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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

[S.l. : American Association of Hip and Knee Surgeons], 2020

Adductor Canal Blocks Significantly Improve Postoperative Pain, Opioid Consumption and Function in TKA

Feng, James E; Mahure, Siddharth A; Waren, Daniel; Ikwuazom, Chibuokem P; Umeh, Uchenna; Furgiuele, David L; Slover, James D; Macaulay, William; Long, William J; Schwarzkopf, Ran
CID: 4840332

Liposomal Bupivacaine plus bupivacaine for interscalene brachial plexus block decreases opioid consumption for up to 1 week compared to bupivacaine alone in patients undergoing total shoulder arthroplasty

Umeh, Uchenna; Cuevas, Randy; Virk, Mandeep; Kwon, Young; Cuff, Germaine; Hertling, Arthur
ISSN: 0265-0215
CID: 4840342

Orthopedic analgesia

Chapter by: Umeh, U
in: Handbook of fractures by Egol, Kenneth A.; Koval, Kenneth J; Zuckerman, Joseph D (Eds)
Philadelphia : Wolters Kluwer, [2020]
pp. 102-115
ISBN: 9781496301031
CID: 4274252

[S.l. : American Society of Anesthesiologists], 2019

Adductor Canal and Distal Femoral Triangle Nerve Blocks Provide Similar Analgesia and Opioid Consumption Following Anterior Cruciate Ligament Surgery

Desai, Prianka; Chuy, Katherine; Thangada, Shruthima; Umeh, Uchenna O; Atchabahian, Arthur
CID: 4840322

Neuraxial anesthesia/analgesia

Chapter by: Marks, R; Umeh, U
in: Acute pain medicine by Buckenmaier, Chester, III (Ed)
New York, NY : Oxford University Press, [2019]
pp. 539-543
ISBN: 0190856645
CID: 4274262