Pain Management in Cardiac Implantable Electronic Device Insertion; Effectiveness of Bupivacaine, Ketorolac, Ketamine, vs Bupivacaine Alone in Reducing Postoperative Pocket Pain

Bupivacaine is the most widely used local anesthetic agent across majority of the Cardiac Implantable Electronic device (CIED) implant procedures in the United States. It is hypothesized that the combination of Bupivacaine-Ketorolac-Ketamine (BKK) is more effective in alleviating perioperative and postoperative pain as compared to the use of bupivacaine alone.
A few studies have been done to look for the effectiveness of BKK in abdominal surgical procedures. However, no study has been done to evaluate its efficacy and effectiveness in patients undergoing CIED insertion.

开始日期2025-01-01

申办/合作机构

Loma Linda University Adventist Health Sciences Center

100 项与 Loma Linda University Adventist Health Sciences Center 相关的临床结果

登录后查看更多信息

0 项与 Loma Linda University Adventist Health Sciences Center 相关的专利（医药）

登录后查看更多信息

880

项与 Loma Linda University Adventist Health Sciences Center 相关的文献（医药）

2025-12-01·Journal of Orthopaedics

Matching lines to designs: A novel radiographic index for shorter femoral stems in total hip arthroplasty

Article

作者: Horodyski, MaryBeth ; Dela Cruz, Jeff ; Trivedi, Sunny ; Parvataneni, Hari ; Kelly, Blane ; Pulido, Luis ; Deen, Justin ; Gray, Chancellor F ; Baez, Catalina ; Prieto, Hernan

IntroductionMatching stem design and femoral morphology to balance stability and osseointegration with complication risk is critical in total hip arthroplasty (THA). Several historical radiographic measurements have assisted surgeons in selecting the best stem design for a patient. As these measurements were developed for longer stems (>150 mm) they have less utility for shorter stems (<120 mm). This study evaluated a set of new radiographic measurements tailored to shorter stems and the relative radiographic performance of several medial-to-lateral (ML) and metaphyseal-filling (MF) stems.MethodsRetrospective cohort study on all elective primary THAs between January 2011 and August 2020 at a single institution. Patients received a short metaphyseal-engaging stem and a minimum six-month follow-up with standardized radiographs. Six radiographic indices were created based on validated reference points. Postoperative radiographs were evaluated for stable fixation by bone ingrowth and lucent zones.ResultsThere were 748 cases, with a mean age of 63 (±12.2) years. Radiolucencies were evident in 13.6 % of stems. Metaphyseal-filling stems had a lower incidence of radiolucencies than ML stems (9.1 vs 19.3 %, p < 0.001 ). A Metaphyseal Flair Index (MFI) below 0.6 and a Lesser Cortical Index (LCI) above 0.3 significantly predicted higher rates of radiolucency ( p < 0.001 ). Patients with an LCI of 0.3 or higher had a 93 % probability of developing radiolucencies when using ML stems ( p < 0.001 ).ConclusionTwo indices (MFI and LCI) predicted areas of osseointegration in modern short femoral stems. Metaphyseal-filling stems have lower radiolucency rates than ML stems. Due to the higher probability of radiolucencies, surgeons should consider avoiding ML stems in patients with LCI values above 0.3.

2025-12-01·European Journal of Trauma and Emergency Surgery

Pragmatic O-Positive Whole-blood RandoMizaTion in male trauma Patients (POWeR-MTP)

Article

作者: Stevens, Wesley T ; Luo-Owen, Xian ; Strada, Anthony M ; Rosenthal, Martin G ; Suarez, Gus ; Mukherjee, Kaushik ; Lum, Sharon S ; Tabrizi, Maryam B

