This article discusses improved pain management techniques and accelerated rehabilitation programs for total hip and knee arthroplasty. The key aspects of the discussed program include:
1. Regional anesthesia using spinal anesthesia supplemented with perioperative nerve blocks and local periarticular injections for multimodal pain control.
2. Preemptive analgesia beginning preoperatively to control pain from onset and minimize narcotic use postoperatively.
3. Accelerated rehabilitation programs enabled by adequate pain control, allowing some patients to begin rehabilitation on the day of surgery to reduce length of stay.
4. Ongoing research into longer-acting local injectable agents and improved periarticular injection cocktails for superior pain management.
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
A presentation by Anil Gupta at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Acute pain after surgery - lessons learned from the last decade - Stephan Sch...scanFOAM
A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Acute pain management requires a multimodal and multidisciplinary approach with a clear organization framework. Regional anesthesia techniques for surgical anesthesia are a highly effective component of acute pain management.
With the advancement of ultrasonographic technology with higher resolution and penetration imaging, there is increasing use of ultrasonography (US) in acute and chronic pain blocks.
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
A presentation by Anil Gupta at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Acute pain after surgery - lessons learned from the last decade - Stephan Sch...scanFOAM
A talk by Stephan Schug at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Preemptive Analgesia for Attenuation of Postoperative Pain in Patients Underg...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Acute pain management requires a multimodal and multidisciplinary approach with a clear organization framework. Regional anesthesia techniques for surgical anesthesia are a highly effective component of acute pain management.
With the advancement of ultrasonographic technology with higher resolution and penetration imaging, there is increasing use of ultrasonography (US) in acute and chronic pain blocks.
Total knee replacement post op pain control protocol for surgeons Al Razi Ort...Farah Jafri
This is the information sheet for surgeons at Al Razi Orthopedic Hospital interested in knowing about the acute pain protocol for Total Knee Replacement.
Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromia...ijtsrd
Introduction Subacromial impingement syndrome SIS is commonest among various joint pains. Study is done in order to compose the efficacy of PEMF treatment of various duration for patients with SIS. Subject and Methods One hundred and eight patients who had been diagnosed with subacromial impingement syndrome by clinical examination. Patients were sequentially enrolled following informed consent were administered PEMF therapy for 15 minutes combined with exercise therapy. The second group received the same treatment except that each of the patients has received 30 minutes therapy the patients were evaluated before and after the treatment. Parameters examined were pain score, disability score and range of motion at shoulder joint. Result Second group was significantly improved in pain score, disability score and range of motion. Conclusion 30 minutes of PEMF therapy was shown to be more effective than 15 minutes of PEMF therapy. Anuja Pasari | Bismay Das | C. Monanty | Saurabh Singh | Sujoy Roy | T. B. Singh "Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromial Impingement Syndrome" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38177.pdf Paper URL : https://www.ijtsrd.com/medicine/other/38177/comparison-of-pemf-therapy-of-various-duration-in-the-treatment-of-subacromial-impingement-syndrome/anuja-pasari
Based in Stony Brook, New York, Dr. Elliott Bennett-Guerrero leads the Department of Anesthesiology at Stony Brook Medicine as the vice chair of clinical research and innovation. Concurrent to this role, Dr. Elliott Bennett-Guerrero helps educate the new generation of medical professionals as a professor of anesthesiology.
Epidural adhesiolysis has been accepted as a treatment for post laminectomy syndrome, failed back syndrome, & radicular syndromes.
The efficacy of caudal approach epidural adhesiolysis depends on the proper diagnosis, patient’s condition, and better techinuqe.
The combined use of long term patient education for neural flossing exercises & the inclusion of the facet-delayed treatment in the algorithm further improves patient outcome.
Additional studies are underway to further refine the technique & indications.
Interventional pain management by dr rajeev harsheRajeev Harshe
This is a brief presentation on how pain can be managed in a better way. Dr Rajeev Harshe is senior pain management consultant in western India. He is attached to Apollo Hospitals and has his private consulting room as well.Email: dr.harshe@gmail.com. If you are anaesthesiologist and if you wish to learn pain management,contact him.
