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Morphine use in fractures

C Swennen, S Bredin, C Eap, C Mensa, X Ohl, V Girard
STUDY DESIGN: retrospective study INTRODUCTION: Local infiltration analgesia is effective in many surgeries as knee arthroplasty, but the analgesic efficacy of local infiltration analgesia with ropivacaine in trauma spine surgery in T10 to L2 has not been clarified. We conducted a trial to assess the analgesic efficacy of intraoperative local infiltration analgesia (LIA) with ropivacaine. OBJECTIVE: The aim of the present study was to clarify the effect of intraoperative local infiltration analgesia with ropivacaine on postoperative pain for patients undergoing thoracolumbar junction fracture surgery...
December 27, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Ida Helsø, Christopher Jantzen, Jes Bruun Lauritzen, Henrik Løvendahl Jørgensen
INTRODUCTION: The aim of this study was to investigate whether there was a difference in opioid usage during admission for hip fracture patients with continuous femoral nerve block (cFNB) when compared to patients nonfemoral nerve block (nFNB). METHODS AND MATERIALS: Patients were identified from the local database on all hip fracture patients admitted to Bispebjerg University Hospital, Denmark. Four hundred fifty-six hip fracture patients were included during the period September 2008 to October 2010...
December 2016: Geriatric Orthopaedic Surgery & Rehabilitation
Åsa Thelaus, Tobias Pettersson, Max Gordon, Ferid Krupic, Olof Sköldenberg
We investigated if a femoral nerve block (FNB) for patients with a proximal femoral fracture (PFF) and administered by an orthopaedic registrar (OR) instead of an anaesthesiology registrar (AR) lowers the lead time to block and reduces the total amount of rescue analgesics during the preoperative phase. 205 patients were included in a prospective observational cohort study. The main outcome variable was rescue analgesics as total intravenous morphine prior to surgery. All results were adjusted for confounding using age, sex, cognitive dysfunction, and ASA classification...
2016: Surgery Research and Practice
Shepard P Johnson, Kevin C Chung, Lin Zhong, Melissa J Shauver, Michael J Engelsbe, Chad Brummett, Jennifer F Waljee
PURPOSE: To evaluate prolonged opioid use in opioid-naïve patients after common hand surgery procedures in the United States. METHODS: We studied insurance claims from the Truven MarketScan databases to identify opioid-naïve adult patients (no opioid exposure 11 months before the perioperative period) who underwent an elective (carpal tunnel release, carpometacarpal arthroplasty/arthrodesis, cubital tunnel release, or trigger finger release) or trauma-related (closed distal radius fracture fixation, flexor tendon repair, metacarpal fracture fixation, or phalangeal fracture fixation) hand surgery procedure between 2010 and 2012 (N = 77,573 patients)...
September 7, 2016: Journal of Hand Surgery
Szilard Szucs, David Jessop, Gabriella Iohom, George D Shorten
BACKGROUND: Fractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur. METHODS: Institutional ethical approval was granted and written informed consent was obtained from each patient...
September 22, 2016: BMC Anesthesiology
Javad Yazdani, Davood Aghamohamadi, Masoomeh Amani, Ali Hossein Mesgarzadeh, Davood Maghbooli Asl, Tannaz Pourlak
BACKGROUND: Postoperative pain from open reduction and internal fixation of mandibular fracture is a serious issue. Amantadine is an N-methyl-D-aspartic acid or N-methyl-D-aspartate (NMDA) receptor antagonist that can be effective against postoperative pain. OBJECTIVES: The present study examined the efficacy of amantadine in alleviating the postoperative pain of mandibular fracture surgery. PATIENTS AND METHODS: In this double-blind study, 60 patients (ASA physical status I-II) were randomly divided into two groups...
June 2016: Anesthesiology and Pain Medicine
Stacy L Reynolds, Jonathan R Studnek, Kathleen Bryant, Kelly VanderHave, Eric Grossman, Charity G Moore, James Young, Melanie Hogg, Michael S Runyon
INTRODUCTION: Fentanyl is the most widely studied intranasal (IN) analgesic in children. IN subdissociative (INSD) ketamine may offer a safe and efficacious alternative to IN fentanyl and may decrease overall opioid use during the emergency department (ED) stay. This study examines the feasibility of a larger, multicentre clinical trial comparing the safety and efficacy of INSD ketamine to IN fentanyl and the potential role for INSD ketamine in reducing total opioid medication usage. METHODS AND ANALYSIS: This double-blind, randomised controlled, pilot trial will compare INSD ketamine (1 mg/kg) to IN fentanyl (1...
