Journal of surgical orthopaedic advances
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Complex regional pain syndrome (CRPS) is a neurological disorder producing peripheral neurogenic inflammatory process in hands and feet distal to injury, which may lead to severe disability. Symptoms are often out of proportion to the initiating event and not limited to a single peripheral nerve. ⋯ Magnetic resonance imaging (MRI) is one of the most useful diagnostic modalities in early stages of CRPS (when clinical diagnosis is most difficult), the most desirable time to diagnose this disorder to expedite treatment and improve function. This article discusses MRI findings of CRPS, particularly in the early phase, and differential considerations.
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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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Total ankle arthroplasty is a procedure that has been shown to greatly improve patient quality of life. However, it is associated with moderate to severe postoperative pain. ⋯ Nerve blocks in particular afford high-quality relief from pain while avoiding many of the side effects of traditional systemic therapies. This review highlights the state-of-the-art practice for providing postoperative analgesia following total ankle arthroplasty.
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The utilization of multimodal pain management following total joint arthroplasty (TJA) has positively affected the quality of postoperative care, reduced surgical pain, and decreased the magnitude of opioid consumption and subsequent dose-related complications. The advent of liposomal bupivacaine is proving to be a highly efficacious and safe method of postoperative pain management with favorable pharmacokinetics that reduces the risk of amide-related toxicity. Additionally, the therapeutic levels of bupivacaine, which are below the toxic range and sustained for 72 hours after injection, are providing an effective mechanism for early hospital discharge and rapid recovery after TJA. This article reviews the rationale behind liposomal bupivacaine, its mechanism of action, pharmacokinetics, indications, and contraindications for use.