Pain Management in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion: Combined Intrathecal Morphine and Continuous Epidural Versus PCA.

Pain Management in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion: Combined Intrathecal Morphine and Continuous Epidural Versus PCA.

Filed under: Rehab Centers

J Pediatr Orthop. 2012 Dec; 32(8): 799-804
Ravish M, Muldowney B, Becker A, Hetzel S, McCarthy JJ, Nemeth BA, Noonan KJ

: A retrospective case-comparison study.: Compare efficacy and safety of combined intrathecal morphine (ITM) and epidural analgesia (EPI) to that of conventional intravenous patient-controlled analgesia (IV-PCA) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).: Pain control after PSF in AIS has been managed traditionally with IV-PCA. More recently studies have shown improvement in pain control with the use of continuous EPI or intraoperative ITM. No studies to our knowledge have compared the use of both ITM and EPI analgesia to that of IV-PCA.: An Institutional Review Board-approved retrospective case-comparison study was performed from 1989 to 2009 of all patients undergoing PSF for AIS. Patients received either IV-PCA or ITM/EPI. Daily pain scores were recorded along with total opioid and benzodiazepine use. Adverse events were recorded for all the patients.: A total of 146 patients were initially included in the study; 95 patients received ITM/EPI and 51 received IV-PCA as a historical control. Eight patients from the ITM/EPI group were excluded from the pain comparison portion of the study. There were no statistical differences in age, sex, weight, or hospital stay between the 2 groups. The ITM/EPI group had, on average, 1 additional level of fusion (P=0.001). Daily average pain scores were lower in the ITM/EPI group on all hospital days, and statistically lower in days 1 and 3 to 5. Total opioid requirement was significantly lower in the ITM/EPI patients, although oral opioid use was higher among this group. Total benzodiazepine use was lower among the IV-PCA group. A total of 15.7% of the IV-PCA patients had bladder hypotonia, compared with 1.1% of the ITM/EPI group (P=0.002). The rate of illeus was 15.7% in the IV-PCA patients and 5.7% in the ITM/EPI (P=0.071). Respiratory depression was reported in 4 ITM/EPI patients, 0 in our PCA group. Technical catheter malfunction was reported in 8.5% of the EPI group.: The use of ITM/EPI after PSF for AIS is safe and effective, this methodology provided significantly lower pain scores and lowers total opioid use which can lead to urinary and bowel dysfunction.
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Arthroscopic stabilization for voluntary shoulder instability.

Filed under: Rehab Centers

J Pediatr Orthop. 2012 Dec; 32(8): 781-6
Greiwe RM, Galano G, Grantham J, Ahmad CS

: Voluntary shoulder instability is characterized by a patient’s ability to sublux their shoulder using selective muscle contraction and relaxation. High failure rates exist with open shoulder stabilization in this group of patients. The purpose of this study was to report the outcomes for patients with voluntary instability treated arthroscopically.: All patients with voluntary instability from 2006 to 2008 treated with arthroscopic stabilization were included. All patients had documentation of preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) questionnaire score, visual analogue scale of pain, simple shoulder test, and range of motion. Subjective satisfaction and return to sport was also determined.: Ten patients were identified for inclusion in the study. The average age of the 5 male and 5 female patients was 16.2±2.33 years. Average clinical follow-up period was 31±6.5 months. Visual analogue scale scores improved from 5.33±3.50 preoperatively to 1.44±2.0 postoperatively, ASES scores improved from 52.2±18.7 to 85.9±14.9 and simple shoulder test improved from 8.17±3.19 to 11.4±1.01. All of the functional evaluation scores improved postoperatively (P<0.05). There was no case of postoperative dislocation or subluxation, all reported excellent subjective outcome, and all those who played sports returned to their previous level.: Good and excellent outcomes can be obtained with arthroscopic stabilization for patients with voluntary instability. Improved results from previous reports may be related to improved patient selection, surgical technique, and postoperative rehabilitation. Although long-term follow-up and comparative studies are necessary, arthroscopic stabilization seems to be an acceptable treatment option for patients who fail nonoperative treatment.: Level IV, case series, retrospective review. HubMed – rehab

 

Return to Work After Coronary Angioplasty or Heart Surgery: A 5-Year Experience With the “CardioWork” Protocol.

Filed under: Rehab Centers

J Occup Environ Med. 2012 Nov 9;
Scafa F, Calsamiglia G, Tonini S, Lumelli D, Lanfranco A, Gentile E, Berzolari FG, Candura SM

OBJECTIVE:: The “CardioWork” protocol, for work resumption after invasive heart procedures and subsequent cardiac rehabilitation, is presented. METHODS:: Over 5 years, 107 consecutive patients of working age were enrolled. Jobs were classified as multiples of basal metabolism according to the entity of physical strain. These data were integrated with instrumental evaluations to provide indications regarding time and modality of work resumption. RESULTS:: A total of 89.7% of patients resumed working. Other relevant findings include the correlation of time for work resumption with the kind of treatment and the task energy requirement; the earliness of return to work, even for older people and those performing heavy tasks; and the difficulty of work resumption for those who failed to restart work within 6 months. CONCLUSIONS:: This study highlights the importance of a multidisciplinary rehabilitative approach to facilitate work resumption, adapting the work tasks to the changed psychophysical capabilities.
HubMed – rehab

 

Portable upper extremity robotics is as efficacious as upper extremity rehabilitative therapy: a randomized controlled pilot trial.

Filed under: Rehab Centers

Clin Rehabil. 2012 Nov 12;
Page SJ, Hill V, White S

Objective:To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the ‘Myomo’ versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment.Subjects:Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment.Interventions:Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually.Main outcome measures:The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention.Results:After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ?2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale.Conclusions:Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.
HubMed – rehab

 


 

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