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A 47-year-old female presents for a total knee arthroplasty. Her medical history is positive for hypertension, rheumatoid arthritis, and a previous history of opioid use disorder. Her current medications include hydrochlorothiazide (HCTZ), lisinopril, and buprenorphine hydrochloride (Subutex). The patient states that if possible she would like to avoid narcotics. What is your anesthetic plan? What is Subutex? How will it affect your anesthetic medications? Is it possible to completely avoid narcotics in the peri-operative period?
A 21-year-old female softball pitcher had a surgical ulnar nerve transposition/release for pain in her pitching arm three months ago. Now she still complains of severe pain daily. She can barely bend her elbow and has decreased function of her hand. She notes increased sensitivity to cold temperatures and generalized swelling, which is more pronounced on the ulnar side of her hand. She is in your office for pain management. What are your concerns? What is her diagnosis? How will you confirm the diagnosis? How will you treat the patient’s pain?