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Pain, ambulatory surgery

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
Jiabin Liu, David H Kim, Daniel B Maalouf, Jonathan C Beathe, Answorth A Allen, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: The need for hospital-based acute care following outpatient surgical procedures is expensive and measured as marker for quality. However, little information is available about events leading to emergency department visit or inpatient admission after ambulatory anterior cruciate ligament (ACL) surgery. METHODS: We studied adult patients who underwent outpatient ACL surgery in New York State between 2009 and 2013 using the Healthcare Cost and Utilization Project database...
July 20, 2018: Regional Anesthesia and Pain Medicine
Joseph T Labrum, Asif M Ilyas
BACKGROUND: Perioperative pain management in hand and upper extremity surgery has become increasingly challenging following recent efforts to accelerate postoperative recovery, decrease length of stay, and maximize the number and complexity of surgical interventions provided in an ambulatory setting. This issue has been further complicated by the growing opioid epidemic in the United States and increasing insights into its detrimental effects on society. Practicing hand surgeons must acknowledge this ongoing public health crisis and adapt their clinical practices to minimize and optimize distribution of prescription opioids...
July 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Michele Divella, Luigi Vetrugno, Daniele Orso, Nicola Langiano, Elena Bignami, Tiziana Bove
BACKGROUND: While interscalenic nerve block (INB) is still considered the 'gold standard' for shoulder arthroscopy, its postoperative analgesic effectiveness has recently been called into question. Meanwhile, in light of its high-quality postoperative pain relief, a renewed interest has emerged in suprascapular nerve block (SNB). The first aim of our study was to compare the postoperative analgesia effects of these two types of block at 2, 4 and 6 hours after surgery. We also assessed shoulder functional recovery over a six-month follow-up period...
July 9, 2018: Minerva Anestesiologica
Mario E Trejo-Ávila, Sujey Romero-Loera, Eduardo Cárdenas-Lailson, Miguel Blas-Franco, Roberto Delano-Alonso, Carlos Valenzuela-Salazar, Mucio Moreno-Portillo
BACKGROUND: Previous observational studies have demonstrated the safety of discharging patients after laparoscopic appendectomy within the same day without hospitalization. The application of Enhanced Recovery After Surgery (ERAS) guidelines has resulted in shorter length of stay, fewer complications, and reduction in medical costs. The aim of this study was to investigate if ERAS protocol implementation in patients with acute uncomplicated appendicitis decreases the length of stay enough to allow for ambulatory laparoscopic appendectomy...
July 9, 2018: Surgical Endoscopy
Ewan D McNicol, Emily Rowe, Tess E Cooper
BACKGROUND: Children who undergo surgical procedures in ambulatory and inpatient settings are at risk of experiencing acute pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce moderate to severe pain without many of the side effects associated with opioids. However, NSAIDs may cause bleeding, renal and gastrointestinal toxicity, and potentially delay wound and bone healing. Intravenous administration of ketorolac for postoperative pain in children has not been approved in many countries, but is routinely administered in clinical practise...
July 7, 2018: Cochrane Database of Systematic Reviews
Ryan K Harrison, Teresa DiMeo, Ryan D Klinefelter, Michael E Ruff, Hisham M Awan
We evaluated postoperative pain control and narcotic usage after thumb carpometacarpal (CMC) arthroplasty or open reduction and internal fixation (ORIF) of the distal radius in patients given opiates with or without other non-opiate medication using a specific dosing regimen. A prospective, randomized study of 79 patients undergoing elective CMC arthroplasty or ORIF of the distal radius evaluated postoperative pain in the first 5 postoperative days. Patients were divided into 4 groups: Group 1, oxycodone and acetaminophen PRN; Group 2, oxycodone and acetaminophen with specific dosing; Group 3, oxycodone, acetaminophen, and OxyContin with specific dosing; and Group 4, oxycodone, acetaminophen, and ketorolac with specific dosing...
