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https://www.readbyqxmd.com/read/28103764/multimodal-pediatric-pain-management-part-2
#1
Stefan J Friedrichsdorf
Dr Stefan Friedrichsdorf speaks to Commissioning Editor Jade Parker: Stefan Friedrichsdorf, MD, is medical director of the Department of Pain Medicine, Palliative Care and Integrative Medicine at Children's Hospitals and Clinics of Minnesota in Minneapolis/St Paul, MN, USA, home to one of the largest and most comprehensive programs of its kind in the country. The pain and palliative care program is devoted to control acute, chronic/complex and procedural pain for inpatients and outpatients in close collaboration with all pediatric subspecialties at Children's Minnesota...
January 20, 2017: Pain Management
https://www.readbyqxmd.com/read/28096578/the-effect-of-pregabalin-and-s-ketamine-in-total-knee-arthroplasty-patients-a-randomized-trial
#2
Lajla Kadic, Frank G van Haren, Oliver Wilder-Smith, Jorgen Bruhn, Jacques J Driessen, Maarten C de Waal Malefijt
BACKGROUND AND AIMS: Pain reduction is important for rehabilitation after total knee arthroplasty. Intra- and peri-articular infiltration with local anesthetics may be an alternative to commonly used locoregional techniques. Adding pregabalin orally and s-ketamine intravenously may further reduce postoperative pain. MATERIAL AND METHODS: This prospective, randomized, double-blind, placebo-controlled study compared two methods of perioperative analgesia. Control patients received a standardized multimodal postoperative analgesic regime of paracetamol, diclofenac, and piritramide-patient-controlled analgesia, including ropivacaine knee infiltration during surgery...
October 2016: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28092334/is-enhanced-recovery-the-new-standard-of-care-in-microsurgical-breast-reconstruction
#3
Anoushka Afonso, Sabine Oskar, Kay See Tan, Joseph J Disa, Babak J Mehrara, Jihan Ceyhan, Joseph H Dayan
BACKGROUND: Enhanced recovery pathways (ERPs) have been shown to aid in patient recovery and improve outcomes in many surgical settings. At present, there is limited data available regarding the use and feasibility of ERPs for patients undergoing microsurgical breast reconstruction. We sought to assess patient outcomes before and after the introduction of an ERP that was adopted by multiple surgeons at a single cancer center. METHODS: A multidisciplinary ERP was developed for patients undergoing deep inferior epigastric perforator (DIEP) or muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction...
January 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28089636/influence-of-perioperative-nonsteroidal-anti-inflammatory-drugs-on-complications-after-gastrointestinal-surgery-a-meta-analysis
#4
REVIEW
Fang Peng, Shijiang Liu, Youli Hu, Min Yu, Jing Chen, Cunming Liu
BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are a key part of multimodal perioperative analgesia. This study aimed to evaluate the influence of perioperative NSAIDs application on complications after gastrointestinal surgery by using meta-analysis. METHODS: A systematic review of published literature was conducted by searching computerized databases including PubMed, CBM, Springer, Chinese Academic Journals, and China Info since the databases were published until June 2015...
January 12, 2017: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
https://www.readbyqxmd.com/read/28089187/effect-of-periarticular-morphine-injection-for-total-knee-arthroplasty-a-randomized-double-blind-trial
#5
Kentaro Iwakiri, Yoshito Minami, Yoichi Ohta, Akio Kobayashi
BACKGROUND: The periarticular multimodal cocktail injection including morphine is currently commonly used to treat postoperative pain after total knee arthroplasty (TKA). Despite its analgesic effect, it is frequently reported to cause nausea and vomiting, which are adverse effects of opioids. This study aimed to assess the efficacy of morphine as a component of a multimodal cocktail injection for providing postoperative analgesia and alleviating swelling in patients who underwent TKA...
December 27, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28072900/efficacy-of-adductor-canal-blockade-compared-to-multimodal-peri-articular-analgesia-following-total-knee-arthroplasty
#6
Chukwuweike U Gwam, Jaydev B Mistry, Priya Jha, Anton Khlopas, Melbin Thomas, Morad Chughtai, Michael A Mont, Ronald E Delanois
INTRODUCTION: Postoperative pain after total knee arthroplasty (TKA) can be an impediment to patient recovery. Many commonly used pain control modalities are effective, but are also associated with adverse effects. Other modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA), have gained popularity due to their efficacy and high safety profile. However, to the best of our knowledge, there are no published studies indicating if a therapeutic advantage exists between the two pain control modalities...
January 10, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28063774/does-addition-of-multimodal-periarticular-analgesia-to-adductor-canal-block-improve-lengths-of-stay-pain-discharge-status-and-opioid-use-after-total-knee-arthroplasty
#7
Chukwuweike U Gwam, Jaydev B Mistry, Anton Khlopas, Morad Chughtai, Melbin Thomas, Michael A Mont, Ronald E Delanois
BACKGROUND: Postoperative pain after total knee arthroplasty (TKA) can be burdensome. Multiple methods of pain control have been used, including adductor canal block (ACB) and multimodal periarticular analgesia (MPA). These two techniques have been studied have proven to be efficacious separately. The purpose of this study was to compare: (1) lengths of stay (LOS), (2) pain level, (3) discharge status, and (4) opioid use in TKA patients who received ACB alone vs patients who received ACB and MPA...
