The American journal of orthopedics
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Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. ⋯ Liposomal bupivacaine uses DepoFoam® technology that allows for the extended release of injected drugs. When used as the foundation of a multimodal regimen, it is effective in reducing postsurgical pain for up to 72 hours while reducing the need for opioids for pain relief.
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Diabetes mellitus is a well-established risk factor for postoperative complications of total joint arthroplasty (TJA). We conducted a study to identify a specific hemoglobin A1c (HbA1c) level at which immediate postoperative complication rates increased after TJA. HbA1c levels were measured within 90 days preoperatively. ⋯ We found that mean postoperative complication rates increased along with HbA1c levels; HbA1c levels higher than 7.5% correlate strongly with a higher rate of postoperative complications. These findings provide a good foundation for prospective studies and further evidence of the effects of HbA1c levels. If an adequate treatment plan for these patients emerges, these findings may help lower readmission rates as well.