June 2018: American Journal of Orthopedics
Jenny C Barker, Kaitlin DiBartola, Corinne Wee, Nicole Andonian, Mahmoud Abdel-Rasoul, Deborah Lowery, Jeffrey E Janis
BACKGROUND: The opioid epidemic demands changes in perioperative pain management. Of the 33,000 deaths due to opioid overdose in 2015, half received prescription opioids. Multimodal analgesia (MMA) is a practice-altering evolution that reduces reliance on opioid medications. Ambulatory breast surgery is an ideal opportunity to implement these strategies. METHODS: A retrospective review of 560 patients undergoing outpatient breast procedures was conducted. Patients received 1) no pre-operative analgesia (n=333), 2) intra-operative IV acetaminophen (n=78), 3) pre-operative oral acetaminophen and gabapentin (n=95), or 4) pre-operative oral acetaminophen, gabapentin and celecoxib (n=54)...
June 30, 2018: Plastic and Reconstructive Surgery
Matthias Behrends, Edward N Yap, Alan L Zhang, Kerstin Kolodzie, Sakura Kinjo, Monica W Harbell, Pedram Aleshi
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Ambulatory hip arthroscopy is associated with postoperative pain routinely requiring opioid analgesia. The potential role of peripheral nerve blocks for pain control after hip arthroscopy is controversial. This trial investigated whether a preoperative fascia iliaca block improves postoperative analgesia. METHODS: In a prospective, double-blinded trial, 80 patients scheduled for hip arthroscopy were randomized to receive a preoperative fascia iliaca block with 40 ml ropivacaine 0...
July 3, 2018: Anesthesiology
Sverre Arvid Ingemar Loggers, Pieter Joosse, Kees Jan Ponsen
INTRODUCTION: Pubic rami fractures are common fractures in a growing osteoporotic geriatric population. Concomitant posterior ring fractures (cPRF) are often found when properly looked for. The pain and consequent immobilization leaves this vulnerable patient group at risk for complications. Conservative therapy is usually sufficient, but with cPRF's surgery can be indicated. Although previous studies have pointed out that mortality rates are high, longer term morbidity outcomes are lacking...
June 12, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Harsha Shanthanna, James Paul, Peter Lovrics, P J Devereaux, Mohit Bhandari, Lehana Thabane
INTRODUCTION: There has been an exponential increase in the number of ambulatory surgeries (AS). Pain and postoperative nausea vomiting (PONV) affects the recovery, discharge and overall satisfaction of patients having AS. Opioids remain the primary modality for moderate to severe pain. Since there is no perfect opioid, physicians should ideally use the opioid that optimally balances benefits and risks. Present decisions on the choice between morphine (M) and hydromorphone (HM) are based on individual experience and observation...
June 22, 2018: BMJ Open
Faraj W Abdallah, Tulin Cil, David MacLean, Caveh Madjdpour, Jaime Escallon, John Semple, Richard Brull
BACKGROUND AND OBJECTIVES: Serratus fascial plane block can reduce pain following breast surgery, but the question of whether to inject the local anesthetic superficial or deep to the serratus muscle has not been answered. This cohort study compares the analgesic benefits of superficial versus deep serratus plane blocks in ambulatory breast cancer surgery patients at Women's College Hospital between February 2014 and December 2016. We tested the joint hypothesis that deep serratus block is noninferior to superficial serratus block for postoperative in-hospital (pre-discharge) opioid consumption and pain severity...
July 2018: Regional Anesthesia and Pain Medicine
Hachem Djeffal, Marie Blouet, Anne-Cécile Pizzoferato, Delphine Vardon, Frederique Belloy, Jean-Pierre Pelage
Tubal sterilization with Essure inserts has become a prevalent alternative to laparoscopic sterilization because of its minimal invasiveness. It is a well-tolerated ambulatory procedure that provides reliable permanent contraception without the risks associated with laparoscopic surgery and general anesthesia. Correct positioning of the Essure device is necessary to achieve the fibrotic reaction induced by the polyethylene terephthalate fibers, subsequently resulting in tubal occlusion usually within 3 months...
