Assessing the Impact of Prophylactic Targeted Brain Rehabilitation (TBR) on Phantom Limb Pain in the Perioperative Period Following Major Amputation, A Prospective Study

This prospective study seeks to evaluate the effectiveness of prophylactic Targeted Brain Rehabilitation (TBR) in preventing or reducing Phantom Limb Pain (PLP).

开始日期2025-08-15

申办/合作机构

Orthocarolina Research Institute, Inc.

NCT06935331

/ Not yet recruiting临床4期IIT

Comparison of Opioid-Free Versus Traditional Opioid-Containing Postoperative Pain Management Pathways for Adolescent Idiopathic Scoliosis

The purpose of this study is to compare the efficacy of a multimodal opioid-free (OF) pain management protocol with a traditional opioid-containing (OC) protocol in pediatric patients undergoing instrumented PSF for idiopathic scoliosis.

开始日期2025-08-15

申办/合作机构

Orthocarolina Research Institute, Inc.

NCT06580899

/ Enrolling by invitation临床4期IIT

Effectiveness of Continuous Local Infiltration Analgesia Intra-Articular Catheters for Pain Relief in Total Knee Replacement

This is a prospective, randomized clinical trial evaluating three groups. The groups are:
Group 1 (Control): Subjects that receive only the existing standard-of-care multimodal pain management protocol and do not receive post-operative intra-articular catheter.
Group 2 (Investigational Treatment/Intervention): Subjects that receive the brand 1 intra-articular catheter pump with existing standard-of-care multimodal pain management protocol in the immediate post-operative period.
Group 3 (Investigational Treatment/Intervention): Subjects that receive the newer brand 2 intra-articular catheter pump with existing standard-of-care multimodal pain management protocol in the immediate post-operative period.

开始日期2025-03-14

申办/合作机构

Orthocarolina Research Institute, Inc.

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2026-02-01·Orthopaedics & Traumatology-Surgery & Research

Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies

Review

作者: Siparsky, Patrick N ; Collins, Michael S ; Fleischli, James E ; Hardrick, Jaden ; Saltzman, Bryan M ; Hamid, Nady ; Trofa, David P ; Ifarraguerri, Anna M

BACKGROUND:

Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic rotator cuff repair (ARCR). ISNBs with anesthetic agents like bupivacaine are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this systematic review and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.

METHODS:

A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.

RESULTS:

Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD -3.45, 95% CI [-5.20, -1.60]; P = 0.0003 and SMD -2.39, 95% CI [-4.01, -0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD -4.66; 95% CI, -7.95 to -1.36; p = 0.006; SMD -3.77; 95% CI, -5.69 to -1.85; p = 0.0001, SMD -3.34 95% CI [-5.13, -1.56]; p = 0.0002, and SMD -3.43; 95% CI, -5.74 to -1.12; p = 0.004, respectively).

DISCUSSION:

LB moderately decreased pain scores 24-72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.

LEVEL OF EVIDENCE:

2025-10-01·Arthroscopy, sports medicine, and rehabilitation

High Variability in Arthroscopic Fluid Use Among Surgeons and Joints for Common Orthopaedic Procedures

Article

作者: Polce, Evan M ; White, Alex B ; Hamid, Nady ; Devarasetty, V V N Manohar ; Gachigi, Kennedy K ; Rees, Andrew B ; Chandler, Calvin C

Purpose:

To determine arthroscopic fluid volume use patterns across common elective orthopaedic procedures, evaluate intersurgeon consistency in fluid use, and assess whether blood loss reduction adjuncts affect fluid consumption to generate actionable insights to guide surgeons in optimizing resource use, reducing waste, and improving efficiency during times of resource constraint.

Methods:

A cross-sectional analysis at a single outpatient surgery center of adult arthroscopic procedures was conducted. A representative sample of 500 arthroscopic cases of the shoulder, elbow, knee, and ankle performed by multiple surgeons were reviewed. A total of 449 cases met inclusion criteria. Analysis of fluid use relative to body area, Current Procedural Terminology codes, surgeon, and blood loss reduction adjuncts (tranexamic acid [TXA] and epinephrine) was performed using analysis of variance tests.

Results:

Mean fluid volume was greatest in shoulder arthroscopy (16,582 ± 7,026 mL), followed by knee (8,677 ± 7,027 mL), elbow (6,489 ± 2,540 mL), and ankle procedures (3,534 ± 1,500 mL). Significant intersurgeon variation was observed (F = 19.61, P = .0001). Epinephrine was used in 58.8% of cases, with mean fluid volume of 11,571 ± 6,896 mL for local injection and 15,401 ± 8,610 mL for arthroscopic fluid administration. Cases without epinephrine averaged 7,676 ± 6,570 mL of fluid use. TXA was used in only 0.7% of cases. Neither epinephrine nor TXA showed significant reduction in fluid consumption (P > .05).

Conclusions:

Arthroscopic fluid use across anatomic regions was highly varied, with shoulder procedures requiring the greatest volumes. Surgeon-specific use patterns also varied considerably. The use of neither TXA nor epinephrine reduced fluid consumption, although this finding may reflect the small sample size and lack of standardized protocols rather than true ineffectiveness.

Level of Evidence:

Level III, cross-sectional study.

2025-10-01·KNEE

Incidence of concomitant intra- and extra-articular lesions and procedures in patients undergoing primary and subsequent revision single-stage or 2-stage revision anterior cruciate ligament reconstruction: a matched retrospective cohort study

Article

作者: Fleischli, James E ; Saltzman, Bryan M ; Graham, George D ; Piasecki, Dana P ; Berk, Alexander N ; Siparsky, Patrick N ; White, Alexander B ; Trofa, David P ; Ifarraguerri, Anna M ; Gachigi, Kennedy K ; Collins, Michael S

PURPOSE:

This study compares the concomitant intra- and extra-articular pathologies in patients undergoing primary anterior cruciate ligament reconstruction (ACLR) to their subsequent single or 2-stage revision ACLR.

METHODS:

Patients from 2012 to 2021 with minimum two-year follow-up after single-stage revision ACLR were matched with patients who underwent 2-stage revision ACLR by age, sex, and body mass index. Concomitant pathologies and procedures were compared from primary to single or 2-stage revision ACLR. The incidence of concomitant knee pathologies and procedures at the time of primary and revision ACLR was compared between the two groups.

RESULTS:

Following primary ACLR, 27 patients had single-stage revision ACLR and 27 had 2-stage revision ACLR. At the time of revision surgery, 2-stage revision ACLR had increased incidence of multi-ligamentous injury and meniscus repair. Rates of chondral injury alone and chondral injury plus concomitant meniscal injury increased significantly from primary to 2-stage revision ACLR. No significant change in the incidence of concomitant pathologies or procedures was found at primary ACLR to single-stage revision ACLR.

CONCLUSION:

Patients with 2-stage revision ACLR are more likely to have concomitant multi-ligamentous pathologies and meniscal repair at the time of revision. Additionally, 25.9% of patients developed chondral pathologies and 18.55% developed both chondral and meniscal lesions from primary ACLR to 2-stage revision ACLR, raising concern about the long-term outcomes of these patients.

LEVEL OF EVIDENCE:

Retrospective Cohort; 3.

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