Pain practice : the official journal of World Institute of Pain
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A retrospective analysis of 659 patients who had undergone a hip or knee arthroplasty was undertaken to determine the incidence of pulmonary embolism (PE) during the 48-hour period following surgery. Data related to pain control, concomitant medications, length of stay, and adverse reactions were also collated. Patients were evenly divided between those receiving extended-release epidural morphine (EREM: n = 327; mean dose 9.7 mg, range 5 mg to 15 mg) or a control group receiving other treatment for postoperative pain (control: n = 332; 44% of controls had an epidural catheter in place). ⋯ Pain control (by a 10-point verbal numerical rating scale) was significantly improved in the EREM group compared with the control group 48 hours after surgery (2.3 +/- 1.8 vs. 4.7 +/- 2.6) and length of stay was significantly reduced (3.9 +/- 1.5 days vs. 4.5 +/- 2.0 days). Adverse event profiles of the EREM and control groups were consistent with prior published studies with EREM. The use of EREM following lower extremity joint arthroplasty may be associated with a significant reduction in the incidence of PE.
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Comparative Study
Aprepitant vs. multimodal prophylaxis in the prevention of nausea and vomiting following extended-release epidural morphine.
Extended-release epidural morphine (EREM) is an effective option for postoperative analgesia following major orthopedic surgery; however, postoperative nausea/vomiting (PONV) is a recognized limitation. The incidence of PONV following prophylactic aprepitant, a neurokinin-1 antagonist, was compared with prophylactic multimodal antiemetic therapy in patients receiving EREM for postoperative analgesia following unilateral primary total knee arthroplasty (TKA). ⋯ While aprepitant significantly reduced the incidence of PONV compared with a multimodal antiemetic regime, used alone it did not eliminate PONV.
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Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related. In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. ⋯ The available evidence for injection of Botulinum toxin A (2 B-) and intra-articular corticosteroid injections (2 C-) supports a negative recommendation. Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).
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More than 50% of patients presenting to a pain clinic with neck pain may suffer from facet-related pain. The most common symptom is unilateral pain without radiation to the arm. Rotation and retroflexion are frequently painful or limited. ⋯ Therapeutic repetitive medial branch blocks, with or without corticosteroid added to the local anesthetic, result in a comparable short-term pain relief (2 B+). Radiofrequency treatment of the ramus medialis of the cervical ramus dorsalis (facet) may be considered. The evidence to support its use in the management of degenerative cervical facet joint pain is derived from observational studies (2 C+).