December 14, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28059913/liposomal-bupivacaine-use-in-transversus-abdominis-plane-blocks-reduces-pain-and-postoperative-intravenous-opioid-requirement-after-colorectal-surgery
#8
Audrey L Stokes, Sanjib D Adhikary, Ashley Quintili, Frances J Puleo, Christine S Choi, Christopher S Hollenbeak, Evangelos Messaris
BACKGROUND: Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery. OBJECTIVE: The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery. DESIGN: This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks...
February 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28058143/evaluation-of-the-analgesic-efficacy-of-dexketoprofen-added-to-paracetamol
#9
Dilek Ceyhan, Ayten Bilir, Mehmet Sacit Güleç
OBJECTIVE: Multimodal analgesic methods are preferred for the treatment of postoperative pain; as a result, the additive effects of analgesics are provided while probable side effects are avoided. The current study aimed to compare the effects of the combination of dexketoprofen and paracetamol with regard to postoperative pain therapy. METHODS: Ninety-six patients who underwent non-malignant gynaecological laparotomy operations were included in this study. Patients were randomized into 3 groups...
December 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/28058142/comparison-of-intraabdominal-and-trocar-site-local-anaesthetic-infiltration-on-postoperative-analgesia-after-laparoscopic-cholecystectomy
#10
Gülsüm Altuntaş, Ömer Taylan Akkaya, Derya Özkan, Mehmet Murat Sayın, Şener Balas, Elif Özlü
OBJECTIVE: This study aimed to compare the efficacy of local anaesthetic infiltration to trocar wounds and intraperitoneally on postoperative pain as a part of a multimodal analgesia method after laparoscopic cholecystectomies. METHODS: The study was performed on 90 ASA I-III patients aged between 20 and 70 years who underwent elective laparoscopic cholecystectomy. All patients had the same general anaesthesia drug regimen. Patients were randomized into three groups by a closed envelope method: group I (n=30), trocar site local anaesthetic infiltration (20 mL of 0...
December 2016: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/28025372/a-pooled-analysis-evaluating-renal-safety-in-placebo-and-active-comparator-controlled-phase-iii-trials-of-multiple-dose-injectable-hp%C3%AE-cd-diclofenac-in-subjects-with-acute-postoperative-pain
#11
Stephen E Daniels, Tong J Tj Gan, Douglas A Hamilton, Neil Singla, Peter G Lacouture, Olufunmibi Johnson, Lauren H Min, Christian R D Reyes, Daniel B Carr
OBJECTIVE : While injectable nonsteroidal anti-inflammatory drugs (NSAIDs) are a key component of postoperative multimodal analgesia, renal safety concerns may limit use in some patients. This study examined the renal safety of injectable HPβCD-diclofenac when given for ≤ 5 days following orthopedic or abdominal/pelvic surgery. METHODS : Pooled analysis of data from two randomized, placebo- and active comparator-controlled phase III trials in 608 total patients was conducted. Renal safety was assessed by examining treatment-emergent adverse events (AEs) and postoperative blood urea nitrogen (BUN) and serum creatinine shifts...
December 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28018759/could-the-use-of-an-enhanced-recovery-protocol-in-laparoscopic-donor-nephrectomy-be-an-incentive-for-live-kidney-donation
#12
Aparna Rege, Harold Leraas, Deepak Vikraman, Kadiyala Ravindra, Todd Brennan, Tim Miller, Julie Thacker, Debra Sudan
INTRODUCTION AND BACKGROUND: Gastrointestinal (GI) recovery after major abdominal surgery can be delayed from an ongoing need for narcotic analgesia thereby prolonging hospitalization. Enhanced recovery after surgery (ERAS) is a multimodal perioperative care pathway designed to facilitate early recovery after major surgery by maintaining preoperative body composition and physiological organ function and modifying the stress response induced by surgical exposure. Enhanced recovery programs (ERPs) in colorectal surgery have decreased the duration of postoperative ileus and the hospital stay while showing equivalent morbidity, mortality, and readmission rates in comparison to the traditional standard of care...
November 22, 2016: Curēus
https://www.readbyqxmd.com/read/28012528/the-effect-of-iv-dexamethasone-versus-local-anesthetic-infiltration-technique-in-postoperative-nausea-and-vomiting-after-tonsillectomy-in-children-a-randomized-double-blind-clinical-trial
#13
Zoher Naja, Saleh Kanawati, Rania Al Khatib, Fouad Ziade, Zeina Z Naja, Ahmad Salah Naja, Mariam Rajab
BACKGROUND: Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain. OBJECTIVES: To compare the effect of intravenous dexamethasone versus pre-incision infiltration of local anesthesia in pediatric tonsillectomy on postoperative nausea and vomiting (PONV). The secondary objective was postoperative pain. METHODS: A randomized double-blind clinical trial was conducted at a tertiary care teaching hospital...
