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Pain, ambulatory surgery

Volker Gebhardt, Sebastian Hausen, Christel Weiss, Marc D Schmittner
PURPOSE: Knee arthroscopies are regularly carried out in an outpatient setting. The purpose of this retrospective analysis was to investigate the impact of different local anaesthetics for spinal anaesthesia on operating room efficiency (perioperative process times) and postoperative recovery. This study aims to determine the optimal LA for SPA in patients undergoing knee arthroscopy at a day-surgery centre. METHODS: Anaesthesia records of all patients undergoing knee arthroscopy under spinal anaesthesia from 2010 until 2017 were analysed...
December 14, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Sabine Schulze, Nele Ondreka, Sara Malberg, Emma J Laws, Martin J Schmidt
A 2-year-old male neutered mixed breed dog with a body weight of 30 kg was presented for evaluation of a soft subcutaneous mass on the dorsal midline at the level of the caudal thoracic spine. A further clinical sign was intermittent pain on palpation of the area of the subcutaneous mass. The owner also described a prolonged phase of urination with repeated interruption and re-initiation of voiding. The findings of the neurological examination were consistent with a lesion localization between the 3rd thoracic and 3rd lumbar spinal cord segments...
October 2018: Tierärztliche Praxis. Ausgabe K, Kleintiere/Heimtiere
David Choi, Menelaos Pavlou, Rumana Omar, Mark Arts, Laurent Balabaud, Jacob Maciej Buchowski, Cody Bunger, Chun Kee Chung, Maarten Hubert Coppes, Bart Depreitere, Michael George Fehlings, Norio Kawahara, Chong-Suh Lee, YeeLing Leung, Juan Antonio Martin-Benlloch, Eric Maurice Massicotte, Christian Mazel, Bernhard Meyer, Fetullah Cumhur Oner, Wilco Peul, Nasir Quraishi, Yasuaki Tokuhashi, Katsuro Tomita, Christian Ulbricht, Jorrit-Jan Verlaan, Michael Wang, Hugh Alan Crockard
AIM: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate. We designed a risk calculator to estimate survival after surgery, to inform clinicians and patients when making management decisions. METHODS: A prospective cohort study was performed, including 1430 patients with spinal metastases who underwent surgery...
December 6, 2018: European Journal of Cancer
Patrícia Oliveira, Ana Duarte, André Guimarães, Armindo Fernandes, Catarina Ferreira, Diana Amorim, Filipa Gouveia, Joana Almeida, Madalena Braga, Mariana Oliveira, Mónica Durães, Rita Pichel, José Romão
INTRODUCTION: Chronic postoperative pain is the most frequent late complication of inguinal hernia repair surgery. The aim of this study is to evaluate the incidence of chronic post-hernioplasty pain in outpatient care at Centro Hospitalar do Porto, describe it, analyse its relation with other variables defined in the literature and study its functional interference. MATERIAL AND METHODS: We performed a retrospective cohort study between February and May 2016, using a structured telephone interview composed of questions from the authors and sections of published questionnaires, two of which are validated for the Portuguese language and culture...
November 30, 2018: Acta Médica Portuguesa
Federico Ampil, Guillermo Sangster, Gloria Caldito, Troy Richards, Yen Ngo, Donghyun Kim, Quyen Chu
BACKGROUND/AIM: Radiotherapy for carcinoma invasion of the sacrum (CIS) is an alternative treatment to surgery in patients with advanced, inoperable tumors or those not medically eligible for resection of the neoplasm. Herein we present an observational study of patients with imaging-confirmed CIS who were treated non-operatively with radiation. PATIENTS AND METHODS: A retrospective chart review of CIS patients treated with palliative radiotherapy (PR) during a 9-year period (2004-2013) was performed...
December 2018: Anticancer Research
Robin N Kamal, Raj Behal
PURPOSE: Carpal tunnel surgery is one of the most common procedures completed on the upper limb in the United States. There is currently no evidence-based high-value clinical care pathway to inform the management of carpal tunnel syndrome (CTS). We created an evidence-based care pathway and implemented a quality improvement initiative to evaluate its effect on patient time, quality, and cost in a tertiary care ambulatory surgery center. METHODS: We developed a high-value clinical care pathway for CTS and implemented the intraoperative phase of the pathway...
November 28, 2018: Journal of Hand Surgery
Mehdi Afathi, Nacer Mansouri, Kaissar Farah, Victor Benichoux, Benjamin Blondel, Stéphane Fuentes
Study Design: Retrospective case series observational study. Purpose: Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. Overview of Literature: Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture...
