Multimodal Analgesia Therapy Reduces Length of Hospitalization in Patients Undergoing Fusions of the Ankle and Hindfoot.

Multimodal Analgesia Therapy Reduces Length of Hospitalization in Patients Undergoing Fusions of the Ankle and Hindfoot.

Foot Ankle Int. 2013 Jul 8;
Michelson JD, Addante RA, Charlson MD

Multimodal postoperative analgesia employs multiple medications given perioperatively to block the generation and perception of pain at different points in the nociceptive pathway. This retrospective study examines its effect on the length of stay for patients undergoing hindfoot and ankle fusions.All patients operated upon by the senior authors between 2007 and 2011, inclusive, underwent ankle fusion, subtalar fusion, pantalar arthrodesis, triple arthrodesis, or combined ankle/subtalar fusions. The perioperative pain management was either the “traditional” method (patient-controlled-analgesia-delivered parenteral narcotics beginning immediately postoperatively) or the multimodal pain protocol (pre- and postoperative oral administration of opioids, celecoxib, pregabalin, acetaminophen, and prednisone). The choice of pain protocol was up to the surgeons, without any exclusion criteria. Physical therapy protocols were not changed during the study. The study included 220 patients; 175 received the multimodal protocol and 45 received traditional management. Multimodal protocol patients were younger (53.9 vs 59.7 years; P < .003), but there were no other differences between the groups with respect to gender, obesity, body mass index, tobacco use, alcohol use, or comorbidities. Complex cases (revision surgeries, Charcot joint surgeries, multiple concurrent procedures, etc) were equally represented in both groups.Multimodal protocol patients had lower lengths of stay (2.5 days; 95% confidence interval [CI], 1.4-3.7) than traditional pain management patients (4.2 days; 95% CI, 2.7-5.7; P < .001). This was also true for both complicated and uncomplicated surgeries when considered separately.This study provides the first evidence that multimodal therapy reduces the length of stay for patients undergoing major hindfoot or ankle fusion surgery, regardless of surgical complexity. HubMed – rehab


Response to the Letter to the Editor regarding “Comparison of Fallers and Non-Fallers at an Inpatient Rehabilitation Facility: A Retrospective Review”.

Rehabil Nurs. 2013 Jul-Aug; 38(4): 212
Beaudoin J

HubMed – rehab


Clinical anatomy of the shoulder after treatment for breast cancer.

Clin Anat. 2013 Jul 8;
Shamley D, Lascurain-Aguirrebeña I, Oskrochi R

Normal painfree movement of the upper limb requires movement at the glenohumeral joint and movement of the scapula on the thorax. Co-ordinated movement of these joints is known as the scapulohumeral rhythm and is required during elevation of the arm. Coordinated movement is further achieved by timing of the many muscles acting across the joints. A pilot study from our laboratory has shown significant alterations to this scapulohumeral rhythm and its muscle control following treatment for breast cancer. The aims of this study were to: (1) correlate altered muscle activity from a larger sample with observed movement deviations; (2) compare movement and muscle deviations in survivors with a healthy population and (3) explore the impact of a mastectomy versus a wide local excision (WLE) on the observed deviations. Cross-sectional study. 155 women treated for unilateral carcinoma of the breast and 21 age-matched healthy women were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). Three-dimensional kinematic data and EMG muscle activity were recorded during scaption on the affected and unaffected side. Patients demonstrated a different movement dysfunction depending on whether the left or the right shoulder was affected. Left affected shoulders demonstrated the greatest degree of internal rotation of all shoulders studied. Compared to healthy shoulders patients following a mastectomy demonstrated increased activity in both the left and right affected shoulders in all the measured muscles. In patients having a WLE, such increases were not observed in serratus anterior and pectoralis major activity on the right affected shoulder, where a decrease was noted. Muscle dysfunction was also observed in the unaffected side of patients. Having received chemotherapy contributed significantly to the difference seen between the affected and unaffected shoulders in patients. Differences in scapular tilt between affected and unaffected shoulders in patients were significantly associated with pain and disability, and changes in serratus anterior activity. Patterns of movement deviation resemble those seen in known shoulder conditions. Anatomical and biomechanical evidence supports the need for integrated rehabilitation and surveillance systems for the shoulder in oncology units. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc. HubMed – rehab



Alcohol Rehab Centers in Cherry Hill NJ | Call 800-839-1682 For HELP – Alcohol Rehab Centers in Cherry Hill NJ – Call 800-839-1682 For HELP If you decide to have your loved one enrolled in a treatment center here in Cherry Hill,…