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Anesthesiology Clinics

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https://www.readbyqxmd.com/read/30092943/regional-anesthesiology-and-acute-pain-medicine-in-the-era-of-value-based-health-care
#1
EDITORIAL
Nabil M Elkassabany, Edward R Mariano
No abstract text is available yet for this article.
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092942/regional-anesthesia-what-we-need-to-know-in-the-era-of-enhanced-recovery-after-surgery-protocols-and-the-opioid-epidemic
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092941/what-can-regional-anesthesiology-and-acute-pain-medicine-learn-from-big-data
#3
REVIEW
Nabil M Elkassabany, Stavros G Memtsoudis, Edward R Mariano
Demonstrating value added to patients' experience through regional anesthesiology and acute pain medicine is critical. Evidence supporting improved outcomes can be derived from prospective studies or retrospective cohort studies. Population-based studies relying on existing clinical and administrative databases are helpful when an outcome is rare and detecting a change would require studying large numbers of patients. This article discusses the effect of regional anesthesiology and acute pain medicine interventions on mortality and morbidity, infection rate, cancer recurrence, inpatient falls, local anesthetic systemic toxicity, persistent postsurgical pain, and health care costs...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092940/pediatric-ambulatory-continuous-peripheral-nerve-blocks
#4
REVIEW
Sible Antony, Harshad Gurnaney, Arjunan Ganesh
Despite the widespread use of ambulatory continuous peripheral nerve blocks in adults, its use in children has been sporadic. Indications for the use of ambulatory continuous peripheral nerve block in children involve orthopedic procedure, where significant pain is anticipated beyond 24 hours. Techniques to place the perineural catheters in children are similar to that used in adults. The incidence of serious side effects in pediatric ambulatory continuous peripheral nerve block is extremely rare. When this is combined with the potential to increase patient and family satisfaction and decrease opioid-related side effects, ambulatory continuous peripheral nerve block become a compelling choice...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092939/regional-anesthesia-and-analgesia-for-acute-trauma-patients
#5
REVIEW
Ian R Slade, Ron E Samet
Regional anesthesia for the acute trauma patient is increasing due to the growing appreciation of its benefits, development of newer techniques and equipment, and more robust training. Block procedures are expanding beyond perioperative interventions performed exclusively by anesthesiologists to paramedics on scene, emergency medicine physicians, and nurse-led services using these techniques early in trauma pain management. Special considerations and indications apply to trauma victims compared with the elective patient and must be appreciated to optimize safety and clinical outcomes...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092938/enhanced-recovery-after-shoulder-arthroplasty
#6
REVIEW
Taras Grosh, Nabil M Elkassabany
Enhanced recovery after surgery (ERAS) protocols depend on multidisciplinary care and should be peer-reviewed and data-driven. ERAS has reduced hospital length of stay and complications, simultaneously improving patient outcomes. ERAS protocol after shoulder arthroplasty features multidisciplinary collaboration among different perioperative services and multimodal analgesia with a focus on regional anesthesia. Despite success, adoption is not universal because ERAS protocols are resource intensive. They require clinicians invested in the success of these programs and patients who can take charge of their own health...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092937/update-on-selective-regional-analgesia-for-hip-surgery-patients
#7
REVIEW
Dario Bugada, Valentina Bellini, Luca F Lorini, Edward R Mariano
In hip surgery, regional anesthesia offers benefits in pain management and recovery. There are a wide range of regional analgesic options; none have shown to be superior. Lumbar plexus block, femoral nerve block, and fascia iliaca block are the most supported by published literature. Other techniques, such as selective obturator and/or lateral femoral cutaneous nerve blocks, represent alternatives. Newer approaches, such as quadratus lumborum block and local infiltration analgesia, require rigorous studies...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092936/novel-methodologies-in-regional-anesthesia-for-knee-arthroplasty
#8
REVIEW
Rodney A Gabriel, Brian M Ilfeld
Maximizing analgesia is critical following joint arthroplasty because postoperative pain is a major barrier to adequate physical therapy. Continuous peripheral nerve blocks have been the mainstay for acute pain management in this population; however, this and similar techniques are limited by their duration of action. Cryoneurolysis and peripheral nerve stimulation are two methodologies used for decades to treat chronic pain. With the advent of portable ultrasound devices and percutaneous administration equipment, both procedures may now be suitable for treatment of acute pain...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092935/updates-in-enhanced-recovery-pathways-for-total-knee-arthroplasty
#9
REVIEW
Lisa Kumar, Amanda H Kumar, Stuart A Grant, Jeff Gadsden
Enhanced recovery after surgery (ERAS) programs for orthopedics involve a multidisciplinary approach to accelerating return to function, reducing pain, improving patient comfort and satisfaction, reducing complications from the surgical procedure, reducing hospital length of stay, and reducing costs. ERAS pathways for patients receiving total knee arthroplasty are different from those having intracavitary surgery; they are less focused on fluid homeostasis and gut motility than they are with optimizing systemic and local analgesics and providing a balance between the highest quality pain control and accelerated return to ambulation...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092934/updates-on-multimodal-analgesia-for-orthopedic-surgery
#10
REVIEW
Darsi N Pitchon, Amir C Dayan, Eric S Schwenk, Jaime L Baratta, Eugene R Viscusi
Pain control after orthopedic surgery is challenging. A multimodal approach provides superior analgesia with fewer side effects compared with opioids alone. This approach is particularly useful in light of the current opioid epidemic in the United States. Several new nonopioid agents have emerged into the market in recent years. New agents included in this review are intravenous acetaminophen, intranasal ketorolac, and newer nonsteroidal anti-inflammatory drugs, and the established medications ketamine and gabapentinoids...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092933/perioperative-considerations-for-the-patient-with-opioid-use-disorder-on-buprenorphine-methadone-or-naltrexone-maintenance-therapy
#11
REVIEW
Thomas Kyle Harrison, Howard Kornfeld, Anuj Kailash Aggarwal, Anna Lembke
As part of a national effort to combat the current US opioid epidemic, use of currently Food and Drug Administration-approved drugs for the treatment of opioid use disorder/opioid addiction (buprenorphine, methadone, and naltrexone) is on the rise. To provide optimal pain control and minimize the risk of relapse and overdose, providers need to have an in-depth understanding of how to manage these medications in the perioperative setting. This article reviews key principles and discusses perioperative considerations for patients with opioid use disorder on buprenorphine, methadone, or naltrexone...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/30092932/establishing-an-acute-pain-service-in-private-practice-and-updates-on-regional-anesthesia-billing
#12
REVIEW
Christopher A J Webb, T Edward Kim
Acute pain management is an expanding perioperative specialty and there is a renewed focus on implementing and developing an acute pain service (APS) in nonacademic hospitals (ie, "private practice"). An anesthesiologist-led APS can improve patient care by decreasing perioperative morbidity and potentially reducing the risk of chronic postsurgical pain syndromes. Elements of a successful APS include multidisciplinary collaboration to develop perioperative pain protocols, education of health care providers and patients, and regular evaluation of patient safety and quality of care metrics...
