🔰 SHOULDER CONCLAVE

🗓️ Date: 26" & 27" January, 2024

🏢 Venue: JW Marriott, Pune

🎟️ Theme: Disruptive Innovation

💻 Click here to register: https://tinyurl.com/OrthoTV-SC-2024

🔘 7 ECLECTIC LIVE SURGERIES

▪️A'scopic Bone block with ceclage : Dr. A. Hachem Spain 🇪🇸

▪️A'scopic DAS procedure : Dr. Alexandre Lädermann Switzerland 🇨🇭

▪️Revision Augmented RSA : Dr. George Athwal Canada 🇨🇦

▪️A'scopic SCR : Dr. Teruhissa Mihata Japan 🇯🇵

▪️Subscap Out of box : Dr. Peter Chalmers USA 🇺🇸

▪️Augmented glenoid RSA : Dr. Ashish Gupta Australia 🇦🇺

▪️Scapulo-Thoacic Fusion : Dr. Bassem ElHassan USA 🇺🇸

▶️Media Partner : OrthoTV Global

What is the risk associated with taking opioids after orthopaedic surgery?

This month my group has a paper coming out in the Journal of Pediatric Orthopaedics(first author Eli Cahan) investigating how the risk of development of opioid use disorders may relate to pain medication prescribed after orthopedic procedures. This specific project used a large database to track children and adolescents who had ACL reconstructions, which is a common orthopaedic procedure. We’re also working on a similar project in patients with scoliosis.

This is a topic that is high up on the list of concerns parents have for me when considering surgery for their child. Awareness of the risks of opioid use is high right now and has dramatically changed since I began my training.  Physicians' understanding of their role in the opioid crisis has evolved rapidly over my time as a doctor. Since I was caring for patients as a resident 12 years ago, I have steadily prescribed less opioid medication for the same procedures. Unfortunately, rates of opioid overdose continue to rise in the US.

The idea for this project came after I read an article by a colleague of mine, Alan Schroeder. Dr. Schroeder has research interest in quantifying risk associated with standard medical practice.  The idea is that even though we mean well we may be exposing patients to a lot of unquantified risk for unintended consequences. His group wrote an interesting paper, looking at the risk of opioid use disorder after wisdom tooth removal. They demonstrated that patients who had opioid prescriptions after wisdom tooth removal had a higher risk of developing opioid use disorders in the year after surgery than age-matched controls who did not have surgery. It was a high impact paper that may change the way surgeons counsel patients before elective procedures. We set out to see if opioid prescribing patterns after orthopedic surgery may also put patients at risk.

There are clearly some differences in these two patient populations and our methods and results were not exactly the same. ACL reconstruction, though it is not an emergent procedure, is in a different category of elective procedures than wisdom tooth removal. Our patients are already starting with an injury that causes pain.  We first demonstrated that the incidence new diagnosis of opioid use disorder in the year after ACL surgery was fairly low at about 0.7% Since people did not choose whether or not to have an ACL injury, we decided to forgo the control group and instead to look at how differences in opioid prescribing patterns after surgery might relate to subsequent risk of developing opioid use disorder.  We looked for, but did not find, a relationship between the volume of the initial prescription and development of opioid use disorder.  We did, however, find that patients who developed an opioid use disorder within a year postop were much more likely to have received a repeat prescription of opioids after their initial prescription.  

It's worth noting that our methods probably only picked up the most severe cases of opioid use disorder so there might be a larger population of patients with milder problems with opioid use that go undiagnosed.  Furthermore, there are probably other benefits to decreasing the amount of opioid initially prescribed.  We work with our anesthesia and pain medicine team to prescribe multimodal regimens that include a lot of non opioid pain control techniques to try to minimize the amount of opioids that patients take.

This should make providers think twice about re-prescribing opioids after ACL reconstruction and may help identify a patient population at risk for opioid use disorders.  We hope that by identifying this patient population early we can decrease the risk!

John Vorhies MD

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🔰Fellows’ Academic Round by Orthokids

📚 Day to Day Pediatric Orthopaedics Module - Session 6

🗓️ Date : Saturday, 30 September 2023

🕗 Timing : 8:00 AM - 9:00 AM

💻Click to watch: https://tinyurl.com/OrthoTV-Orthokids-43

🔘 Topic & Faculty

▫️ Approach to a limping child - Dr. Ashish Ranade (Pune)

▪️ Approach to a toe walker - Dr. Nirmal Raj Gopinathan (Chandigarh),

🔆 Moderator : Dr.Chinmay Sangole, Amravati

🤝OrthoTV Team: Dr Ashok Shyam, Dr Neeraj Bijlani

📺 Streaming live on OrthoTV www.orthotvonline.com

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‼️ONLY 7 Days to GO‼️

🙋🏻Second Slab Closes on 31st Jan

🔰PUNE TRAUMA OPERATIVE COURSE The most revolutionary trauma course of 2023 is Back Again🔅

12, 13, 14 April 2024 I JW Marriott, Pune

🎟️ THEME - COMPLEX FRACTURES & RECONSTRUCTIVE SURGERIES

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🔆Organising Team 🔹Parag Sancheti (Chairman) 🔹Chetan Pradhan (Co-Chairman) 🔹Atul Patil (Co-Chairman) 🔹Chetan Puram (Co-Chairman) 🔹Warid Altaf (Co-Chairman) 🔹Sachin Tapasvi (Co-Chairman) 🔹Sandeep Patwardhan (Scientific Chair) 🔹Ashok Shyam (Organising Secretary)

The Conference that Offers So Much More....

▶️ Media partner: OrthoTV Global Ashok Shyam, Neeraj Bijlani

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