса таза с искривлением позвоночника. Одной из основных причин асимметрий осанки, повышенной утомляемости и хронических болей опорно-двигательной системы является нераспознанная структуральная разница в длине ног. При такой ситуации всякое мануальное и фармакологическое лечение носит лишь симптоматический характер. Решение механической проблемы требует механического подхода путем биомеханической коррекции с помощью индивидуальных ортезов стопы по системе Формтотикс. The article describes the clinical and diagnostic significance of the anatomical short leg in 150 patients. Hip and knee arthroplasty was performed in 24 patients. The patients had chronic pain syndrome. All those observed during the examination revealed the presence of a difference in the length of the legs of more than 10 mm. In this situation, pharmacological treatment is symptomatic. One of the solutions to the problem is to correct the difference in leg length with the help of individual Formtotics orthoses.

scholarly journals Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study

2021 ◽  
pp. bmjqs-2021-013450
Author(s):  
Luke Farrow ◽  
William T Gardner ◽  
Chee Chee Tang ◽  
Rachel Low ◽  
Patrice Forget ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Waiting Times ◽  
Sample Size Calculation ◽  
Wait Time ◽  
University Teaching ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Hip And Knee Arthroplasty ◽  
Prescription Rates

BackgroundCOVID-19 has had a detrimental impact on access to hip and knee arthroplasty surgery. We set out to examine whether this had a subsequent impact on preoperative opioid prescribing rates for those awaiting surgery.MethodsData regarding patient demographics and opioid utilisation were collected from the electronic health records of included patients at a large university teaching hospital. Patients on the outpatient waiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) were compared with historical controls (Controls) who had previously undergone surgery. A sample size calculation indicated 452 patients were required to detect a 15% difference in opioid prescription rates between groups.ResultsA total of 548 patients (58.2% female) were included, 260 in the COVID-19 group and 288 in the Controls. Baseline demographics were similar between the groups. For those with data available, the proportion of patients on any opioid at follow-up in the COVID-19 group was significantly higher: 55.0% (143/260) compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% (11/260) vs 4.8% (13/272)) for COVID-19 and Controls, respectively. The median waiting time from referral to follow-up was significantly longer in the COVID-19 group compared with the Controls (455 days vs 365 days; p<0.0001).ConclusionThe work provides evidence of potential for an emerging opioid problem associated with the influence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia for those with end-stage arthritis should be explored, and prolonged waiting times for surgery ought to be avoided in the recovery from COVID-19 to prevent more widespread opioid use.

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