September 8, 2016: BMJ Open
José Aguirre, Alain Borgeat, Melanie Hasler, Philipp Bühler, John M Bonvini
BACKGROUND: Morphine and other opioids are routinely used systemically and as wound infusions in the postoperative period. Their effect on wound and fracture healing remains unclear. OBJECTIVE: The primary outcome was to assess the potential cytotoxicity of clinically relevant concentrations of morphine on human fibroblasts. DESIGN: Laboratory in-vitro study. SETTING: Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich...
November 2016: European Journal of Anaesthesiology
Avin Yaldo, Lonnie Wen, Augustina Ogbonnaya, Adriana Valderrama, Jonathan Kish, Michael Eaddy, Charles Kreilick, Krishna Tangirala, Katarzyna Shields
PURPOSE: The development of skeletal-related events (SREs) (pathologic fracture, need for surgery and/or radiation to bone, spinal cord compression, and hypercalcemia of malignancy) in metastatic prostate cancer (MPC) is associated with worsened pain and compromised quality of life. Opioids are frequently used throughout the course of SRE treatment. This study describes the treatment patterns and incremental use of opioids in MPC patients diagnosed with SREs. METHODS: PC patients with bone metastases newly diagnosed with an SRE between January 1, 2005, and September 30, 2014, were identified using MarketScan Commercial and Medicare databases...
August 2016: Clinical Therapeutics
Casey L Shelley, Stepheny Berry, James Howard, Martin De Ruyter, Melissa Thepthepha, Niaman Nazir, Tracy McDonald, Annemarie Dalton, Michael Moncure
BACKGROUND: Rib fractures are common in trauma admissions and are associated with an increased risk of pulmonary complications, intensive care unit admissions, and mortality. Providing adequate pain control in patients with multiple rib fractures decreases the risk of adverse events. Thoracic epidural analgesia is currently the preferred method for pain control. This study compared outcomes in patients with multiple acute rib fractures treated with posterior paramedian subrhomboidal (PoPS) analgesia versus thoracic epidural analgesia (TEA)...
September 2016: Journal of Trauma and Acute Care Surgery
Md Moniruzzaman, Md Sarwar Hossain, Partha Sharoti Bhattacharjee
ETHNAPHARMACOLOGICAL RELEVANCE: Stephania japonica is a common plant, widely distributed in all over Bangladesh. Traditionally, this plant is considered as one of the important ingredients in treatment of a variety of ailments including inflammation, pain, rheumatism, cancer, bone fracture, fever etc. However, the scientific reports regarding the antinociceptive effect of this plant are very limited. This study evaluated the antinociceptive effect of methanolic extract of S. japonica (MESJ) leaves...
June 20, 2016: Journal of Ethnopharmacology
Nick C Leegwater, Peter A Nolte, Niels de Korte, Martin J Heetveld, Kees J Kalisvaart, Casper P Schönhuth, Bas Pijnenburg, Bart J Burger, Kees-Jan Ponsen, Frank W Bloemers, Andrea B Maier, Barend J van Royen
BACKGROUND: The number of hip fractures and resulting post-surgical outcome are a major public health concern and the incidence is expected to increase significantly. The acute recovery phase after hip fracture surgery in elder patients is often complicated by severe pain, high morphine consumption, perioperative blood loss with subsequent transfusion and delirium. Postoperative continuous-flow cryocompression therapy is suggested to minimize these complications and to attenuate the inflammatory reaction that the traumatic fracture and subsequent surgical trauma encompass...
April 8, 2016: BMC Musculoskeletal Disorders
Christina Jensen-Dahm, Henrik Palm, Christiane Gasse, Jørgen B Dahl, Gunhild Waldemar
BACKGROUND/AIMS: Prior studies have shown that patients with dementia are at risk of receiving insufficient treatment for pain after a hip fracture. We therefore hypothesized that elderly hip fracture patients with dementia received less postoperative pain treatment than those without dementia. METHOD: All patients (age ≥65 years) who had been operated on for a hip fracture in the Copenhagen University Hospital region in 2009 were included. Data about analgesic use for the first 72 h after surgery were acquired from the hospitals' electronic medication system and linked with information about dementia, comorbidity, and prior drug use...
2016: Dementia and Geriatric Cognitive Disorders
Yanjiang Yang, Xin Zhao, Tianhua Dong, Zongyou Yang, Qi Zhang, Yingze Zhang
BACKGROUND: No formal systematic review or meta-analysis was performed up to now to summarize the risk factors of delirium after hip surgery. AIMS: The present study aimed to quantitatively and comprehensively conclude the risk factors of delirium after hip surgery in elderly patients. METHODS: A search was applied to CNKI, Embase, Medline, and Cochrane central database (all up to August 2015). All studies assessing the risk factors of delirium after hip surgery in elderly patients without language restriction were reviewed, and qualities of included studies were assessed using the Newcastle-Ottawa Scale...