Breakout 1.1 - Dr Kerri Jones
Consultant Anaesthetist & Associate Medical Director
Adviser Dept Health Enhanced Recovery Programme
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Pharmacist Educational Intervention in Intravenous Patient Controlled Analges...Sunil Vadithya
Pharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative PainPharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative Pain
Full Epub Atlas of Temporomandibular Joint Surgery unriotingasnerrty
This second edition of the Atlas of Temporomandibular Joint Surgery is a major revision of Dr. Quinn's classic work taking into account new procedures equipment and evidencebased findings from the latest research in TMJ treatment. Assuming that readers are familiar with nonsurgical therapies to correct temporomandibular pain and disorders Drs. Quinn and Granquist focus on the surgical remedies for disorders that are beyond conservative treatment. This concise howto surgical atlas guides both the novice and experienced surgeon through the intraarticular and extraarticular procedures that have proven efficacious in the treatment of advanced craniomandibular dysfunction. Chapters take readers through decision making for TMJ surgery diagnostic imaging methods surgical approaches surgery for internal derangements trauma osseous surgical procedures total joint replacement and pathologies.
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
Total knee replacement post op pain control protocol for surgeons Al Razi Ort...Farah Jafri
This is the information sheet for surgeons at Al Razi Orthopedic Hospital interested in knowing about the acute pain protocol for Total Knee Replacement.
Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromia...ijtsrd
Introduction Subacromial impingement syndrome SIS is commonest among various joint pains. Study is done in order to compose the efficacy of PEMF treatment of various duration for patients with SIS. Subject and Methods One hundred and eight patients who had been diagnosed with subacromial impingement syndrome by clinical examination. Patients were sequentially enrolled following informed consent were administered PEMF therapy for 15 minutes combined with exercise therapy. The second group received the same treatment except that each of the patients has received 30 minutes therapy the patients were evaluated before and after the treatment. Parameters examined were pain score, disability score and range of motion at shoulder joint. Result Second group was significantly improved in pain score, disability score and range of motion. Conclusion 30 minutes of PEMF therapy was shown to be more effective than 15 minutes of PEMF therapy. Anuja Pasari | Bismay Das | C. Monanty | Saurabh Singh | Sujoy Roy | T. B. Singh "Comparison of PEMF Therapy of Various Duration in the Treatment of Subacromial Impingement Syndrome" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd38177.pdf Paper URL : https://www.ijtsrd.com/medicine/other/38177/comparison-of-pemf-therapy-of-various-duration-in-the-treatment-of-subacromial-impingement-syndrome/anuja-pasari
Based in Stony Brook, New York, Dr. Elliott Bennett-Guerrero leads the Department of Anesthesiology at Stony Brook Medicine as the vice chair of clinical research and innovation. Concurrent to this role, Dr. Elliott Bennett-Guerrero helps educate the new generation of medical professionals as a professor of anesthesiology.
Epidural adhesiolysis has been accepted as a treatment for post laminectomy syndrome, failed back syndrome, & radicular syndromes.
The efficacy of caudal approach epidural adhesiolysis depends on the proper diagnosis, patient’s condition, and better techinuqe.
The combined use of long term patient education for neural flossing exercises & the inclusion of the facet-delayed treatment in the algorithm further improves patient outcome.
Additional studies are underway to further refine the technique & indications.
Interventional pain management by dr rajeev harsheRajeev Harshe
This is a brief presentation on how pain can be managed in a better way. Dr Rajeev Harshe is senior pain management consultant in western India. He is attached to Apollo Hospitals and has his private consulting room as well.Email: dr.harshe@gmail.com. If you are anaesthesiologist and if you wish to learn pain management,contact him.
