Donor site pain from the ilium. A complication of lumbar spine fusion

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

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31 A phase 3 open-label, controlled, randomized trial evaluating the efficacy and safety of a bioengineered allogeneic cellularized construct in patients with deep partial-thickness thermal burns

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.035 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S25-S26

Author(s):

Angela L F Gibson ◽

James H Holmes ◽

Jeffrey W Shupp ◽

David Smith ◽

Victor Joe ◽

...

Keyword(s):

Donor Site ◽

Efficacy And Safety ◽

Phase 3 ◽

Thermal Burns ◽

Treatment Site ◽

Severe Burns ◽

Donor Site Pain ◽

The Difference ◽

Percent Area ◽

Site Pain

Abstract Introduction Autograft (AG) is the standard of care for treatment of severe burns. While AG provides effective wound closure (WC), the procedure creates a donor site wound prone to pain and scarring. In a phase 1b trial, no deep partial-thickness (DPT) wound treated with a bioengineered allogeneic cellularized construct (BACC) required AG by Day 28 and WC at the BACC site was achieved in 93% of patients by Month (M) 3. This phase 3 study (NCT03005106) evaluated the efficacy and safety of this BACC in patients with DPT burns. Methods Enrolled patients were aged ≥18 years with 3–49% TBSA thermal burns on the torso or extremities. In each patient, two DPT areas (≤2,000 cm2 total) deemed comparable following excision were randomized to treatment with either cryopreserved BACC or AG. Coprimary endpoints were 1) the difference in percent area of BACC treatment site and AG treatment site autografted at M3 and 2) the proportion of patients achieving durable WC of the BACC treatment site without AG at M3. Ranked secondary endpoints were: 1) the difference between BACC and AG donor sites in average donor site pain intensity through Day 14; 2) the difference between BACC and AG donor site cosmesis at M3; and 3) the difference between BACC and AG treatment site cosmesis at M12. Safety assessments were performed in all patients through M12. Results Seventy-one patients were enrolled. By M3, there was a 96% reduction in mean percent area of BACC treatment sites that required AG, compared with AG treatment sites (4.3% vs 102.1%, respectively; P<.0001). BACC treatment resulted in durable WC at M3 without AG in 92% (95% CI: 85.6, 98.8; 59/64) of patients for whom data was available. By M3, mean donor site Patient and Observer Scar Assessment Scale (POSAS) observer total score (±SD) was significantly lower (more like normal skin) for BACC donor sites compared with AG donor sites (6.3 ± 1.71 vs 16.3 ± 7.71; P<.0001). At M12, mean POSAS observer total score (±SD) was 15.6 (± 8.34) for BACC treatment sites compared with 16.3 (± 9.41) for AG treatment sites (P=.4268). The most common BACC-related adverse event (AE) was pruritus, which occurred in 11 (15%) patients. All BACC-related AEs were mild or moderate in severity. Conclusions This phase 3 study achieved both coprimary endpoints, including significant autograft sparing and durable WC in DPT burns. Both donor site pain and donor site cosmesis were favorable outcomes of significantly reduced use of AG in BACC-treated patients. M12 POSAS for BACC did not differ significantly from AG. This BACC may offer a new treatment for severe burns to reduce or eliminate the need for AG. Applicability of Research to Practice This BACC has shown clinical benefit in patients with DPT thermal burns, potentially mitigating donor site morbidity. External Funding Stratatech, a Mallinckrodt Company; Funding and technical support for the Phase 3 clinical study were provided by the Biomedical Advanced Research and Development Authority (BARDA), under the Assistant Secretary for Preparedness and Response, within the U.S. Department of Health and Human Services, under Project BioShield Contract No. HHSO100201500027C.

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Degenerative Lumbar Spine Disease, Not Fusion, May Be a Risk Factor for Instability after Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719114 ◽

2020 ◽

Vol 4 (04) ◽

pp. 193-200

Author(s):

Daniel K. Witmer ◽

Evan R. Deckard ◽

R. Michael Meneghini

Keyword(s):

Lumbar Spine ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spine Fusion ◽

Joint Disease ◽

Total Hip ◽

Female Sex ◽

Lumbar Spine Fusion ◽

Radiographic Measurements ◽

Acetabular Protrusio

AbstractDislocation rates after total hip arthroplasty (THA) in patients with fixed spinopelvic motion have been reported as high as 20%. Few studies exist specifically for lumbar spine degenerative joint disease (DJD) and its relationship to THA instability. There were two study objectives: (1) report the incidence of lumbar spine DJD and previous lumbar spine fusion and (2) evaluate the relationship of these two conditions and other potential risk factors to postoperative dislocation after THA. We retrospectively reviewed 818 consecutive THAs performed by a single surgeon utilizing a posterior approach. Comprehensive medical chart and radiographic review was performed to identify patients with lumbar spine DJD and lumbar spine fusion. Radiographic measurements, patient factors, surgical factors, and incidences of dislocation also were recorded. Eight hundred and twelve THAs were analyzed. There were 10 dislocations (1.2%, 10/812). Lumbar spine DJD and previous lumbar spine fusion occurred in 33.4% (271/812) and 5.9% (48/812) of patients, respectively. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation using a Firth penalized maximum likelihood estimation specifically for rare events (area under receiver-operator characteristic curve = 0.91, 95% confidence interval 0.86, 0.96). Interestingly, only 2 of 10 dislocations had a previous lumbar spine fusion. Lumbar spine DJD, acetabular protrusio, and female sex were significant predictors of dislocation, while lumbar spine fusion was largely unrelated. This study used data available to most practicing surgeons and provides useful information for counseling patients preoperatively.

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