Gbadebo Hakeem Ibraheem
@unilorin.edu.ng
Lecturer, Faculty of Clinical Sciences
Head
University of Ilorin
EDUCATION
MBBS, University of Ibadan, 2002
Fellow West African College of Surgeons (Ortho) 2010
Master of Surgery (Tr&Orth), University of Edinburgh, 2016
RESEARCH, TEACHING, or OTHER INTERESTS
Orthopedics and Sports Medicine, Surgery
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
SummaryBackgroundExcessive opioid prescribing following surgery contributes to the growing opioid crisis. Prescribing practices are modifiable, yet data to guide appropriate prescription of opioids at surgical discharge remain sparse. This study aimed to evaluate factors associated with opioid consumption following discharge from surgery.MethodsAn international prospective multicentre cohort study was performed recruiting adult patients undergoing common general, orthopaedic, gynaecological and urological surgery, with follow‐up 7 days after discharge. The primary outcome measures were the quantities of prescribed and consumed opioids in oral morphine milligram equivalents. Descriptive and multivariable analyses were performed to investigate factors associated with the primary outcome measures.ResultsThis analysis included 4273 patients from 144 hospitals in 25 countries. Overall, 1311 (30.7%) patients were prescribed opioids at discharge. For those patients prescribed opioids, mean (SD) 179 (240) oral morphine milligram equivalents were prescribed, yet only 81 (145) oral morphine milligram equivalents were consumed within the first 7 days after discharge. An increased dose of opioids prescribed at discharge was associated with an increased dose of opioids consumed during the follow‐up period (β = 0.33 (95%CI 0.31–0.34), p < 0.001). The risk of prescribing more opioids than patients consumed increased as quantities of opioids prescribed at discharge exceeded 100 oral morphine milligram equivalents, independent of patient comorbidity, procedure and pain. Patients were prescribed more than twice the quantity of opioids they consumed in the first 7 days following discharge from surgery.ConclusionsOur data suggest that the current quantities of opioids provided at discharge exceed patient needs and may contribute to increasing community opioid use and circulation.
, William Xu, Gordon Liu, Chris Varghese, Cameron Wells, Nicolas Smith, John Windsor, Lorane Gaborit, Sarah Goh, Aya Basam,et al.
Oxford University Press (OUP)
Abstract Background Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. Methods This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. Results The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1–30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80–100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. −1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. Conclusion Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
GlobalSurg Collaborative Covidsurg Collaborative, Ergin Erginöz, Juan J. Segura-Sampedro and Fardis Vosoughi
Oxford University Press (OUP)
Abstract Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
O. Salawu, G. Ibraheem, J. Mejabi, C. Nwosu, B. Ahmed, A. Suleiman and O. Babalola
Limb gangrene is a common orthopedic emergency in this part of the world, but neonatal limb gangrene is a rare pathology. Sepsis is a common complication of limb gangrene which can lead to mortality if not managed early. Here is a case of left leg gangrene in a 16-day-old female neonate following the application of local cosmetic agent ("lele") by the mother prior to naming ceremony. The patient presented with features of septicemia; she was resuscitated, and left below-knee amputation was done for her. Harmful and unnecessary cosmetics should be avoided in neonates.
OniNasiru Salawu, OM Babalola, JO Mejabi, AA Fadimu, BA Ahmed, GH Ibraheem, and DM Kadir
Medknow
Background: Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation. Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population. Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below-knee amputation (46.8%), followed by above-knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis. Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees.
ZA Suleiman, IK Kolawole, BA Ahmed, OM Babalola, and GH Ibraheem
Medpharm Publications
Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria. Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months. Results: The pain and ODI scores at baseline and at six months’ follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively. Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.
Kolawole Wasiu Wahab, Emmanuel O. Sanya, Philip B. Adebayo, Musbaudeen O. Babalola, and Hakeem G. Ibraheem
Oman Medical Journal
Entrapment neuropathy is the result of pressure on a peripheral nerve as it passes through a narrow canal that is bounded by stiff tissues. In spite of their ubiquitous nature, they are underdiagnosed, underreported, and sometimes not properly managed, especially in developing countries. Entrapment neuropathies are of various types, but the most common type is carpal tunnel syndrome. Mechanisms involved in the pathophysiology of entrapment neuropathies include mechanical compression and nerve ischemia. A clear understanding of the various types and the underlying mechanisms of entrapment neuropathies are invaluable in the decision-making process involved in the management of every patient with the condition.
GH Ibraheem, ON Salawu, OM Babalola, DM Kadir, BA Ahmed, SB Agaja, A Olawepo, and AA Nasir
Medknow
Background: Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. Objective: The objective of this study is to determine the outcome of management of closed femoral shaft fractures in adult patients, using open locked intramedullary nailing. Patients and Methods: This is a prospective study which was carried out on all adult patients aged 16 years and above who presented within 2 weeks of sustaining closed femoral shaft fractures to the accident and emergency unit of a University Teaching Hospital in Nigeria from January 2013 to December 2013. Pathological fractures were excluded from the study. The procedure was carried out using standard techniques, and each patient was followed up for a minimum of 1 year. Results: Forty-three patients were recruited into the study. They had a mean age of 36.9 ± 11.7 years, with a male to female ratio of 2.9:1. The most common cause of closed femoral shaft fractures was road traffic crashes (95.3%), with motorcycle-related injuries found to be the highest type (56.1%). The rate of union in the study was 95.3%. The average time to radiological union was 14.0 ± 1.2 weeks while the mean time to painless full weight bearing was 14.2 ± 1.2 weeks. Among the complications encountered were broken nails (4.7%), infection, loosening of the distal screw, and limb length discrepancy (2.3% each). Using Thoresen's criteria, excellent results were obtained in 93% and poor results in 4.7% of patients. Conclusion: Open locked intramedullary nailing gives excellent clinical outcomes with high union and low complication rates in the management of closed femoral shaft fractures in adult patients.
Salawu ON, Babalola OM, Ahmed BA, Ibraheem GH, and Kadir DM
Malaysian Orthopaedic Association
Introduction: Bone graft is harvested from bone and used to stimulate bone healing due to its properties. The aims of the study were to compare the quantity of graft harvested from proximal tibia and iliac crest, and the complications at these donor sites. Materials and Methods: This was a prospective study carried out on all consecutive patients who had orthopaedic procedures that required bone grafting at the study centre, from April, 2015 to March, 2016. Results: During the study period, 86 patients were recruited; 43 of these patients had bone graft harvested from the proximal tibia, while the other 43 patients had graft harvested from the iliac crest. There were 53 males, and 33 females. Mean age of patients was 41.2 ± 11 years and 40.8 ± 16 years, for proximal tibia and iliac crest group respectively. Average compressed volume of graft harvested from proximal tibia and iliac crest were 7cm3 and 5.5cm3 respectively. Non-unions were the commonest indications for bone grafting, femur was the commonest bone requiring bone grafting. Complications such as primary haemorrhage, pain and surgical site infection were commoner with iliac crest than proximal tibia donor sites, however bone graft harvested from both proximal tibia and iliac crest provided adequate bone union of the indicated procedure. Conclusion: Larger quantity of graft can be harvested from proximal tibia than the iliac crest. Though graft harvested from both the proximal tibia and the iliac crest have good healing properties, the proximal tibia donor site gave less complication than the iliac crest.