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Pain, ambulatory surgery

Gildasio S De Oliveira, Mark C Kendall, Robert J McCarthy
INTRODUCTION: Intraoperative systemic esmolol has been shown to reduce postsurgical pain. Nonetheless, it is unknown whether the use of intraoperative systemic esmolol can improve patient-reported postsurgical quality of recovery. The main objective of the current investigation was to evaluate the effect of intraoperative esmolol on postsurgical quality of recovery. We hypothesized that patients receiving intraoperative esmolol would report better quality of postsurgical recovery than the ones receiving saline...
October 2018: Medicine (Baltimore)
Laxmaiah Manchikanti, Vijay Singh, Ramsin M Benyamin, Alan D Kaye, Vidyasagar Pampati, Joshua A Hirsch
On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. This July 12th rule proposes substantial payment changes for evaluation and management (E&M) services, with documentation requirements, and blending of Level II to V CPT codes for E&M into a single payment...
September 2018: Pain Physician
Jean-Baptiste Ducloyer, Chloé Couret, Cécile Magne, Corinne Lejus-Bourdeau, Michel Weber, Guylène Le Meur, Pierre Lebranchu
PURPOSE: To date, no protocol of anesthesia for pediatric ophthalmic surgery is unanimously recognized. The primary anesthetic risks are associated with strabismus surgery, including oculocardiac reflex, postoperative nausea and vomiting, and postoperative pain. METHODS: This was a prospective, monocentric, observational study conducted in a tertiary pediatric ophthalmic unit. Our anesthetic protocol for strabismus surgery included postoperative nausea and vomiting prevention using dexamethasone and ondansetron...
October 3, 2018: European Journal of Ophthalmology
Kai-Uwe Lewandrowski
Background: The objective of this study was to analyze readmission rates after outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis done in an ambulatory surgery center. Endoscopic lumbar spinal surgery is gaining popularity for the treatment of lumbar disc herniations. Recent advances in surgical techniques allow for percutaneous endoscopically assisted bony decompression for neurogenic claudication symptoms due to spinal stenosis...
June 2018: International Journal of Spine Surgery
Stephen Meisenhelter, Markus E Testorf, Mark A Gorenstein, Nicholas R Hasulak, Thomas K Tcheng, Joshua P Aronson, Barbara C Jobst
BACKGROUND: Electrocorticography studies are typically conducted in patients undergoing video EEG monitoring, but these studies are subject to confounds such as the effects of pain, recent anesthesia, analgesics, drug changes, antibiotics, and implant effects. NEW METHOD: Techniques were developed to obtain electrocorticographic (ECoG) data from freely moving subjects performing navigational tasks using the RNS® System (NeuroPace, Inc., Mountain View, CA), a brain-responsive neurostimulation medical device used to treat focal onset epilepsy, and to align data from the RNS System with cognitive task events with high precision...
September 26, 2018: Journal of Neuroscience Methods
José Luis Mosso Vázquez, Dejanira Mosso Lara, José Luis Mosso Lara, Ian Miller, Mark D Wiederhold, Brenda K Wiederhold
Virtual reality (VR) pain distraction has been applied across medical, surgical, and behavioral healthcare domains, marking a shift in pain attenuation practices. However, there is little research that has been performed to compare the efficacy of traditional head-mounted displays (HMDs) versus portable VR devices. The present study evaluated 44 outpatients in need of lipoma resection. Randomized into two groups-HMD versus mobile phone VR-participants navigated pain distraction virtual environments while undergoing surgery...
September 25, 2018: Cyberpsychology, Behavior and Social Networking
Brandon P Hirsch, Benjamin Khechen, Dil V Patel, Kaitlyn L Cardinal, Jordan A Guntin, Kern Singh
STUDY DESIGN: Retrospective Analysis. OBJECTIVE: To investigate differences in perioperative outcomes between patients undergoing revision minimally invasive lumbar spine decompression (MIS LD) in the ambulatory and hospital-based surgical settings. SUMMARY OF BACKGROUND DATA: Revision LD has been associated with an increased risk of complications compared to primary LD. Furthermore, ambulatory primary LD has been demonstrated to be a safe and viable option in appropriately selected patients...