November 29, 2018: Asian Spine Journal
Jorinde Aw Polderman, Violet Farhang-Razi, Susan Van Dieren, Peter Kranke, J Hans DeVries, Markus W Hollmann, Benedikt Preckel, Jeroen Hermanides
BACKGROUND: In the perioperative period, dexamethasone is widely and effectively used for prophylaxis of postoperative nausea and vomiting (PONV), for pain management, and to facilitate early discharge after ambulatory surgery.Long-term treatment with steroids has many side effects, such as adrenal insufficiency, increased infection risk, hyperglycaemia, high blood pressure, osteoporosis, and development of diabetes mellitus. However, whether a single steroid load during surgery has negative effects during the postoperative period has not yet been studied...
November 23, 2018: Cochrane Database of Systematic Reviews
Avani Vaishnav, Patrick Hill, Steven McAnany, Catherine H Gang, Sheeraz Qureshi
STUDY DESIGN: This was a retrospective review of prospectively collected data. OBJECTIVE: To evaluate differences in patient factors, procedural factors, outcomes and safety in 2-level anterior cervical discectomy and fusion (ACDF) performed in ambulatory surgery centers (ASCs) versus the hospital setting. BACKGROUND: Emphasis on reducing health care costs has led to numerous surgeries across specialties being performed in ASCs. Because of short operative times and moderate postoperative pain, 1-level ACDF is one of the most common spine surgeries successfully performed in ASCs...
November 20, 2018: Clinical Spine Surgery
Natalie Vaughn, Niraja Rajan, Michael Darowish
BACKGROUND: Bier block provides anesthesia of an entire extremity distal to the tourniquet without necessitating direct injection at the surgical site. This avoids obscuring anatomy with local anesthetic and anesthetizes a wide area, allowing for multiple procedures and incisions. We hypothesize that a low-volume Bier block with forearm tourniquet, rather than a traditional brachial tourniquet, is a safe, well-tolerated, and effective anesthesia technique. METHODS: All cases in which adult patients underwent hand procedures using Bier block anesthesia by a single surgeon over a 4-year period were reviewed...
November 21, 2018: Hand: Official Journal of the American Association for Hand Surgery
M F Watcha, E Medellin, A D Lee, M A Felberg, S A Bidani
BACKGROUND: As the intensity of nausea, a subjective symptom, is difficult to estimate in children, vomiting is used as the objective clinical endpoint in managing paediatric postoperative nausea and vomiting. The pictorial Baxter Retching Faces (BARF) scale is a validated quantitative measure of paediatric nausea, but versions in languages other than English have not been validated. METHODS: Healthy Spanish-speaking children aged 7-18 yr (n=184) undergoing elective ambulatory surgery rated perioperative pain and nausea using visual analogue (VAS) and pictorial Faces Pain Scale - Revised and BARF scales, along with a Likert scale measurement of symptom changes...
December 2018: British Journal of Anaesthesia
Jack M Haglin, Jakub Godzik, Rohit Mauria, Tyler Cole, Corey T Walker, Udaya Kakarla, Juan S Uribe, Jay D Turner
BACKGROUND: Sagittal imbalance in adult spinal deformity (ASD) likely influences balance and ambulatory capacity due to muscular demand, pain, and disability. Disability measures for ASD rely heavily on ambulatory function, yet current metrics may fail to fully capture its contribution. We sought to determine (1) the utility of continuous remote step-count monitoring and activity tracking in ASD using a consumer-friendly accelerometer, and (2) investigate trends and patterns both before and after surgical intervention...
November 12, 2018: World Neurosurgery
Anudeep Jafra, Sukanya Mitra
The concept of fast-track or ambulatory surgery appeared to facilitate early recovery and discharge from the hospital and early resumption of normal daily activities after elective surgical procedures as well to reduce the health-care costs. Multimodal/balanced analgesia is an increasingly popular approach for this. The use of conventional modalities including central neuraxial blockade and opioids cannot be extended to patients undergoing fast-track surgery. Hence, an aggressive perioperative analgesic regimen/protocol is required for effective pain relief, with minimal side effects and which could be managed easily by the patient or the relatives at home away from the hospital setting...
