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Transmuscular Quadratus Lumborum Block Does Not Provide Significant Benefit for Primary Hip Arthroscopy with Pericapsular Infiltration: A Randomized Control Trial

Umeh, Uchenna O; Kaplan, Daniel J; Diskina, Dina; Commeh, Ekow; Cuff, Germaine; Hertling, Arthur; Youm, Thomas
PURPOSE/OBJECTIVE:To prospectively evaluate the effectiveness of the transmuscular quadratus lumborum block (TQLB) with pericapsular injection (PCI) versus PCI alone in patients undergoing hip arthroscopy for treatment of femoroacetabular impingement (FAI) in terms of perioperative pain control, as well as postoperative function in the postoperative anesthesia unit (PACU) setting. METHODS:Patients undergoing hip arthroscopy for FAI were prospectively randomized to receive 30 mL of 0.5% bupivacaine in a TQLB (n = 52) with PCI versus PCI alone (n = 51). The PCI included 20 mL of 0.25% bupivacaine given by the surgeon. All analyzed patients received general anesthesia. The primary outcome was postoperative pain scores assessed via the numerical rating scale (NRS) at 30 minutes postoperatively and immediately prior to discharge. Secondary outcomes were opioid utilization, expressed as morphine milligram equivalents (MMEs), PACU recovery time, quadriceps strength (assessed after completion of PACU phase 1 criteria), and adverse events (nausea/vomiting). RESULTS:Average age, body mass index, and preoperative pain assessment were not significantly different between groups. There were no differences in NRS pain scores preoperatively, 30 minutes postoperatively, or immediately prior to discharge between groups (P > .05). Intraoperative opioid consumption was significantly lower in the TQLB group (MME: 16.8 ± 7.9) compared to controls (MME 20.6 ± 8.0; P = .009). However, there was no difference in the total opioid consumption (P > .05). There was no significant difference in total PACU length of stay (minutes) between the treatment (133.0 ± 48) and control groups (123.5 ± 47; P > .05). Quadriceps weakness was not significantly different between groups (P = .2). There was no difference in the number of patients that experienced nausea or vomiting between the TQLB group and control group (13% vs 16%; P = .99). Neither group had any reported serious adverse events. CONCLUSIONS:TQLB and PCI do not improve postoperative pain scores or total opioid consumption compared to PCI alone. TQLB may decrease the amount of intraoperative opiate usage. LEVEL OF EVIDENCE/METHODS:Level I, randomized controlled trial.
PMID: 37100214
ISSN: 1526-3231
CID: 5605642

Implementing Telemedicine During the COVID-19 Pandemic: Disparities in Utilization in an Urban Pain Medicine Practice

Rockholt, Mika M; Addae, Gifty; Chee, Alexander; Chin, Wanda; Cuff, Germaine; Wang, Jing; Umeh, Uchenna O; Doan, Lisa V
PURPOSE/UNASSIGNED:The COVID-19 pandemic led to a drastic expansion in utilizing telemedicine, circumventing some of the geographical barriers to accessing pain care. However, uncertainties around the impact of telemedicine across various sociodemographic groups still exist, prompting further exploration. Therefore, this study aimed to evaluate the impact of sociodemographic factors in telemedicine utilization during and after the COVID-19 pandemic. PATIENTS AND METHODS/UNASSIGNED:All outpatient non-procedural visits at the pain medicine division of a large academic institution in the epicenter of the pandemic (New York, USA), between March 2019 and October 2021, were retrospectively included. Sociodemographic data including gender, age, ethnicity/race, postal code, and type of health insurance, across three time periods associated with the COVID-19 pandemic - pre-lockdown (in-office visits only), lockdown (telemedicine visits only) and post-lockdown (offering both in-office and telemedicine visits) - were analyzed and compared. RESULTS/UNASSIGNED:In total, 12,615 unique patients - The majority being women (58%) - were seen during the whole study period. In the post-lockdown period, telemedicine was utilized by 42% of all patients. Follow-up visits, younger patients, white patients, patients residing further away from the hospital, and privately insured patients were more likely to utilize telemedicine post-lockdown (p <0.05). Older patients, minorities, Manhattan residents, and Medicare/Medicaid recipients, were more likely to use in-office visits post-lockdown (p <0.05). CONCLUSION/UNASSIGNED:We identified disparities in the utilization of telemedicine in Pain Medicine, which may be due to socioeconomic factors such as lack of access to reliable internet access, cost of devices, and technological know-how. This emphasizes the need for further studies to better understand the reasons for and barriers to telemedicine use. This could help inform policymaking to safeguard equitable access to telemedicine use for pain care.
PMCID:10422968
PMID: 37577160
ISSN: 1178-7090
CID: 5599502