September 17, 2018: Spine
Gotardo Zini Pinho, Gustavo Ruschi Bechara, Samira Pereira das Posses, Carla Regina Santos De Carli, Marcio Maia Lamy de Miranda
Background: Laparoscopic port-site metastases remain rare for urologic tumors, despite the increasing use of laparoscopic techniques on the approach of urologic malignancy. Herein, we report a case of port-site mass after laparoscopic radical prostatectomy whose immunohistochemistry demonstrated metastasis from a pancreatic lesion. Case Presentation: A 62-year-old man presented to our ambulatory clinic with an elevated prostate-specific antigen (PSA) of 7.7 ng/mL. Transrectal biopsies revealed prostate cancer Gleason 6 (3 + 3) on the right side...
2018: Journal of Endourology Case Reports
Enrique J Grau-Talens, José Jacob Motos-Micó, Rafael Giraldo-Rubio, José M Aparicio-Gallego, José F Salgado, Carlos D Ibáñez, Pablo G Mangione-Castro, Martina Arribas-Jurado, Carlos Jordán-Chaves, Javier Arias-Díaz
BACKGROUND: Transcylindrical cholecystectomy (TC) can be performed under local anaesthesia and sedation (LAS) in ambulatory surgery (AS). The aim of this study was to assess the feasibility and results of TC under LAS. METHODS: TC under LAS was proposed to 583 consecutive patients with cholelithiasis in an AS unit. For the TC procedure, a cylindrical retractor with a transparent plunger was inserted into the hepatocystic triangle, and cholecystectomy was performed through the retractor with reusable open instruments...
September 15, 2018: Langenbeck's Archives of Surgery
Stergios Boussios, Deirdre Cooke, Catherine Hayward, Foivos S Kanellos, Alexandros K Tsiouris, Aikaterini A Chatziantoniou, Nikolaos Zakynthinakis-Kyriakou, Afroditi Karathanasi
Malignant spinal cord compression (MSCC) is one of the most devastating complications of cancer. Patients often present with a history of progressive pain, paralysis, sensory loss, progressive spinal deformity, and loss of sphincter control. It is an emergency that requires rapid decision making on the part of several specialists, given the risk of permanent spinal cord injury or death. The goals of treatment in spinal metastases are pain control and improvement of neurological function in order to achieve better quality of life (QoL)...
September 2018: Anticancer Research
Aline Ceulemans, Danny De Looze, Dirk Van de Putte, Eline Stiers, Marc Coppens
BACKGROUND: Ambulatory surgery for anorectal procedures has become widely accepted. Recent reviews recommend a multimodal approach to pain management. However, these recommendations are largely based on single intervention studies. Our goal was to evaluate post-operative pain in patients receiving a multimodal analgesic regimen. METHODS: All patients undergoing an ambulatory anorectal procedure between December 2015 and September 2016 received a pain diary. Mean pain throughout the day and pain during defecation where recorded on day 0-14 and day 21 postoperatively using a numeric rating scale-11...
September 7, 2018: Acta Chirurgica Belgica
James F Fraser, Jonathan R Danoff, Jorge Manrique, Michael J Reynolds, William J Hozack
BACKGROUND: As total hip arthroplasty (THA) gains popularity in ambulatory surgery centers, it is important to understand the causes of failed same-day discharge (SDD). The purpose of this study is to (1) identify reasons for an overnight stay among patients selected as candidates for SDD following THA and (2) determine what pre-operative factors are more common among patients who fail SDD. METHODS: This is a prospective cohort study of patients undergoing THA who were identified as candidates for SDD (<75 years, ambulate without walker, American Society of Anesthesiologists score 1-3, body mass index <40 kg/m2 , and agreed to SDD pre-operatively)...
August 9, 2018: Journal of Arthroplasty
Brian M Ilfeld, Engy T Said, John J Finneran, Jacklynn F Sztain, Wendy B Abramson, Rodney A Gabriel, Bahareh Khatibi, Matthew W Swisher, Pia Jaeger, Dana C Covey, Catherine M Robertson
OBJECTIVES: The purpose of this prospective proof of concept study was to investigate the feasibility of using percutaneous peripheral nerve stimulation of the femoral nerve to treat pain in the immediate postoperative period following ambulatory anterior cruciate ligament reconstruction with a patellar autograft. MATERIALS AND METHODS: Preoperatively, an electrical lead (SPRINT, SPR Therapeutics, Inc., Cleveland, OH, USA) was percutaneously implanted with ultrasound guidance anterior to the femoral nerve caudad to the inguinal crease...