Breakout 1.1 - Dr Kerri Jones
Consultant Anaesthetist & Associate Medical Director
Adviser Dept Health Enhanced Recovery Programme
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Pharmacist Educational Intervention in Intravenous Patient Controlled Analges...Sunil Vadithya
Pharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative PainPharmacist Educational Intervention in Intravenous Patient Controlled Analgesia is Associated with Decreased Postoperative Pain
Full Epub Atlas of Temporomandibular Joint Surgery unriotingasnerrty
This second edition of the Atlas of Temporomandibular Joint Surgery is a major revision of Dr. Quinn's classic work taking into account new procedures equipment and evidencebased findings from the latest research in TMJ treatment. Assuming that readers are familiar with nonsurgical therapies to correct temporomandibular pain and disorders Drs. Quinn and Granquist focus on the surgical remedies for disorders that are beyond conservative treatment. This concise howto surgical atlas guides both the novice and experienced surgeon through the intraarticular and extraarticular procedures that have proven efficacious in the treatment of advanced craniomandibular dysfunction. Chapters take readers through decision making for TMJ surgery diagnostic imaging methods surgical approaches surgery for internal derangements trauma osseous surgical procedures total joint replacement and pathologies.
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
Austin Pain & Relief is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pain & Relief.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pain & Relief. Austin Pain & Relief accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pain and relief.
Austin Pain & Relief strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Kesimpulan:
ANTI INFLAMMATORY DRUGS
a valuable adjuvant as part of a multimodal analgesic regimen for the management of pain in the perioperative period
effective adjunct in multimodal regimens to reduce postoperative pain
Dr. Alan Kaye Shreveport is a leading Anesthesiologist, Pain Medicine Specialist and Interventional Pain Management Specialist with over 3 decades of experience. He has helped many thousands of people gain relief from acute and chronic pain through proven therapy methods, technology, and his wealth in education.
Pregabalin is an effective and safe adjuvant for reducing chronic
post-thoracotomy pain, without significant side effects, in all age
groups and either gender. The pain relief becomes statistically
significant after three weeks of treatment and it continues till six
months. However, larger randomized and placebo-controlled trials
of longer durations are required to further validate these findings.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
2. Pain Management and Accelerated Rehabilitation Ranawat and Ranawat 13
postoperative pain control program for total joint Table 1. Preoperative
surgery should address all of these influences.
Preemptive Analgesia Given Preoperatively
Therefore, a multimodal approach is logical and
has been supported by numerous authors [2]. 1. Celecoxib 400 mg orally
2. Acetaminophen 1000 mg orally
Not only does the fear of pain limit the number of 3. Tramadol 50 mg
patients who seek total joint surgery, but uncon- 4. Oxycodone 20 mg orally
trolled postoperative pain has many deleterious 5. Pantoprazole 40 mg orally
6. Warfarin 5 mg orally
effects. It has a profound impact on the recovery of
function, and it is the leading cause of delayed
discharge from the hospital [3]. For all these
reasons, it is the opinion of the senior author that The bottom line is that pain must be controlled
the next great advance in the practice of total joint from the onset for any pain management program to
surgery will be further improvements in postopera- work, and secondly, the anesthetic choice should act
tive pain management. to minimize rebound pain, which commonly occurs
with the discontinuation of 24-hour epidurals.
At our institution, preemptive analgesia begins pre-
Anesthesia operatively with most patients receiving 1000 mg of
acetaminophen, 400 mg of celecoxib, 50 mg of tra-
It has now been well documented that regional madol, and 20 mg of extended-release oxycodone in the
anesthesia offers significant advantages over general holding area. In addition, patients are given a proton-
anesthesia with regard to intraoperative blood loss, pump inhibitor, an antiemetic, and warfarin (Table 1).
DVT, and postoperative pain management [4]. As a
result, single-shot spinal anesthesia is our preferred
method. To minimize the DVT risk in THA specifi- Nerve Blocks
cally, this is supplemented with 500 U of IV heparin
during femoral preparation [5]. The use of nerve blocks with and without cathe-
There are many other regional anesthetic options ters has been proven to be very effective at
besides spinal anesthesia, such as hypotensive, controlling pain and minimizing narcotic require-
epidural anesthesia with or without indwelling ments after THA and TKA. There are, however,
catheters for 24 or 48 hours; combined spinal/ several drawbacks, including the increased time it
epidurals; intrathecal morphine (Duramorph, Baxter takes to place the blocks; the availability of skilled
Heathcare Corporation, Deerfield, IL); and most anesthesiologists to place them; and, perhaps most
recently, extended-release epidural morphine (Depo- importantly, the associated motor blockade that
dur, Skyepharma, London, England) [6]. Although limits functional recovery and delays rehabilitation.