Regional anesthesia for acute and subacute orthopedic trauma: A review

Fisher, N D; Bi, A S; Umeh, U O; Vaz, A M; Egol, K A
Pain management in the setting of acute and subacute orthopedic trauma can be challenging. Due to the recent focus on the rising opioid epidemic, as well as the adverse side of effects of opioid pain medication, multimodal pain control has become the standard of care for management of orthopedic trauma, particularly during operative fixation. The purpose of this paper is to report on the use of regional anesthesia for surgical intervention of extremity fractures in patients who present following traumatic injury as part of a multimodal pain management protocol. Types of, indications for, and outcomes of both upper and lower extremity peripheral nerve blocks will be reviewed.
Copyright
EMBASE:2019050654
ISSN: 2772-6320
CID: 5511842

Satisfaction with telemedicine among anesthesiologists during the COVID-19 pandemic

Umeh, U O; Roediger, F; Cuff, G; Romanenko, Y; Vaz, A; Hertling, A
The COVID-19 pandemic has rapidly changed the way that health care providers interact with patients, particularly through the widespread implementation of telemedicine. Previous studies in other medical specialties have examined the role of telemedicine and physician satisfaction with the modality [1], but no such studies have been reported in the field of anesthesiology. The purpose of the study was to evaluate the scope of use and satisfaction with telemedicine among anesthesiologists who were ASA and ESAIC members. We developed a survey that was sent out to anesthesia providers through the European Society of Anaesthesiology and Intensive Care (ESAIC) and the American Society of Anesthesiology (ASA). The survey was open for the duration of 30 days, after which it was closed and no new responses could be generated. The survey comprised three major sections and examined, (1) the characteristics of the anesthesia providers, (2) the settings within which they were using telemedicine, and (3) their satisfaction with the experience. We performed analyses to determine if there was a significant difference in satisfaction for those who used telemedicine prior to COVID-19 compared to those who started using it during the pandemic. There were a total of 708 responses from various provider demographics. Satisfaction with developing patient rapport was higher than satisfaction with airway and physical exam. Providers who were using telemedicine before the pandemic had consistently higher rates of satisfaction across all the subcategories. Familiarity with the software could have played a role in this result. Overall, satisfaction among users was high and the majority of practitioners, 86.3%, plan to continue using telemedicine in their practice.
Copyright
EMBASE:2018837797
ISSN: 2210-8467
CID: 5292942

Anesthesia in Total Shoulder Arthroplasty: A Systematic Review and Meta-Analysis

Boin, Michael A; Mehta, Devan; Dankert, John; Umeh, Uchenna O; Zuckerman, Joseph D; Virk, Mandeep S
»:For shoulder arthroplasty, regional anesthesia is safer when compared with general anesthesia. There is insufficient evidence to demonstrate the superiority of regional anesthesia with respect to pulmonary complications and hospital length of stay. »:Infiltration of the shoulder with local anesthetics offers no additional benefits compared with single-shot or continuous brachial plexus blocks for shoulder arthroplasty. »:There is high-quality evidence (Level I) demonstrating lower pain scores and lower perioperative opioid requirements after a continuous peripheral nerve block compared with a single-shot nerve block. However, catheter dislodgment and logistical issues with catheter insertion are impediments to the widespread usage of a continuous nerve block with an indwelling catheter. »:Liposomal bupivacaine is comparable with non-liposomal local anesthetic agents with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after total shoulder arthroplasty. »:Perioperative dexamethasone administration improves postoperative pain control, decreases perioperative opioid requirements, and reduces postoperative nausea.
PMID: 34757963
ISSN: 2329-9185
CID: 5050572