February 12, 2016: Aging Clinical and Experimental Research
David K Galos, David P Taormina, Alexander Crespo, David Y Ding, Anthony Sapienza, Sudheer Jain, Nirmal C Tejwani
BACKGROUND: Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction and improve functional outcomes. Little is known about which anesthesia technique (general anesthesia versus brachial plexus blockade) is most beneficial for pain control after distal radius fixation which could significantly affect patients' postoperative course and experience. QUESTIONS/PURPOSES: We asked: (1) Did patients receiving general anesthesia or brachial plexus blockade have worse pain scores at 2, 12, and 24 hours after surgery? (2) Was there a difference in operative suite time between patients who had general anesthesia or brachial plexus blockade, and was there a difference in recovery room time? (3) Did patients receiving general anesthesia or brachial plexus blockade have higher narcotic use after surgery? (4) Do patients receiving general anesthesia or brachial plexus blockade have higher functional assessment scores after distal radius fracture repair at 6 weeks and 12 weeks after surgery? METHODS: A randomized controlled study was performed between February, 2013 and April, 2014 at a multicenter metropolitan tertiary-care referral center...
May 2016: Clinical Orthopaedics and related Research
Z Al Dabbagh, K Å Jansson, C O Stiller, S Montgomery, R J Weiss
BACKGROUND: The use of opioids in non-cancer-related pain following skeletal trauma is controversial due to the presumed risk of dose escalation and dependence. We therefore examined the pattern of opioid prescriptions, that is, those actually dispensed, in patients with femoral shaft fractures. METHODS: We analysed data from the Swedish National Hospital Discharge Register and the Swedish Prescribed Drug Register between 2005 and 2008. RESULTS: We identified 1471 patients with isolated femoral shaft fractures...
May 2016: Acta Anaesthesiologica Scandinavica
Efe Levent Aras, Cody Bunger, Ebbe Stender Hansen, Rikke Søgaard
STUDY DESIGN: Historical, register-based cohort study following 85 patients in the course of a time frame extending from 2 years before to 2 years after trauma occurrence. OBJECTIVE: To investigate the cost-effectiveness of surgery versus conservative management for thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Despite the prevalence of thoracolumbar burst fractures, consensus has still not been reached in terms of their clinical management and whereas from a health policy point of view, efficient use of resources is equally important, literature pertaining to this aspect is limited...
February 2016: Spine
Aurélie Chaudet, Guillaume Bouhours, Emmanuel Rineau, Jean-François Hamel, Damien Leblanc, Vincent Steiger, Sigismond Lasocki
BACKGROUND: Upon arrival at the emergency department, hip-fracture pain relief is usually carried out via systemic opioids. Continuous nerve blocks are efficient in the postoperative period, but have not been evaluated preoperatively. This study compared the reduction in morphine consumption and related side effects of a continuous femoral block with a single shot block in hip-fracture patients. METHODS: Hip-fracture patients admitted to the emergency department received a femoral nerve catheter, with a single lidocaine injection...
February 2016: Anaesthesia, Critical Care & Pain Medicine
Jennifer Hagen, Renan Castillo, Andrew Dubina, Greg Gaski, Theodore T Manson, Robert V O'Toole
BACKGROUND: Debate remains over the role of surgical treatment in minimally displaced lateral compression (Young-Burgess, LC, OTA 61-B1/B2) pelvic ring injuries. Lateral compression type 1 (LC1) injuries are defined by an impaction fracture at the sacrum; type 2 (LC2) are defined by a fracture that extends through the posterior iliac wing at the level of the sacroiliac joint. Some believe that operative stabilization of these fractures limits pain and eases mobilization, but to our knowledge there are few controlled studies on the topic...
June 2016: Clinical Orthopaedics and related Research
T Parras, R Blanco
INTRODUCTION: A double-blind randomised controlled trial was conducted to compare the analgesic effect of the transversus abdominis plane block posterior approach or the quadratus lumborum block I versus femoral block, both ultrasound-guided. MATERIAL AND METHODS: Prospective study with parallel groups with 104 patients with neck of femur fracture undergoing hemiarthroplasty (although 7 participants did not finish the study). The inclusion criteria were patients older than 65 years old, ASA I-III status, who required and gave their consent for hemiarthroplasty...
March 2016: Revista Española de Anestesiología y Reanimación
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