Journal of surgical orthopaedic advances
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This study examines the amputees from the Army and Marine Corps, the two military branches that have sustained the majority of combat-related amputations. All U. S. service members who sustained major extremity amputations from October 2001 through July 2011 were analyzed. ⋯ Marine amputees were significantly (p < .0001) more likely to be dismounted than Army amputees. The number of multiple amputees increased substantially in 2010 and 2011. Marine amputees, particularly dismounted, are at an increased risk of sustaining multiple amputations.
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Total hip arthroplasty (THA) has been shown to improve long-term quality of life, although the immediate postoperative period can be associated with intense postoperative pain that hampers rehabilitation. Effective postoperative analgesia is paramount in the recovery period. ⋯ Appropriate pain management can reduce the associated total direct medical costs for lower extremity joint replacement surgeries by reducing hospital stays and the services needed during hospitalization. Factors contributing to the shorter lengths of stay include homogenous entities such as regular staff and continuity of nursing care, the use of timely and up-to-date information including expectations on a short stay, functional discharge criteria, early mobilization, and the use of a multimodal analgesia approach centered on opioid sparing.
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Pain management following total knee arthroplasty (TKA) can be challenging. Inadequate pain management following TKA may inhibit rehabilitation, increase morbidity and mortality, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. ⋯ With careful planning and a multimodal analgesic approach instituted perioperatively, appropriate pain management following TKA can be achieved. Utilizing an extensive review of the literature, this article discusses the analgesic techniques available for the perioperative management of TKA.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of a single-dose, extended-release epidural morphine formulation for pain control after lumbar spine surgery.
DepoDur, an extended-release epidural morphine, has been used effectively for postoperative pain control following many orthopaedic and general surgery procedures and has provided prolonged analgesia when compared with Duramorph. The goal of this article was to compare the safety and analgesic efficacy of DepoDur versus Duramorph after lumbar spine surgery. A prospective, randomized, double-blind clinical study was completed at a single extended-stay ambulatory surgery center. ⋯ The control group received DepoDur before surgery, while the treatment group received Duramorph. Although results show no significant differences between the two groups in postoperative visual analog pain scale scores, use of pain medication, and adverse events, subjects receiving DepoDur were less likely to receive Naloxone and oxygen supplementation, experience nausea or fever, and were more likely to experience hypotension. DepoDur proved to be safe and effective, offering similar prolonged analgesic activity when compared with Duramorph.