Physician Sportsmed
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Physician Sportsmed · May 2014
Pregabalin reduces opioid consumption and improves outcome in chronic pain patients undergoing total knee arthroplasty.
Recently, multimodal pain control has been used to manage postoperative pain in patients undergoing total knee arthroplasty (TKA). This approach combines numerous modalities, such as opioids, nonsteroidal anti-inflammatory drugs, local anesthetics, and acetaminophen, in an effort to reduce overall opioid consumption and also to provide better pain control. Gabapentinoids are a class of drugs that have been used as part of multimodal approach, and may be effective in patients who are previous users of chronic pain medication. The hypothesis of this study was that the addition of pregabalin reduces opioid consumption and/or improves pain after TKA, even in patients who are previous users of chronic pain medications. ⋯ Pregabalin in the context of multimodal pain management may be associated with reduced opioid consumption and other medical complications in patients undergoing TKA, including previous users of chronic pain medications.
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Physician Sportsmed · May 2014
Functional results following surgical repair of simultaneous bilateral quadriceps tendon ruptures.
Unilateral quadriceps tendon ruptures are common conditions treated by orthopedic surgeons. There is a paucity of information concerning functional outcomes in bilateral tendon ruptures. The aim of this study is to assess a series of 5 cases with simultaneous quadriceps tendon ruptures that underwent acute surgical repair with the purpose of identifying the functional outcomes as compared with unilateral injuries. We hypothesize that patients with bilateral quadriceps tendon ruptures have worse functional outcomes than patients with unilateral ruptures. ⋯ Patients with early surgical repair of bilateral, simultaneous extensor mechanism ruptures exhibit adequate recovery and return to a high level of function. Our patients were younger than those reported in the literature and had minimal comorbidities. The IKDC scores reflected good outcomes in the bilateral rupture group, albeit lower than in the unilateral group.
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Physician Sportsmed · May 2014
Case ReportsCase report: upper extremity deep venous thrombosis in a 19-year-old baseball player.
This report describes a case of a collegiate baseball player who presented with 3 weeks of worsening right shoulder pain and mild swelling and faint discoloration of the right arm and hand. He was found to have a nonocclusive clot on his brachial vein and was treated with anticoagulants. ⋯ Upper extremity deep vein thromboses are extremely uncommon. However, because they can have potentially life-threatening consequences, deep vein thromboses must be on the differential for any athlete who presents with increased pain, swelling, or discoloration of an extremity.
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Physician Sportsmed · May 2014
ReviewEvidence-based approach of treatment options for postoperative knee pain.
Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. ⋯ Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.
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Physician Sportsmed · Nov 2013
Randomized Controlled Trial Multicenter StudyIndomethacin submicron particle capsules provide effective pain relief in patients with acute pain: a phase 3 study.
Although frequently prescribed to relieve acute pain in patients, non-steroidal anti-inflammatory drugs (NSAIDs) are associated with dose-related gastrointestinal, cardiovascular, and renal complications. Investigational, submicron particle NSAIDs are being developed that could provide effective pain relief at lower doses than currently available oral NSAIDs. This is the first phase 3 study evaluating the analgesic efficacy and safety of lower-dose indomethacin submicron particle capsules in patients following elective surgery. ⋯ Some evidence of pain control was observed in patients as early as 2 hours following administration of indomethacin submicron particle capsules and was sustained throughout the treatment period. Indomethacin submicron particle capsules were generally well tolerated by patients. These results suggest that lower-dose indomethacin submicron particle capsules are a potentially promising treatment option for patients with acute pain.