In The News: May 2012
Anesthesia May Be More Effective Than Opioids After Knee Surgery
A recent study has shown that local anesthesia delivered through a catheter in the joint may be more beneficial than traditional opioids, such as morphine and oxycodone, for the management of pain following knee replacement surgery. Researchers administered either bupivacaine, a common analgesic, or normal saline through a catheter in the joint of 150 knee-replacement patients. The catheters released fluid for two days following surgery. Patients were asked to complete questionnaires on the day of surgery, twice each day until discharge, and at four-week follow-up. Patients who received bupivacaine reported the least pain and the lowest narcotic consumption. There also was no significant difference in postoperative complications. Researchers concluded that delivery of an analgesic into the joint space provided an effective alternative for pain relief with no increase in infection risk and without the disadvantages encountered with epidural anesthesia, regional nerve blocks, and patient-controlled analgesia pumps.
Rapid Bone Loss Seen as Potential Side Effect of Anti-Obesity Drug
An endocrine hormone used in clinical trials as an anti-obesity and anti-diabetes drug has been found to cause significant and rapid bone loss in mice, raising concerns about its safety. The hormone, fibroblast growth factor 21 (FGF21), promoted bone loss by enhancing the activity of a protein that stimulates fat cells but inhibits bone cells. The study, carried out by researchers at the University of Texas Southwestern Medical Center, found that rodents fed a drug form of the hormone over a two-week period lost 78 percent of their spongy bone. Conversely, researchers found that mice completely lacking the hormone had comparable gains in bone mass. Authors of the study said that use of the hormone is a trade-off of benefits and risks, concluding, “The key will be to design a drug that can leverage the two against each other, dialing out the side effects and dialing in the positive.”
Heart Failure Associated With Increased Fracture Risk
A new study has shown that heart failure is associated with a significant increase in major fractures. Previous studies have suggested that heart failure may lead to fractures not only because it increases a patient’s propensity to fall, but because both heart failure itself and its medical treatments can lead to loss of bone mass. This study, however, demonstrated for the first time that heart failure and bone thinning go hand in hand. The study included 45,509 adults undergoing bone mineral density testing for the first time who were followed for up to 10 years. Of these adults, 1,841 had recent-onset heart failure. After adjusting for traditional osteoporosis risk factors, researchers found that heart failure was linked to a 30 percent increase in major fractures. Authors of the study suggested that part of the osteoporosis screening process should involve examination of chest X-rays of patients who have experienced heart failure. Such X-rays often incidentally show fractures of the spine that would provide an indication of osteoporosis and need for treatment.
Large U.S. Study Shows Obesity Linked to Pain
A clear association between obesity and pain—with higher rates of pain identified in the heaviest individuals—has been found in a study of more than one million Americans. Researchers at New York’s Stony Brook University surveyed 1,010,762 respondents by phone between 2008 and 2010. Sixty-three percent of those who responded were classified as overweight (38 percent) or obese (25 percent) Obese respondents were further classified into one of three obesity levels. In comparison to individuals with low to normal weight, the overweight group reported 20 percent higher rates of pain. The increase of reported pain in comparison to the normal-weight group grew rapidly in the obese groups: 68 percent higher for the slightly obese group, 136 percent higher for the more obese group, and 254 percent higher for the group considered most obese. The study’s authors said their findings suggest that obesity alone may cause pain, aside from the presence of painful diseases.