Shilpadevi Patil

Purpose of Review Total knee replacement (TKR) is a common procedure to alleviate pain in patients with severe osteoarthritis of the knee after failed conservative treatment. While generally safe, postoperative pain is a significant issue many patients experience following surgery. Recent Findings To control postoperative pain, numerous treatments may be administered which may be given preoperatively, intraoperatively, or postoperatively. These treatments include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids. Additionally, peripheral nerve blocks (PNB) may be performed prior to total knee replacement to limit pain after the surgery. A specific type of PNB done prior to total knee replacement is the genicular nerve block (GNB) which targets five genicular nerves that innervate different parts of the knee joint. This type of block is designed to prevent pain impulses from being sent to the central nervous system from the knee without affecting movement of the lower extremity by sparing efferent nerves innervating muscles. PubMed was used to identify the studies found in this review that are less than 5 years old using the search term “genicular nerve block clinical studies.” Most studies compared GNB alone compared to other blocks, however some used GNB in combination with other blocks, most at a maximum of 48 h postoperative. Summary GNB is typically performed by anesthesiologists under ultrasound guidance to ensure accurate placement of the block. Clinical studies have shown that GNB is effective in controlling pain following TKR leading to lower pain scores following surgery as well as a reduced level of opioid consumption. Additionally, GNB has shown reduced motor weakness following TKR compared to other types of PNBs allowing earlier mobilization of patients. However, more studies are needed to further investigate the efficacy of GNB compared to other PNBs to treat postoperative pain following TKR.

Background This analysis is a systematic literature review assessing efficacy and adverse effects of three alpha-2 agonists for the symptomatic management of autism spectrum disorder (ASD). Methods The present investigation involved an extensive systematic search for eligible studies in PubMed, Embase, Cochrane Library, and Google Scholar. Nine studies, collectively incorporating 226 patients, were assessed. Results The results demonstrated promising indications for use of alpha-2 agonists in the symptomatic management of autism spectrum disorders, including improvement of hyperactivity, impulsivity, attention deficit symptoms, irritability, and stereotypies in many of the participants studied. Conclusion The present investigation encourages physicians to consider treatment outcomes of clonidine, guanfacine, and lofexidine to determine the most effective management of ASD-related symptoms and to minimize adverse effects. However, our review cannot provide definitive treatment protocols related to various study limitations.

Purpose of Review Chronic pain affects a significant portion of the population globally, making it a leading cause of disability. Understanding the multifaceted nature of chronic pain, its various types, and the intricate relationship it shares with risk factors, comorbidities, and mental health issues like depression and anxiety is critical for comprehensive patient care. Factors such as socioeconomic status (SES), age, gender, and obesity collectively add layers of complexity to chronic pain experiences and pose management challenges. Recent Findings Low SES presents barriers to effective pain care, while gender differences and the prevalence of chronic pain in aging adults emphasize the need for tailored approaches. The association between chronic pain and physical comorbidities like cardiovascular disease, chronic obstructive pulmonary disease (COPD), and diabetes mellitus reveals shared risk factors and further highlights the importance of integrated treatment strategies. Chronic pain and mental health are intricately linked through biochemical mechanisms, profoundly affecting overall quality of life. This review explores pharmacologic treatment for chronic pain, particularly opioid analgesia, with attention to the risk of substance misuse and the ongoing opioid epidemic. We discuss the potential role of medical cannabis as an alternative treatment with a nuanced perspective on its impact on opioid use. Summary Addressing the totality and complexity of pain states is crucial to individualizing chronic pain management. With different types of pain having different underlying mechanisms, considerations should be made when approaching their treatment. Moreover, the synergistic relationship that pain states can have with other comorbidities further complicates chronic pain conditions.

Background This analysis is the first systematic review and meta-analysis assessing occurrences of ICD in PD patients treated with oral DAs: ropinirole (ROP) and pramipexole (PRX). This study compares the two oral DAs to a transdermal patch, rotigotine (RTG). Methods We performed an extensive systematic search for eligible studies from PubMed, Embase, Cochrane Library, and Google Scholar. The data was analyzed by various software, including EndNote, Rayyan, PRISM, and RevMan. Two studies incorporating 658 patients collectively were assessed. Results This meta-analysis shows a significant correlation between the usage of PRX (25.3%) or ROP (21.8%) and the development of ICD in PD patients. Compared to the transdermal patch, RTG, PRX was found to have a significant relative risk (P < 0.0001) of 3.46 (95% CI 2.07–5.76), and ROP was found to have a significant relative risk (P < 0.0001) of 2.98 (95% CI 1.77–5.02). The data collected shows RTG is approximately three times less likely to cause ICDs than oral PRX and ROP. Conclusion The present investigation provides insight into ICD occurrences with PRX, ROP, and RTG to allow physicians to make more informed decisions on risk versus reward when deciding how to treat a PD patient with these drugs. However, related to various disclosed limitations, our conclusion cannot provide definitive practice protocols.