AbstractPurposeHemorrhage is a significant cause of trauma-related death. Low-titer O-positive whole blood (LTOWB) is an alternative to component therapy (CT) [packed red blood cells (PRBC) and fresh frozen plasma (FFP)]. We evaluated if LTOWB reduces transfusion requirement or mortality.MethodsAdult male trauma activations requiring uncrossmatched transfusion in the emergency department underwent nonblinded 24-hour block randomization to receive uncrossmatched LTOWB or CT in the emergency department (ED). Female patients, children, and known prisoners were excluded. If LTOWB was not available, CT was used. Primary outcome was transfusion requirement in patients surviving ≥ 24 h, with a subset analysis for patients undergoing hemorrhage control interventions (HCI). Dichotomous variables were evaluated with Chi-Square testing and continuous outcomes with Student’s T-test.ResultsOverall, 199 patients were randomized (52 LTOWB, 147 CT); 36 patients (12 LTOWB, 24 CT) were excluded post-randomization for mortality within 24 h. The remaining 40 LTOWB and 123 CT patient cohorts had similar age, Glasgow Coma Scale, Injury Severity Score, heart rate, systolic blood pressure, and temperature. LTOWB patients received 1.4 ± 0.75 LTOWB units. LTOWB patients trended toward less transfusion (PRBC [3.8 ± 5.6 vs. 5.7 ± 6.2 units, p = 0.077], FFP [2.3 ± 3.8 vs. 3.5 ± 4.3 units, p = 0.088], and CRYO [0.13 ± 0.34 vs. 0.28 ± 0.68 units, p = 0.061]). Mortality was similar (LTOWB:10.2% [4/39] vs. CT:10.5% [13/123], p = 0.956). LTOWB patients undergoing HCI had less transfusion than CT patients (PRBC [3.9 ± 5.1 vs. 7.4 ± 7.2 units, p = 0.013]; in the HCI cohort the differences were even more pronounced when severe traumatic brain injury (TBI) deaths were excluded (PRBC [3.0 ± 3.6 vs. 7.4 ± 7.2 units, p < 0.001], FFP [2.1 ± 2.3 vs. 4.5 ± 5.2 units, p = 0.005]).ConclusionLTOWB is associated with reduced PRBC transfusion in patients undergoing HCI, and a trend toward decreased PRBC, FFP, and CRYO transfusion in all patients.Trial registrationClinicalTrials.gov (NCT05081063), posted 10/18/2021.

2025-05-01·Annals of Pharmacotherapy

Incidence and Risk Factors of Hypomagnesemia in Patients With Bone Metastasis From Solid Malignancies Treated With Denosumab

Article

作者: Hana, Myrna M. ; Lee, Jane S. ; Jeong, Sehyun ; Donkor, Kofi N.

Background:Hypomagnesemia is associated with poor clinical outcomes in cancer patients. Patients with bone metastasis from solid malignancies receiving denosumab (Dmab) to prevent skeletal-related events often receive concurrent antineoplastic agents for cancer treatment. The incidence and risk factors of hypomagnesemia in patients receiving Dmab and the optimal frequency of monitoring serum magnesium (Mg) levels have not been studied in these patient populations.Objective:The objective is to investigate the incidence and potential risk factors of hypomagnesemia and the optimal frequency of monitoring serum Mg levels.Methods:A retrospective chart review identified patients with solid malignancies with bone metastases treated with Dmab at the Loma Linda University Cancer Center between January 2013 and February 2024. The incidence of hypomagnesemia was determined using the number of patients with hypomagnesemia and the total number of patients in the study. Univariate and multivariate logistic regression analyses identified risk factors for hypomagnesemia.Results: Hypomagnesemia was observed in 19% (29/153) of patients, the majority of whom were on concurrent antineoplastic agents with ≥15% hypomagnesemia incidence (high-hypomagnesemic antineoplastics) or nonantineoplastic drugs with documented cases or incidence of hypomagnesemia (hypomagnesemic nonantineoplastics) in addition to high-hypomagnesemic antineoplastics. Multivariate analysis showed increased odds of developing hypomagnesemia with high-hypomagnesemic antineoplastics (odds ratio [OR]: 174.93, 95% confidence interval [CI]: 12.82 to 387.43, P < 0.001); hypomagnesemic nonantineoplastics plus high-hypomagnesemic antineoplastics (OR: 210.09, 95% CI: 11.80 to 3740.12, P < 0.001); and Mg level ≤ 0.85 prior to Dmab administration (OR: 16.79, 95% CI: 2.30 to 122.41, P = 0.005). Conclusion and relevance:This study describes the incidence and potential risk factors for hypomagnesemia in patients with solid malignancies and metastatic bone disease treated with Dmab. This study’s findings provide additional clinical insight into potential risk factors for hypomagnesemia and the need for more frequent serum Mg level monitoring of at-risk patients. Future prospective studies are needed to determine the exact frequencies most appropriate in monitoring serum Mg levels in this group of patients.

100 项与 Loma Linda University Adventist Health Sciences Center 相关的药物交易

登录后查看更多信息

100 项与 Loma Linda University Adventist Health Sciences Center 相关的转化医学

登录后查看更多信息