Jeffrey Sterritt

Purpose of Review This narrative review addresses the growing public health concern of persistent opioid use following major orthopedic surgery. It aims to identify and analyze the critical factors that contribute to the transition from acute to persistent opioid consumption in this context. Recent Findings Patient-related characteristics, including pre-existing conditions and prior substance use, are critical predictors of prolonged opioid use. Additionally, surgery-related factors such as the type and duration of procedures complicate postoperative pain management. The prevalence of persistent opioid use after surgery remains high despite the emergence of effective Enhanced Recovery After Surgery protocols and patient education initiatives. Multimodal analgesia is highlighted as a vital strategy for reducing the risk of long-term opioid dependency. Summary Persistent opioid use after orthopedic surgery poses significant challenges, including increased risks of physical and mental health complications, the development of opioid use disorder, and a substantial economic burden on healthcare systems. Targeted interventions and continuous research are essential to mitigate these risks, reduce long-term opioid dependency, and improve overall patient outcomes.

Purpose of Review Hip surgeries are commonly associated with significant postoperative pain, which can hinder early mobilization, prolong hospital stays, and increase healthcare costs. Effective pain management in this patient population is crucial to improving outcomes and reducing complications. Recent Findings Traditional pain control methods, such as systemic opioids, are often associated with adverse effects, including respiratory depression, nausea, and delayed recovery. Regional anesthesia techniques, particularly the suprainguinal fascia iliaca block (SFIB), have gained attention for the potential to provide targeted, long-lasting analgesia with fewer systemic side effects. Conclusion This narrative review evaluates efficacy of the SFIB, an effective and safe technique for postoperative pain management in hip surgeries. The fascia iliaca block, initially described as a low-volume alternative to the lumbar plexus block, has evolved, with the suprainguinal approach demonstrating particular promise. By accessing the lumbar plexus and blocking the femoral, obturator, and lateral femoral cutaneous nerves, the SIFIB provides broad analgesia to the hip region. Recent studies have highlighted that, compared to traditional infrainguinal approaches, the suprainguinal technique offers superior spread and more consistent pain control related to its targeted proximity to the inguinal ligament. Consequently, this technique may optimize perioperative pain management and improve functional recovery in patients undergoing hip surgeries.

Etizolam is a thienodiazepine derivative which produces an anxiolytic effect similar to benzodiazepines such as alprazolam (Xanax). Like classic benzodiazepines, etizolam has a high affinity towards the GABA_A receptor, and allosterically potentiates the effects of GABA resulting in neuronal hyperpolarization related to chloride influx. When taken in therapeutic doses, etizolam produces a similar effect to Xanax. Counterfeit Xanax tablets contain variable amounts of etizolam. Tablets with high amounts of etizolam can cause toxicity if ingested, especially when combined with other substances. When toxic symptoms occur in patients, they may include severe sedation, unconsciousness, and depression of the medullary respiratory center. In this regard, there is the potential for death. Additionally, the rise in fake Xanax tablets containing etizolam and other counterfeit medications has been exacerbated by the difference in regulations regarding these substances in different countries as well as the illegal drug trade. Healthcare providers may also play a role through the over- or underprescribing of certain medications. Thus, in order to combat the rise in counterfeit medications such as fake Xanax, international cooperation, regulation, and enforcement of laws pertaining to the manufacture, prescription, and distribution of these substances are needed.

Purpose of Review Patients often experience a significant degree of knee pain following total knee replacement (TKR). To alleviate this pain, nerve blocks may be performed such as the adductor canal block (ACB). However, ACBs are unable to relieve pain originating from the posterior region of the knee. A new type of nerve block known as the IPACK block may be used in conjunction with ACBs as it is designed to inhibit nerve branches innervating this area. In this article, we examine the rationale behind the IPACK procedure, how it is performed, and clinical trials examining its efficacy. Recent Findings 5 of the 7 clinical trials examined in this article showed the IPACK + ACB block to show superior efficacy in treating pain following TKR compared to other blocks. These blocks included PMDI+ACB, SPANK+ACB, PAI+ACB, ACB alone, and SCAB. 2 of the 7 clinical trials showed the IPACK + ACB to be less effective in managing patients pain following TKR compared to other blocks which included the CACB and 4 in 1 block. Summary In most instances, the IPACK + ACB showed superior efficacy in managing patients’ pain following TKR when compared to other types of nerve blocks. This was determined by measuring usage of opioids, reported postoperative pain, and length of hospital stays following TKR. Thus, we suppose the IPACK block may be used in conjunction with the ACB to effectively reduce patient’s pain following TKR.