The Economics of APS

Dr. Hari Parvataneni, a prominent orthopaedic surgeon who specializes in joint replacement surgery wrote this interesting editorial on liposomal bupivacaine and separates pseudo-science from real science. He argues that the market penetration of this drug far exceeds the scientific evidence behind it. For at least the past 30 years since 1988 companies sought for this magic bullet, but because not only the effects but also the side effects of such long-acting local anesthetic agents would linger.

The mystery quadriceps weakness has alluded us for decades. Traditionally femoral nerve block has been vilified as the sole perpetrator. The rediscovery of the forgotten truths around Arthrogenic Muscle Inhibition (AMI) and the influence of surgery and trauma of muscle function has shed new light on this issue. Long-term continuous femoral nerve block may even block the neurological pathway of AMI and enhance recovery of, for example, quadriceps muscle function after total knee arthroplasty. DR. Hari Parvataneni and his colleagues…

Dr. Boezaart wrote this editorial on the sensitive topic of the opioid epidemic that is upon us.

Outpatient shoulder and elbow replacement surgery has been practiced since the early 1990’s. Now, there is a big push for outpatient total joint replacement surgery of the hip and knee as well. Because the patients need their lower extremities to ambulate, this pose some unique and complicated problems. This is the protocol used by the University of Florida orthopaedic surgeons to manage these.

Dr. Kiki Nin and her colleagues have been very interested in this question for some time now and wrote this fascinating paper for the December edition of the journal Techniques in Orthopaedics. They challenge the age-old dogma that regional anesthesia may be contra-indicated in patients with crush injuries and fractures in danger of acute compartment syndrome (ACS). They (successfully) argue that the pain of ACS is ischemic pain, transmitted to the central nervous system by the sympathetic nerves that run…

Very often nurses, patients, physical and occupational therapists and other healthcare professional, or even medical device manufacturers and their representatives, do not really fully understand what continuous peripheral nerve blocks are, what the rationale is for sending patients home with such CPNBs, and, finally, what the potential problems could be. This series deals with it, and this third tutorial explains what can go wrong with CPNBs.

Very often nurses, patients, physical and occupational therapists and other healthcare professional, or even medical device manufacturers and their representatives, do not really fully understand what continuous peripheral nerve blocks are, what the rationale is for sending patients home with such CPNBs, and, finally, what the potential problems could be. This series deals with it, and this second tutorial explains the rational use of CPNBs at the patient’s home.

Very often nurses, patients, physical and occupational therapists and other healthcare professional, or even medical device manufacturers and their representatives, do not really fully understand what continuous peripheral nerve blocks are, what the rationale is for sending patients home with such CPNBs, and, finally, what the potential problems could be. This series deals with it, and this first tutorial explains what CPNBs are.

Drs. Boezaart and Zasimovich wrote this paper recently for journal Techniques in Orthopaedics and explain their views on why continuous peripheral nerve blocks fail. Secondary block failure numbers increased dramatically over the past number of years, which led to a decrease of the popularity of CPNBs amongst surgeons. This paper addresses that issue.

After 45 years of practice, of which the last quarter century was practicing acute and peri-operative pain medicine, Professor André Boezaart teamed up with renowned shoulder surgeon Tom Wright and produced these unique insights into the rational use and pitfalls of regional anesthesia for acute pain management. This article was published in the December 2017 issue of the journal Techniques in Orthopaedics.