January 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28007030/ultrasound-anatomy-of-the-transversus-abdominis-plane-region-in-pregnant-women-before-and-after-cesarean-delivery
#14
Nicholas Kiefer, Stefanie Krahe, Ulrich Gembruch, Stefan Weber
BACKGROUND: After cesarean delivery, analgesia is often incomplete and a multimodal approach to analgesia is necessary. Transverse abdominal plane (TAP) block has been advocated in this setting, yet no systematic description of the ultrasound anatomy in pregnant women exists in the literature. Therefore, we aimed to describe the sonographical features of relevant structures in pregnant women before and after elective cesarean. METHODS: Sixty women at, or close to term scheduled for elective cesarean delivery underwent a standardized ultrasound examination before and after delivery...
December 22, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/28005125/the-role-of-liposomal-bupivacaine-in-value-based-care
#15
Richard Iorio
Multimodal pain control strategies are crucial in reducing opioid use and delivering effective pain management to facilitate improved surgical outcomes. The utility of liposomal bupivacaine in enabling effective pain control in multimodal strategies has been demonstrated in several studies, but others have found the value of liposomal bupivacaine in such approaches to be insignificant. At New York University Langone Medical Center, liposomal bupivacaine injection and femoral nerve block were compared in their delivery of efficacious and cost-effective multimodal analgesia among patients undergoing total joint arthroplasty (TJA)...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005123/addressing-the-opioid-epidemic-with-multimodal-pain-management
#16
Michael A Kelly
The opioid epidemic has become a national public health and safety problem affecting both adults and adolescents. There is little doubt that this epidemic is rooted in the need for pain control after surgery and that orthopedic surgeons have in part contributed to opioid overprescription. Indeed, opioid abuse, misuse, and diversion are associated with increased hospitalizations, emergency department visits, and associated health care costs. In addition, postoperative exposure to opioids correlates with long-term use and abuse...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28005122/opioid-sparing-pain-control-in-outpatient-total-joint-arthroplasty
#17
John W Barrington
Postoperative pain management is vital to promoting recovery and improving clinical outcomes. Although improved understanding of pain pathways has led to the development of varied approaches for controlling pain after surgery, some approaches are associated with potentially harmful side effects. Several lines of evidence have demonstrated that opioid analgesics can have unwanted adverse effects on patients having surgery. Similarly, risks associated with femoral nerve blocks have outweighed the benefits. Liposomal bupivacaine has shown efficacy in reducing the need for opioid analgesics and nerve blocks...
November 2016: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28002096/duloxetine-as-an-analgesic-reduces-opioid-consumption-after-spine-surgery-a-randomized-double-blind-controlled-study
#18
Antonio Bedin, Rafael Antonio Caldart Bedin, Joaquim Edson Vieira, Hazem Adel Ashmawi
OBJECTIVES: Multimodal analgesia is widely advocated for the control of perioperative pain in an effort to reduce the use of opioid. Duloxetine is a selective inhibitor of serotonin and norepinephrine reuptake with efficacy for chronic pain conditions. The primary objective of this study was to evaluate the efficacy of two 60 mg oral doses of duloxetine in terms of fentanyl consumption during the postoperative period in patients undergoing elective spine surgery. METHODS: This study was prospective, double blind, randomized, and placebo controlled...
December 19, 2016: Clinical Journal of Pain
https://www.readbyqxmd.com/read/27984226/intraperitoneal-instillation-of-lidocaine-improves-postoperative-analgesia-at-cesarean-delivery-a-randomized-double-blind-placebo-controlled-trial
#19
Ruchira Patel, Jose C A Carvalho, Kristi Downey, Marcelo Kanczuk, Paul Bernstein, Naveed Siddiqui
BACKGROUND: Cesarean delivery is a commonly performed procedure worldwide. Despite improvements in balanced multimodal analgesia, there remains a proportion of women for whom postoperative pain relief and patient satisfaction are still inadequate. Intraperitoneal instillation of local anesthetic has been shown to be effective in reducing postoperative pain after abdominal surgery. We sought to investigate the effect of intraperitoneal instillation of lidocaine on postcesarean delivery pain as part of a multimodal analgesia regimen...
February 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27984223/multimodal-analgesic-therapy-with-gabapentin-and-its-association-with-postoperative-respiratory-depression
#20
Alexandre N Cavalcante, Juraj Sprung, Darrell R Schroeder, Toby N Weingarten
BACKGROUND: Gabapentinoids are widely used in perioperative multimodal analgesic regimens. The primary aim of this study was to determine whether gabapentin was associated with respiratory depression during phase-I postanesthesia recovery after major laparoscopic procedures. METHODS: We retrospectively reviewed the electronic health records of 8567 patients who underwent major laparoscopic procedures (lasting ≥90 minutes) from January 1, 2010, to July 31, 2014...
December 15, 2016: Anesthesia and Analgesia
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