they all offer the aforementioned benefits of regional Nonetheless, several specialized centers have made
anesthesia, they have different risk profiles and femoral nerve blocks for TKA and “3-in-1” blocks
require different levels of postoperative monitoring. for THA routine for all patients because of its
The use of epidural catheters also precludes the use of excellent pain-relieving capability [8].
certain anticoagulants such as the low-molecular-
weight heparins. Unfortunately, because many of
Local Periarticular Injections
these other modalities also use narcotics as part of the
anesthetic, they are not immune from its attendant
At our center, we have been focused on using
side effects, as previously described.
local, periarticular injections as part of our overall
pain management protocol. It is our belief that the
Preemptive Analgesia right cocktail in the right patient offers the most
effective pain control with the least amount of side
The idea of preemptive analgesia is not a new one; effects (Tables 1 and 2). We have demonstrated the
nonetheless, it is rarely used. More often than not, safety and efficacy of this program with a rando-
patients are only given pain medications well after mized, prospective study, which has been duplicated
the onset of symptoms. It is now known that by other authors as well [9]. The results of our study
continuous, around-the-clock dosing of pain med- are pending publication in this journal.
ications is far more effective at alleviating pain than Ultimately, we believe that most surgeons across
the standard “as-needed or prn” dosing [7]. the country will be using local, periarticular injec-
Furthermore, it creates a lower narcotic require- tions for their arthroplasties because of their
ment, which has obvious benefits. excellent pain-relieving ability, their low side-effect
3. 14 The Journal of Arthroplasty Vol. 22 No. 7 Suppl. 3 October 2007
Table 2. Intraoperative satisfaction. Most high-volume centers use a variety
teaching aids such as audiovisuals, booklets, web-
Intraoperative Injection
based learning, as well as individual and group
1. 0.5% Bupivacaine 200-400 mg classes to educate patients preoperatively and post-
2. Morphine sulphate (0.4-1.0 cc) 4-10 mg
3. Epinephrine 1/1000 (0.3 cc) 300 μg operatively [10]. To do this effectively requires a
4. Methylprednisolone acetate 40 mg tremendous allocation of time and resources. It
5. Cefuroxime (10 cc) 750 mg usually necessitates a full-time, dedicated, and
6. Normal saline 22 cc
No steroids in diabetic/immunocompromised patients experienced nurse to appropriately handle the
Vancomycin if allergic to penicillin barrage of patient-generated questions that inevi-
Clonidine transdermal patch applied in operating tably arise. It is also a good idea to revisit these
room—100 μg/24 h
Injection sites for intraoperative periarticular injection classes on a regular basis to ensure proper teaching
and training of staff members.
THA
Before final reduction
Anterior capsule Accelerated Rehabilitation
Iliopsoas tendon and insertion site
After final reduction (before irrigation and closure)
Abductors There are 2 factors that permit patients to participate
Fascia lata in an accelerated rehabilitation program. The first, and
Gluteus maximus and its insertion
Posterior capsule and short external rotators perhaps most important, is the motivated patient.
Synovium Even with some pain that most patients would
consider unbearable, the motivated patient can
TKA
Before insertion of liner and reduction power through. By extension, the second necessary
Posterior capsule factor for most patients is achieving adequate post-
Posteromedial and posterolateral structures operative pain control. The focus of any rehabilitation
After reduction
Extensor mechanism protocol should be to control pain because this is the
Synovium variable the surgeon can manipulate [11]. No amount
Capsule of encouragement or education can convert unmoti-
Pes anserinus, anteromedial capsule, and periosteum
Iliotibial band vated patients into motivated ones, especially if they
Collateral ligaments and origins are experiencing pain.