September 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759291/integrating-academic-and-private-practices-challenges-and-opportunities
#13
REVIEW
Aviva Regev, Aman Mahajan
As health care reform shifts toward value over volume, academic medical centers, known for highly specialized, high-cost care, will suffer from erosion of their traditional funding sources. Academic medical centers have undertaken mergers and partnerships with community medical centers, to maintain a more diversified, cost-effective, and competitive presence in their markets. These consolidations have seen varying results. Cultural factors are frequently cited as a cause of dysfunction and disintegration. Anesthesiology groups integrating academic and private practice physicians are likely to face many of the same challenges...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759290/anesthesiology-s-future-with-specialists-in-population-health
#14
REVIEW
Mike Schweitzer
In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759289/comprehensive-acute-pain-management-in-the-perioperative-surgical-home
#15
REVIEW
John-Paul J Pozek, Martin De Ruyter, Talal W Khan
The careful coordination of care throughout the perioperative continuum offered by the perioperative surgical home (PSH) is important in the treatment of postoperative pain. Physician anesthesiologists have expertise in acute pain management, pharmacology, and regional and neuraxial anesthetic techniques, making them ideal leaders for managing perioperative analgesia within the PSH. Severe postoperative pain is one of many patient- and surgery-specific factors in the development of chronic postsurgical pain...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759288/perioperative-surgical-home-for-the-patient-with-chronic-pain
#16
REVIEW
Talal W Khan, Smith Manion
The management of acute pain for the phenotypically different patient who suffers from chronic pain is challenging. The care of these patients is expensive and siloed. The physician-led, multidisciplinary, patient-centric, care coordination framework of the perioperative surgical home is an optimal vehicle for the management of these patients. The engagement of physician anesthesiologists in the optimization, in-hospital management, and postdischarge care of the patient with chronic pain will lead to improved outcomes, reduced health care expenditures, and improve the health of this challenging population...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759287/comprehensive-preoperative-assessment-and-global-optimization
#17
REVIEW
Neil N Shah, Thomas R Vetter
To successfully deliver greater perioperative value-based care and to effectively contribute to sustained and meaningful perioperative population health management, the scope of existing preoperative management and its associated services and care provider skills must be expanded. New models of preoperative management are needed, which rely extensively on continuously evolving evidence-based best practice, as well as telemedicine and telehealth, including mobile technologies and connectivity. Along with conventional comorbidity optimization, prehabilitation can effectively promote enhanced postoperative recovery...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759286/bundled-payments-and-hidden-costs
#18
REVIEW
Stanley W Stead, Sharon K Merrick
In a fee-for-service environment, anesthesiologists are paid for the volume of services billed, with little relation to the cost of delivering the services. In bundled payments, anesthesiologists are paid a set fee for an episode of care inclusive of all the anesthesia, pain medicine, and related services for the surgical episode and a period of time after the initial procedure to cover complications and redo procedures. When calculating a bundled payment, all the services typically used by a patient must be counted when calculating both the costs and expected payment...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759285/value-proposition-and-anesthesiology
#19
REVIEW
Joseph W Szokol, Keith J Chamberlin
Health care in general and anesthesia in particular have seen dramatic changes in the economic landscape. It is vital if anesthesia groups wish to survive and prosper in this new environment to understand the changes occurring in health care and be flexible and proactive in taking on these challenges. More than ever anesthesia groups must be good corporate citizens and seek ways in which to enhance their value to the organization, whether in the operating room or out of operating room locations, and be a proactive partner with the hospital...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29759284/quality-and-the-health-system-becoming-a-high-reliability-organization
#20
REVIEW
Monaliza Gaw, Frank Rosinia, Thomas Diller
Since the publication of "To Err is Human" in 1999, substantial efforts have been made within the health care industry to improve quality and patient safety. Although improvements have been made, recent estimates continue to indicate the need for a marked change in approach. In this article, the authors discuss the concepts and characteristics of high reliability organizations, safety culture, and clinical microsystems. The health care delivery system must move beyond current quality and patient safety approaches and fully engage in these new concepts to transform health care system performance...
June 2018: Anesthesiology Clinics
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