August 30, 2018: Neuromodulation: Journal of the International Neuromodulation Society
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...
August 28, 2018: Cochrane Database of Systematic Reviews
Mick P Kelly, Tyler E Calkins, Chris Culvern, Monica Kogan, Craig J Della Valle
BACKGROUND: More surgeons are offering patients the option of having adult reconstructive procedures performed as an outpatient at an ambulatory surgery center. However, it is unknown if these patients have higher or lower satisfaction with their care than patients having a traditional inpatient stay. The purpose of this study is to compare satisfaction between inpatients and outpatients undergoing hip or knee arthroplasty. METHODS: Portions of the Health Consumer Assessment of Healthcare Providers and Systems survey, the Friends and Family Test, and 8 additional questions were administered to 174 consecutive patients...
November 2018: Journal of Arthroplasty
Omar Kadri, Toufic R Jildeh, Jason E Meldau, Jacob Blanchett, Peter Borowsky, Stephanie Muh, Vasilios Moutzouros, Eric C Makhni
Background: Challenges exist in routinely collecting patient-reported outcomes (PROs) from patients at a busy ambulatory clinic. A number of validated Patient-Reported Outcomes Measurement Information System (PROMIS) subdomains allow for efficient PRO administration. Purpose: To determine the time to completion (TTC) of 3 PROMIS computer adaptive test (CAT) scores. CAT questionnaires were administered at the ambulatory clinic with the following PROMIS subdomains: Pain Interference (PI), Depression, and Physical Function for lower extremity (PF) or for upper extremity (UE)...
August 2018: Orthopaedic Journal of Sports Medicine
Nabil M Elkassabany, Anthony Wang, Jason Ochroch, Matthew Mattera, Jiabin Liu, Andrew Kuntz
Objectives: Pain control after shoulder arthroscopy can be challenging, often relying on opioids. The study aims to measure the quality of recovery (QoR) before and after implementation of a "Multimodal Perioperative Pain Protocol" (MP3) in patients undergoing ambulatory shoulder arthroscopy. Design: Prospective cohort study. Setting: Free-standing ambulatory surgery facility of a tertiary care academic center. Subjects: Patients undergoing ambulatory shoulder arthroscopy...
August 3, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Olubukola O Nafiu, Aleda Thompson, S Devi Chiravuri, Benjamin Cloyd, Paul I Reynolds
BACKGROUND: Many children recovering from anesthesia experience pain that is severe enough to warrant intravenous (IV) opioid treatment within moments of admission to the postanesthesia care unit (PACU). Postoperative pain has several negative consequences; therefore, preventing significant PACU pain in children is both a major clinical goal and a moral/ethical imperative. This requires identifying patient-level and perioperative factors that may be used to predict PACU IV opioid requirement...
August 14, 2018: Anesthesia and Analgesia
Bradley J Waffa, Richard S Funk
Herpetology specialists may find a rewarding model in production medicine, where patients are evaluated on a population basis in an ambulatory setting. Ambulatory medicine combines clinical advantages, such as being able to evaluate patients and their living conditions in situ, with the benefits of building close client relationships and tethering the growth of the business with that of an increasingly popular niche industry. Ambulatory medicine does present some logistical challenges when working with reptiles and amphibians, but they represent surmountable growing pains for the veterinarian committed to growing alongside the ever-evolving practice of reptile and amphibian medicine and surgery...
September 2018: Veterinary Clinics of North America. Exotic Animal Practice
Jonathan J Lee, Richard K Simpson, Brian Dalm
Objectives A significant number of chronic pain patients rely on spinal cord stimulation (SCS) for treatment of their intractable pain. A screening trial using percutaneous electrodes is an integral step for predicting a successful treatment course with a permanent SCS system. Most of these trials are performed in an outpatient ambulatory surgical center and some in the office setting. However, there are select patients who are considered poor candidates for percutaneous trials. We present the initial report of patients who have received surgical implantation of permanent paddle-leads for SCS trials at our institution and show that this was a safe and effective alternative for our patients who could not undergo percutaneous trials...
May 18, 2018: Curēus
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