Finger growth plate injuries are the most common youth climbing injuries. The purpose of our study was to understand youth awareness of the most common youth climbing injury and safe training practices. We surveyed climbers, ages eight to 18 years old, at the 2017 USA Climbing Sport and Speed Youth National Championships. A total of 267 climbers completed the survey (mean age = 14 ± 2.7 years; 52% male). The A2 pulley injury was reported as the most common youth climbing injury by the largest portion of participants, 36%. The second most commonly identified injury was at the growth plate of the finger, 15% of participants, which was reported as significantly less than the A2 pulley injury, p < 0.001. Six percent of climbers reported the correct safe age to start double dyno campus board training. Roughly 18% of athletes identified growth plate injuries exclusively as a stress fracture, whereas 29.2% of those climbers self-reported as informed about finger growth plate injuries, but only 7.4% of climbers who self-reported as uninformed answered this question correctly. Misperceptions about skeletally-immature climbing injuries are prevalent amongst youth climbers. Education on the prevalence of finger growth plate injuries and the scarcity of A2 pulley injuries in youth climbers can increase diagnostic accuracy, improve care, and reduce long-term complications.

Study Design: A prospective observational study with a historical reference group. Objectives: The main objectives of this study were to determine the impact of preventative multimodal analgesia (PMA) on postoperative opioid requirements and analgesic effectiveness in patients undergoing lumbar fusion surgery. Summary of Background Data: PMA addresses the multiple pathways of acute and chronic pain by interfering with peripheral and central sensitization and should provide a way to achieve safer and more effective pain management with reduced opioid medication use. Materials and Methods: This study compared postoperative opioid requirement and analgesic effect in a total of 101 patients undergoing elective, 1-level or 2-level transforaminal lumbar interbody fusion surgeries for symptomatic lumbar degenerative disk disease. The PMA patient group included 51 consecutive patients who received 1000 mg of acetaminophen, 300–900 mg of gabapentin, and 200–400 mg of celecoxib 1 hour before their index procedure. The reference group included 50 patients who received 15 mg of morphine-equivalent dose (MED) preoperatively. Multiple linear regression was used to evaluate the effect of PMA on postoperative pain and MED over 4 postoperative days, while controlling for all variables likely to influence these outcomes, including age, sex, baseline opioid use, duration of surgery, postoperative intrathecal morphine use and the administration of muscle relaxants and anticonvulsants. Results: The differences in opioid requirement and postoperative pain scores were statistically significant on all 4 postoperative days. The effect size varied from −0.54 to −0.99 (34.8%–54.2% MED reduction) for the postoperative opioid requirement and from −0.59 to −1.16 (28.9%–37.3% visual analog scale reduction) for postoperative pain indicating that these measures were reduced by about ½ to 1 SD in the PMA patient group. Conclusions: PMA is a highly effective and safe method for postoperative pain management in patients undergoing elective lumbar fusion surgeries by improving pain control and reducing opioid requirement. Level of Evidence: Level III.

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INTRODUCTION Preventive multimodal analgesia (PMA) addresses multiple sources and pathways of acute and chronic pain by interfering with peripheral and central sensitization and should provide a way to achieve safer and more effective pain management with reduced opioid medication use. The main objectives of this study were to determine the impact of PMA on postoperative opioid requirements and analgesic effectiveness in patients undergoing lumbar fusion surgery. METHODS A prospective observational study with a historical reference group was performed. The study compared the postoperative opioid requirement and analgesic effect in a total of 103 patients undergoing elective, one- or two-level transforaminal lumbar interbody fusion (TLIF) surgeries for symptomatic lumbar degenerative disc diseases. The PMA patient group included 52 consecutive patients who received 1000 mg of acetaminophen, 300 consecutive patients receiving 900 mg of gabapentin, and 200 consecutive patients receiving 400 mg of celecoxib 1 h before the procedure. The reference group included 51 patients who received 15 mg of morphine-equivalent dose (MED) preoperatively. Multiple linear regression was used to evaluate the influence of PMA on pain, MED, and acetaminophen use over 4 postoperative days (PODs), while controlling for all variables likely to influence these outcomes, including age, gender, baseline opioid use, duration of surgery, postoperative intrathecal morphine use, and administration of muscle relaxants and anticonvulsants. RESULTS The differences in opioid requirement and postoperative pain scores were statistically significant on all 4 postoperative days. The effect size varied from –0.54 to –0.99 for the postoperative opioid requirement and from –0.59 to –1.16 for postoperative pain, indicating that these measures were reduced by about ½ to 1 standard deviation in the PMA patient group. CONCLUSION PMA is a highly effective method for postoperative pain management in patients undergoing lumbar fusion surgeries, which not only improves pain control, but also reduces the opioid requirement.

A number of influent rivers cross the southern outcrop of the Carboniferous Limestone in South Wales. They lose a proportion of their flow to groundwater via both discrete sinks and leaky river beds. These influent rivers represent a pollution threat to local springs that is dependent upon many factors including antecedent conditions, pollutant type, the location of pollutant loss and the nature and volume of influent flow. An attempt is made to define the catchment area of Schwyll Spring public water supply, near Bridgend in South Wales, prior to considering the potential for pollution fi'om influent rivers.