Patient Opioid Requirements Are Often Far Less Than Their Discharge Prescription After Orthopaedic Surgery: the Results of a Prospective Multicenter Survey.
Patient Opioid Requirements Are Often Far Less Than Their Discharge Prescription After Orthopaedic Surgery: the Results of a Prospective Multicenter Survey. J Am Acad Orthop Surg. 2020 Sep 11;: Authors: Wyles CC, Thiels CA, Hevesi M, Ubl DS, Gazelka HM, Turner NS, Trousdale RT, Pagnano MW, Mabry TM, Habermann EB Abstract INTRODUCTION: Evidence-based, procedure-specific guidelines for opioid prescribing after orthopaedic surgery are urgently needed to standardize care and minimize excess opioids. METHODS: We developed a prospective, multicenter survey study conducted from March 2017 to January 2018 including 7 common elective orthopaedic surgical procedures (total knee arthroplasty, total hip arthroplasty, lumbar fusion, lumbar laminectomy, rotator cuff repair, arthroscopic meniscectomy, and carpal tunnel release). Phone surveys were conducted between 21 and 35 days postoperatively. We aimed to document both the amount and length of time patients consumed opioid medications to inform further improvements in opioid management and prescribing. RESULTS: Among the 919 orthopaedic patients who completed the survey, 94.3% received opioids at discharge with a median of 388 oral morphine equivalents (OMEs) (interquartile range [IQR] 225 to 675). A median of 128 (IQR 23 to 360) OME were consumed with 77% of patients having leftover opioids. Sixty percent of prescribed opioids were unused; 18.2% of patients used no opioids, and 34.7% required
Conclusions Although plastic surgery trainees endorse gradual operative autonomy overall, a majority of final-year trainees do not perceive supervision only independence in the majority of core procedures queried. Faculties perceive higher trainee operative autonomy than trainees for most procedures. Discordant approaches to case logging were identified both among trainees and between trainees and faculties. Standardization may improve both progression and assessment of operative autonomy in plastic surgery training.
Condition: Carpal Tunnel Syndrome Interventions: Drug: Triamcinolone Acetonide; Drug: Dextrose 5% in water Sponsor: National Taiwan University Hospital Not yet recruiting
Publication date: Available online 29 September 2020Source: Journal of OrthopaedicsAuthor(s): Amanda Spielman, Sriram Sankaranarayanan, Piotr Skowronski, Anne-Sophie Lessard, Zubin Panthaki
Heart failure due to cardiomyopathy is a frequent manifestation of hereditary transthyretin amyloidosis (hATTR), a progressive, multisystem, and fatal disease that results from the deposition of misfolded transthyretin (TTR) protein in major organs and systems. Other common symptoms are due to polyneuropathy and carpal tunnel syndrome. The hATTR Compass Program offers confidential genetic testing to patients in the United States, Canada, and Puerto Rico suspected of having hATTR with polyneuropathy or with a family history of hATTR.
The goal of this study was to determine whether the type of anesthesia (monitored anesthesia care [MAC] vs wide-awake local anesthesia no tourniquet technique [WALANT]) or the surgical technique (mini-open vs endoscopic) would affect patient satisfaction with postoperative pain control, postoperative pain, or opioid use after carpal tunnel release (CTR). The hypothesis was that endoscopic and open CTR surgery would have the same patient satisfaction with postoperative pain control, postoperative pain, and opioid use, but WALANT surgery would have higher patient satisfaction with postoperative pain control, postoperative pa...
A 73-year-old white female with history of bilateral carpal tunnel syndrome, lumbar spinal stenosis, and family history of cardiomyopathy presented with worsening dyspnea on exertion. Exam showed right-sided crackles. There was no jugular venous distention, edema, macroglossia, or peri-orbital ecchymosis.
What Are the Warning Signs of Carpal Tunnel Syndrome?
Clinical features of soft tissue amyloid light-chain (AL) amyloidosis include macroglossia, arthropathy, muscle pseudohypertrophy, skin plaques, and carpal tunnel syndrome. Vascular manifestations of AL amyloid include periorbital ecchymosis, jaw or limb claudication, and even myocardial infarction caused by occlusion of small vessel coronary arteries. Some of these features, such as macroglossia, periorbital ecchymosis, and the so-called shoulder-pad sign, are pathognomonic for AL amyloidosis. These findings may be the initial presenting features of the disease, and the recognition of these red flag symptoms is very impor...
Conclusions: This study reviews malpractice claims in hand surgery over the past 30 years. Providing timely diagnoses, managing expectations, and reducing procedural error may decrease the risk of litigation.
Conclusion: Optimising the regression equation for wrist circumference-dependent ULN cross-sectional area of the median nerve at the wrist inlet might improve diagnostic accuracy of ultrasonography in patients with carpal tunnel syndrome and seems to be more accurate than using fixed cut-off values.