BMI, Opioid Use, and Pain Perception: Insights from the DIPA Scale in Orthopedic Patients

Introduction Body Mass Index (BMI) and Morphine Milligram Equivalents (MMEs) are critical factors in pain management, especially for patients undergoing orthopedic procedures such as joint replacement and spinal surgeries. The Detroit Interventional Pain Assessment (DIPA) scale is a novel tool for stratifying pain severity to optimize pain management strategies. This study evaluates the relationship between BMI, MME levels, and pain ratings using this scale, to inform tailored analgesic strategies for orthopedic patients. Methods 527 patients undergoing joint replacement or spinal procedures were included in this retrospective analysis. Patients were categorized by BMI (\u3c30 or ≥30) and MME levels (0, 1–20, 21–49 MME). Pain ratings (no pain, tolerable, intolerable) were assessed using the DIPA scale. Chi-squared tests were used to evaluate associations between BMI and MME levels for each pain rating category. Sample sizes varied across groups, with higher MME categories limited by smaller sample sizes. Statistical significance was determined at p\u3c0.05. Results For MME=0, a significant association was observed between BMI and pain ratings (p=0.022). For MME=1–20 and MME=20–49, no significant associations were noted (p=0.528 and p=0.313, respectively). These findings suggest that BMI may play a significant role in pain perception without opioid usage but becomes less predictive with increasing MME levels due to limited sample sizes. Conclusion This study highlights the interplay between BMI, MMEs, and pain ratings, demonstrating significant associations with no opioid usage. Future research should explore larger cohorts for higher MMEs to refine individualized pain management strategies using the DIPA scale

Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications

An American Text-Book of Gynecology, Medical and Surgical for Practitioners and Students

2nd Edition. 189

All-Suture Anchor Techniques for Biceps Tenodesis Are Noninferior in End-Cycle Stiffness to an Interference Screw Technique; However, Secondary Outcomes, Such as Ultimate Failure Load, Yield Load, Creep, and Load-to-Failure Stiffness, Are Inferior in an Ovine Model

Purpose: To assess the biomechanical performance of 2 simplified loop-and-tack biceps tenodesis techniques, all-suture anchor and all-suture anchor with a button, compared with the interference screw technique in an ovine model. Methods: Twenty-one biceps tenodesis procedures were executed on the humeri and flexor digitorum profundus tendons of skeletally mature, female sheep. Limbs were evenly randomized into 2 experimental groups (all-suture anchor with or without button) and 1 control group (interference screw). Cyclic loading followed by a load-to-failure test was conducted. The primary outcome metric was end-cycle stiffness, or stiffness measured at the end of cyclic loading, because it modeled the resistance of the construct to the lower-force activities of postoperative physical therapy. Secondary metrics included ultimate failure load (UFL), yield load, creep, and load-to-failure stiffness. End-cycle stiffness difference-of-means testing was conducted with a minimal clinically important difference threshold of –15 N/mm (–1.5 kg/mm). Groups were compared using analysis of variance for all recorded variables. Results: Both the all-suture anchor techniques, without a button and with a button, were found to be noninferior in end-cycle stiffness to the interference screw technique (–5.2 N/mm [95% confidence interval, –13.6 to 3.3 N/mm] and –3.8 N/mm [95% confidence interval, –12.5 to –4.9 N/mm], respectively) with a minimal clinically important difference of –15 N/mm. The all-suture techniques showed significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness (P < .001, P < .001, P = .002, and P < .001, respectively). Tendon dimensions did not vary significantly across groups. Conclusions: Under subfailure loading conditions, the all-suture anchor techniques with a button and without a button showed end-cycle stiffness noninferiority to an interference screw technique; however, these techniques were inferior in all secondary outcomes, including significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness. Clinical Relevance: The all-suture anchor approaches with a button and without a button may retain the natural length-tension dynamics of the long head of the biceps tendon because fixation can occur before the release of the tendon origin. Additionally, they may offer a simpler and more cost-effective alternative to prevailing arthroscopic methods

Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis

BACKGROUND Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. METHODS We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). RESULTS Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P = 0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (−2.3 mm Hg; 95% CI, −4.4 to −0.2; P = 0.03). CONCLUSIONS Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; ClinicalTrials.gov number, NCT00081731.