July 13, 2018: British Journal of Radiology
Ulrich J Spreng, Vegard Dahl, Johan Ræder
Background and objective Perioperative low-dose ketamine has been useful for postoperative analgesia. In this study we wanted to assess the analgesic effect and possible side-effects of perioperative low-dose S (+) ketamine when added to a regime of non-opioid multimodal pain prophylaxis. Methods Seventy-seven patients scheduled for haemorrhoidectomy were enrolled in this randomized, double-blind, controlled study. They received oral paracetamol 1-2 g, total intravenous anaesthesia, intravenous 8 mg dexamethasone, 30 mg ketorolac and local infiltration with bupivacaine/epinephrine...
April 1, 2010: Scandinavian Journal of Pain
Brian M Ilfeld, Rodney A Gabriel, Engy T Said, Amanda M Monahan, Jacklynn F Sztain, Wendy B Abramson, Bahareh Khatibi, John J Finneran, Pia T Jaeger, Alexandra K Schwartz, Sonya S Ahmed
BACKGROUND AND OBJECTIVES: Percutaneous peripheral nerve stimulation (PNS) is an analgesic modality involving the insertion of a lead through an introducing needle followed by the delivery of electric current. This modality has been reported to treat chronic pain as well as postoperative pain the day following knee surgery. However, it remains unknown if this analgesic technique may be used in ambulatory subjects following foot procedures beginning within the recovery room immediately following surgery, and with only short series of patients reported to date, the only available data are derived from strictly observational studies...
August 2018: Regional Anesthesia and Pain Medicine
Helen H Lee, Nicholas M Dalesio, Anthony T Lo Sasso, William C Van Cleve
BACKGROUND: Pediatric adenotonsillectomies are common and carry known risks of potentially severe complications. Complications that require a revisit, to either the emergency department or hospital readmission, increase costs and may be tied to lower reimbursements by federal programs. In 2011 and 2012, recommendations by pediatric and surgical organizations regarding selection of candidates for ambulatory procedures were issued. We hypothesized that guideline-associated changes in practice patterns would lower the odds of revisits...
August 2018: Anesthesia and Analgesia
Alexandra M Hart, Justine Broecker, Leslieann Kao, Albert Losken
PURPOSE: The increasing rate of opioid abuse warrants standardization of postoperative pain management. The purpose of this study is to analyze the use of opioids in pain control and patient satisfaction following ambulatory breast surgery. METHODS: This is a prospective study of a consecutive series of patients undergoing secondary breast reconstruction [SBR: n=60)] or breast reduction [BR:n=35]. All patients were given a pain questionnaire preoperatively. Postoperatively, women received 30 tablets of oxycodone 5...
June 2, 2018: Plastic and Reconstructive Surgery
Aria Jafari, Sarek A Shen, David J Bracken, John Pang, Adam S DeConde
BACKGROUND: Excessive postoperative opioid prescription is a source of prescription diversion in the United States opioid crisis and may contribute to chronic opioid use. Efficient prescription by the surgeon can mitigate opioid abuse and improve postoperative pain control. In this study we sought to better characterize the incidence and predictive baseline characteristics associated with the need for additional opioid prescription after endoscopic sinus surgery (ESS) for chronic rhinosinusitis...
May 31, 2018: International Forum of Allergy & Rhinology
Jacques T YaDeau, Kara G Fields, Richard L Kahn, Vincent R LaSala, Scott J Ellis, David S Levine, Leonardo Paroli, Thuyvan H Luu, Matthew M Roberts
BACKGROUND: Neuraxial anesthesia is often viewed as superior to general anesthesia but may delay discharge. Comparisons do not typically use multimodal analgesics and nerve blockade. Combining nerve blockade with general anesthesia may reduce pain, opioid consumption, and nausea. We hypothesized that general anesthesia (with nerve blocks) would lead to earlier readiness for discharge, compared to spinal anesthesia (with nerve blocks). METHODS: All patients underwent ambulatory foot and ankle surgery, with a predicted case duration of 1-3 hours...
May 25, 2018: Anesthesia and Analgesia
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