The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery

Perskin, Cody R; Littlefield, Connor P; Wang, Charles; Umeh, Uchenna; Egol, Kenneth A
»:Tranexamic acid (TXA) is a drug used to control hemorrhage by preventing the breakdown of fibrin. »:TXA is a cost-effective treatment for trauma patients across a variety of economic settings. »:Concerns of TXA causing thromboembolic events (TEEs) in orthopaedic trauma patients are not supported by evidence. »:TXA has been shown to reduce blood loss in hip fracture surgery.
PMID: 34270510
ISSN: 2329-9185
CID: 5003872

Adductor Canal Blocks Reduce Inpatient Opioid Consumption While Maintaining Noninferior Pain Control and Functional Outcomes After Total Knee Arthroplasty

Feng, James E; Ikwuazom, Chibuokem P; Umeh, Uchenna O; Furgiuele, David L; Slover, James D; Macaulay, William; Long, William J; Schwarzkopf, Ran
BACKGROUND:The use of perioperative adductor canal blocks (PABs) continues to be a highly debated topic for total knee arthroplasty (TKA). Here, we evaluate the effect of PABs on immediate postoperative subjective pain scores, opioid consumption, and objective functional outcomes. METHODS:On December 1, 2019, an institution-wide policy change was begun to use PABs in primary elective TKAs. Patient demographics, immediate postoperative nursing documented pain scores, opioid administration events, and validated physical therapy functional scores were prospectively collected as part of the standard of care and retrospectively queried through our electronic data warehouse. A historical comparison cohort was derived from consecutive patients undergoing TKA between July 1, 2019 and November 30, 2019. RESULTS:405 primary TKAs received PABs, while 789 patients were in the control cohort. Compared with controls, average verbal rating scale pain scores were lower among PAB recipients from 0-12 hours (2.42 ± 1.60 vs 2.05 ± 1.60; <.001) and 24-36 hours (4.92 ± 2.00 vs 4.47 ± 2.27; <.01). PAB recipients demonstrated significantly lower opioid consumption within the first 24 hours (44.34 ± 40.98 vs 36.83 ± 48.13; P < .01) and during their total inpatient stay (92.27 ± 109.81 vs 77.52 ± 123.11; <.05). AM-PAC scores within the first 24 hours were also higher for PABs (total scores: 20.28 ± 3.06 vs 20.71 ± 3.12; <.05). CONCLUSION/CONCLUSIONS:While the minimal clinically important differences in pain scores and functional status were comparable between both cohorts, patients demonstrated a significant reduction in overall inpatient opiate consumption after the introduction of PABs. Surgeons should consider these findings when evaluating for perioperative pain management, opioid-sparing, and rapid discharge protocols.
PMID: 33618955
ISSN: 1532-8406
CID: 4794342

Coagulation and Regional Anesthesia

Chapter by: Cherenfant, Chrissy; Umeh, Uchenna
in: Essentials of Blood Product Management in Anesthesia Practice by Scher, Corey S; Kaye, Alan David; Liu, Henry; Perelman, Seth; Leavitt, Sarah (Eds)
Cham : Springer International Publishing AG, 2021
pp. 423-431
ISBN: 3030592952
CID: 4832072

Considerations and Guidelines for Use of Anticoagulants and Antithrombotics in Patients Undergoing Interventional Pain Management

Chapter by: Renschler, Jordan S; Granier, Amanda L; Jeha, George M; Scheinuk, John E; Nungesser, Matthew E; Etienne, Joshua M; Erwin, Abigail P; Cherenfant, Chrissy; Umeh, Uchenna; Webb, Michael PK
in: Essentials of Blood Product Management in Anesthesia Practice by Scher, Corey S; Kaye, Alan David; Liu, Henry; Perelman, Seth; Leavitt, Sarah (Eds)
Cham : Springer International Publishing AG, 2021
pp. 443-454
ISBN: 3030592952
CID: 4832082

ANESTHESIA IN TOTAL SHOULDER ARTHROPLASTY A Systematic Review and Meta-Analysis [Review]

Boin, Michael A.; Mehta, Devan; Dankert, John; Umeh, Uchenna O.; Zuckerman, Joseph D.; Virk, Mandeep S.
ISI:000756914000007
ISSN: 2329-9185
CID: 5242902