October 2018: Saudi Journal of Anaesthesia
Andrea Angelini, Giulia Trovarelli, Antonio Berizzi, Elisa Pala, Anna Breda, Marco Maraldi, Pietro Ruggieri
BACKGROUND: Metastatic lesions to the proximal femur occur frequently and require special consideration due to the high risk of pathologic fractures. Type of surgery might influence patient survival considering the growing concept of oligometastases. In fact, the use of modular tumor megaprosthesis is increasing in the last decades compared to intramedullary nailing. Aim of this study was to evaluate oncological and functional results of treatment in patients with pathologic or impending fracture of the proximal femur, with patient survival being the primary, complications the secondary, and functional results the tertiary endpoint...
November 2018: Injury
Stefan Schraag, Lorenzo Pradelli, Abdul Jabbar Omar Alsaleh, Marco Bellone, Gianni Ghetti, Tje Lin Chung, Martin Westphal, Sebastian Rehberg
BACKGROUND: It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. This study is intended to compare the effects of propofol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisfaction. METHODS: Studies were identified by electronic database searches in PubMed™, EMBASE™ and the Cochrane™ library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied...
November 8, 2018: BMC Anesthesiology
Josef Maxwell Gutman, Kelvin Kim, Ran Schwarzkopf, Ilya Kister
Background: Hip and knee replacements for osteoarthritis are established procedures for improving joint pain and function, yet their safety in patients with multiple sclerosis (MS) is unknown. Patients with MS face unique surgical challenges due to underlying neurologic dysfunction. Current literature on arthroplasty in MS is limited to case reports focusing on adverse events. Methods: Of 40 identified patients who underwent hip or knee replacement, 30 had sufficient data for inclusion...
September 2018: International Journal of MS Care
E M Castilla Parrilla, B Gironés Camarasa, C García Dueñas, E Liceras Liceras, K Mattar Sattuf, G Castilla Peinado
OBJECTIVE: The study purpose was to evaluate the analgesic efficacy of the association of paracetamol + metamizol versus tramadol in pediatric surgery. METHODS: A prospective, randomized and double-blinded study of 60 patients between 3 and 8 years, undergoing abdominal surgery in the ambulatory unit. Patients were divided into 2 groups who received paracetamol plus metamizol (Group I) or tramadol (Group II), prior to the end of the procedure. The anesthetic technique in all cases consisted of general anesthesia balanced...
October 17, 2018: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
Dustin H Massel, Ankur S Narain, Fady Y Hijji, Benjamin C Mayo, Daniel D Bohl, Gregory D Lopez, Kern Singh
Background: Several studies have compared outcomes between hospital-based (HBCs) and ambulatory surgery centers (ASCs) following anterior cervical discectomy and fusion (ACDF). However, the association between narcotic consumption and pain in the early postoperative period has not been well characterized. As such, the purpose of this study is to compare pain, narcotic consumption, and length of stay (LOS) between HBC and ASC patients undergoing same-day-discharge following ACDF. Methods: A surgical registry of patients who underwent a primary, 1- or 2-level ACDF during 2013-2015 was reviewed...
October 2018: International Journal of Spine Surgery
Dilip Chand Raja S, Ajoy Prasad Shetty, Balavenkat Subramanian, Rishi Mugesh Kanna, S Rajasekaran
BACKGROUND CONTEXT: Surgical procedures involving the spine are known to cause moderate to severe postoperative pain. Inadequate management of acute pain in the postoperative period results in higher morbidity, and consequently may lead to chronic pain due to central sensitization. The role of preemptive and intraoperative analgesia in management of postoperative pain has gained precedence over recent years. Pathophysiology of postoperative pain in spine surgery is unique, as it is a combination of nociceptive, inflammatory and neuronal stimuli...
October 22, 2018: Spine Journal: Official Journal of the North American Spine Society
Frédéric Aubrun, Claude Ecoffey, Dan Benhamou, Laurent Jouffroy, Pierre Diemunsch, Kristina Skaare, Jean Luc Bosson, Pierre Albaladejo
OBJECTIVES: Since pain and post-operative nausea and vomiting (PONV) are the main reasons for failed discharge after day-case surgery, assessing pain and PONV is important. The aim was to describe the perioperative pain and PONV management within selected day-case surgical procedures in France. METHODS: The OPERA trial was carried out on given days between December 2013 and December 2014. Each participating centre was required to fill out 3 separate questionnaires aiming at describing (1) protocols about pain and PONV, (2) patients' characteristics and procedures, (3) analgesic and PONV practice patterns for selected procedures...
October 16, 2018: Anaesthesia, Critical Care & Pain Medicine
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