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Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Ankle block can be used as a sole anaesthetic technique for foot surgeries including bunionectomy, forefoot reconstruction, osteotomy, foreign body removal and amputation. It can also provide excellent postoperative analgesia for foot and ankle procedures. The block impairs ambulation to a lesser degree than the sciatic or popliteal blocks and this block may be preferable for outpatient forefoot surgery.
Time
Published in Solomon Posen, Edward J Huth, The Doctor in Literature, 2018
Occasionally patients complain, mostly inappropriately, that they require two surgical operations and that the doctors, through indifference or lack of organizational skills, fail to have the two procedures performed simultaneously. Alfred Groves, Dr Rushton’s truculent patient, who requires an emergency aortic embo-lectomy,19,20 feels aggrieved because his bunions are not fixed while he is anesthetized. Groves cannot understand that quite apart from the dangers inherent in orthopedic procedures on ischemic feet, it would be most disruptive for the orthopedic surgeons and their other patients if Groves’ bunionectomy were to be scheduled as an emergency procedure.
Foot and ankle disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
Surgical treatment: The primary problem leading to hallux valgus is the underlying deformity of the first metatarsal and proximal phalanx bones. Therefore, simply removing the bunion (bunionectomy) leads to almost 100% recurrence. The surgical treatment for hallux valgus correction involves metatarsal and phalangeal osteotomies in addition to bunionectomy and soft tissue release (Figure 8.10).
A critical review of oliceridine injection as an IV opioid analgesic for the management of severe acute pain
Published in Expert Review of Neurotherapeutics, 2022
The two randomized, double-blind, placebo- and morphine-controlled studies in patients with moderate-to-severe acute pain following either orthopedic surgery-bunionectomy (APOLLO-1; N = 389) or plastic surgery-abdominoplasty (APOLLO-2; N = 401), evaluated the efficacy of oliceridine [18,19]. Patients with a numeric (pain) rating scale (NRS; 0 to 10) score ≥4 in the bunionectomy trial, and an NRS score ≥5 in the abdominoplasty study were randomized to receive one of five demand-dose regimens: oliceridine 0.1 mg, 0.35 mg or 0.5 mg; a morphine-control of 1 mg; or a volume-matched placebo dose. Patients were treated for up to 48 hours in the orthopedic surgery–bunionectomy study, and for up to 24 hours in the plastic surgery-abdominoplasty study. The loading dose for all oliceridine treatment regimens was 1.5 mg; demand doses were 0.1, 0.35, or 0.5 mg, according to assigned treatment group; supplemental doses of 0.75 mg were permitted, beginning 1 hour after the loading dose, and hourly thereafter, as needed. The loading dose for the morphine treatment regimen was 4 mg; the demand dose was 1 mg; and supplemental doses of 2 mg were permitted, beginning 1 hour after the loading dose, and hourly thereafter, as needed. A lockout interval of 6 minutes was used for all patient-controlled analgesia (PCA) regimens. Patients could receive rescue pain medication (pre-defined in the protocols as etodolac 200 mg every 6 hours, as needed) if they requested rescue pain medication and reported an NRS score ≥4. Oliceridine was not administered as part of multimodal analgesia in these studies [18,19].
Preclinical discovery and development of oliceridine (Olinvyk®) for the treatment of post-operative pain
Published in Expert Opinion on Drug Discovery, 2022
Ammar A.H. Azzam, David G. Lambert
There are two phase-2 studies. Viscusi et al. performed a two-phase randomized placebo and active control study in bunionectomy (moderate to severe acute pain; hard tissue) patients [NCT02100748]. They compared morphine with TRV-130 and placebo. Morphine 4 mg and TRV-130 at 2 and 3 mg were better than placebo for change in numerical rating scale for pain. Analgesia was observed 5 min after administration and the response at 2 and 3 mg was greater than morphine 4 mg. Tolerability of TRV-130 was similar to morphine and there were no serious adverse events [48]. Singla and colleagues studied abdominoplasty (moderate to severe acute pain; soft tissue) patients in a randomized trial of morphine and oliceridine compared to placebo [NCT02335294] [49]. The authors compared 2 × 0.75 mg (1.5 mg total) loading dose of oliceridine followed by demand 0.1–0.35 mg with 2 × 2 mg (4 mg total) loading dose of morphine followed by demand 1 mg. Numerical rating scale for pain was reduced by oliceridine and morphine and was greater than placebo. Time to significant analgesia was faster with oliceridine than morphine. Oliceridine was well tolerated and adverse events were characteristic of opioid treatment (nausea, vomiting, and headache); post hoc analysis showed a lower incidence of nausea and vomiting compared to morphine. Importantly the study reports reduced respiratory adverse events compared to morphine [49].
Utilization of manual therapy to the lumbar spine in conjunction with traditional conservative care for individuals with bilateral lower extremity complex regional pain syndrome: A case series
Published in Physiotherapy Theory and Practice, 2020
Zachary Walston, Luis Hernandez, Dale Yake
Patient 2 was 33-year-old female who underwent bilateral bunionectomy in the fall of 2011. Prior to the surgery, she had no significant pain or symptoms associated with CRPS. Following her surgery, she reported the following symptoms at time of evaluation: purple discoloration of her feet and ankles, hyperalgesia, and allodynia. She reported inability to sleep with the bedsheet on her feet, as the tactile reaction would cause an increase in pain. She was unable to sleep more than 2–3 consecutive hours secondary to pain in her lower extremities. The patient was unable to wear socks or wear shoes secondary to the pain. The patient was diagnosed with CRPS-1 approximately 1 year after having her surgery. She was given Neurontin and referred to outpatient PT for a desensitization program by her pain management doctor. She attended her initial evaluation 1 year after receiving the diagnosis of CRPS-1. At the initial evaluation, the patient gave a localized pain response using NPRS reporting a 24-hour averaged pain of 5/10; current pain, 6/10; maximum pain, 7/10; and minimal pain, 3/10.