The fact is that many patients, especially younger,
active males, could and should participate in a
profile, and their ease of use. Further research in this rehabilitation program on the day of surgery,
area will produce improved cocktails with longer- provided they are medically stable. The limiting
acting agents. factor for most institutions, however, will be the lack
of skilled physiotherapists needed to accomplish this
Other Pain-Reducing Adjuvants feat. The benefits include immediate, direct psycho-
logic feedback to the motivated patient, with the
As the industry becomes more aware of the ultimate potential of reducing his or her length-of-
importance of controlling postoperative pain, more stay. The long-term benefits of an accelerated
adjuvant therapies and devices will become avail-
able (Table 3). Recently, patient-activated transder- Table 3. Postoperative
mal analgesic patches, which obviate the need for
Postoperative Analgesia/Medications
intravenous lines, have been released. Other strate-
gies have focused on using anesthetic-coated sutures Recovery room
1. Ketorolac IV every 6 h (15 mg if age N65 y, 30 mg if b65 y, hold
and implants as carriers. Newer hemostatic agents if with renal impairment)
and drain systems are also now available to help 2. If ketorolac ineffective, morphine 2-4 mg IV every 15 min
minimize the risk of developing postoperative 3. Metoclopramide 10 mg IV PRN
Orthopedic floor
hematomas, which are a significant cause of pain 1. Ketorolac IM every 6 h PRN (15 mg if age N65 y, 30 mg if
and wound complications. b65 y, hold if with renal impairment)
2. If ketorolac ineffective, morphine 2-4 mg IM every 2-4 h
3. Celecoxib 200 mg orally daily for 10 d
Patient Education 4. Oxycodone SR 10/20 mg orally every 12 h for 48 h
5. Oxycodone 5 mg orally every 6 h PRN
6. Acetaminophen 1000 mg orally every 6 h
Managing patients' expectations and preparing 7. Pantoprazole 40 mg orally daily
them for total joint surgery has been shown to be
very effective at improving outcomes and patient PRN, as needed; SR, sustained release.
4. Pain Management and Accelerated Rehabilitation Ranawat and Ranawat 15
program are probably negligible; however, the same length of hospital stay after total joint arthroplasty.
could be said for the use of continuous, passive J Arthroplasty 2006;21(6 Suppl 2):132.
motion machines, which have become a part of the 3. Horlocker TT, Kopp SL, Pagnano MW, et al. Analgesia
community standard despite little evidence to for total hip and knee arthroplasty: a multimodal
pathway featuring peripheral nerve block. J Am Acad
support its use.
Orthop Surg 2006;14:126.
4. Indelli PF, Grant SA, Nielsen K, et al. Regional
Conclusions anesthesia in hip surgery. Clin Orthop Relat Res
2005;441:250.
Achieving the painless THA or TKA is within 5. DiGiovanni CW, Restrepo A, Gonzalez Della Valle AG,
et al. The safety and efficacy of intraoperative heparin
reach using regional anesthesia and multimodal
in total hip arthroplasty. Clin Orthop Relat Res 2000;
pain control techniques that avoid the unnecessary
379:178.
use of narcotics. This has been documented by 6. Viscusi ER, Parvizi J, Tarity TD. Developments in
several prospective, randomized studies, including spinal and epidural anesthesia and nerve blocks for
our own. The use of local, periarticular injections total joint arthroplasty: what is new and exciting in
will be a major player in these programs in the years pain management. AAOS ICL 2007;56:139.
to come. Further research is still necessary to 7. Skinner HB, Shintani EY. Results of a multimodal
identify longer-acting injectable agents. analgesic trial involving patients with total hip or total
Although patient education and accelerated reha- knee arthroplasty. Am J Orthop 2004;33:85.
bilitation programs are important in facilitating a 8. Pagnano MW, Hebl J, Horlocker T. Assuring a
patient's recovery, it cannot be overemphasized that painless total hip arthroplasty: a multimodal approach
emphasizing peripheral nerve blocks. J Arthroplasty
the focus of any total joint program should be in
2006;21(4 Suppl 1):80.
controlling postoperative pain.
9. Parvataneni HK, Ranawat AS, Ranawat CS. The use of
local peri-articular injections in the management of
postoperative pain after total hip and knee replace-
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