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Narcotics management

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https://www.readbyqxmd.com/read/28636707/incidence-and-predictors-of-opioid-prescription-at-discharge-after-traumatic-injury
#1
Muhammad Ali Chaudhary, Andrew J Schoenfeld, Alyssa F Harlow, Anju Ranjit, Rebecca Scully, Ritam Chowdhury, Meesha Sharma, Stephanie Nitzschke, Tracey Koehlmoos, Adil H Haider
Importance: In the current health care environment with increased scrutiny and growing concern regarding opioid use and abuse, there has been a push toward greater regulation over prescriptions of opioids. Trauma patients represent a population that may be affected by this regulation, as the incidence of pain at hospital discharge is greater than 95%, and opioids are considered the first line of treatment for pain management. However, the use of opioid prescriptions in trauma patients at hospital discharge has not been explored...
June 21, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28617422/reduced-narcotic-and-sedative-utilization-in-a-nicu-after-implementation-of-pain-management-guidelines
#2
D Rana, B Bellflower, J Sahni, A J Kaplan, N T Owens, E L Arrindell, A J Talati, R Dhanireddy
OBJECTIVE: To assess the opioid and benzodiazepine usage in a level IV NICU after implementation of pain guidelines. STUDY DESIGN: Guidelines were developed for infants undergoing surgical procedures and infants on mechanical ventilation. Data collected for period 1 (July to December 2013) and period 2 (March to August 2014). RESULTS: Gestational age, birth weight and infants with hypoxic respiratory failure or requiring major procedures were comparable in two periods...
June 15, 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/28610706/ultrasound-guided-bilateral-rectus-sheath-block-vs-conventional-local-analgesia-in-single-port-laparoscopic-appendectomy-for-children-with-nonperforated-appendicitis
#3
Caroline Maloney, Michelle Kallis, Ibrahim Abd El-Shafy, Aaron M Lipskar, John Hagen, Michelle Kars
INTRODUCTION: Despite its minimally invasive approach, laparoscopic surgery can cause considerable pain. Regional analgesic techniques such as the rectus sheath block (RSB) offer improved pain management following elective umbilical hernia repair in the pediatric population. This effect has not been examined in laparoscopic single-incision surgery in children. We sought to compare the efficacy of bilateral ultrasound-guided RSB versus local anesthetic infiltration (LAI) in providing postoperative pain relief in pediatric single-incision transumbilical laparoscopic assisted appendectomy (TULA) with same-day discharge...
June 2, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28608417/otolaryngology-practice-patterns-in-pediatric-tonsillectomy-the-impact-of-the-codeine-boxed-warning
#4
Julie L Goldman, Craig Ziegler, Elizabeth M Burckardt
OBJECTIVES/HYPOTHESIS: To determine if otolaryngologists at a single children's hospital were adherent to the boxed warning for codeine use in post-tonsillectomy patients and the implications for practice patterns. STUDY DESIGN: Case series with chart review. METHODS: Charts from all patients undergoing adenotonsillectomy at a single children's hospital from January 1, 2010 through December 31, 2015 were analyzed and stratified according to date (pre- or post-boxed warning) and practitioner type (academic otolaryngologists [AO] vs...
June 13, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28604381/miniinvasive-surgical-interventions-in-management-of-cholelithiasis-a-retrospective-study
#5
Mamuka R Gurgenidze, Merab A Kiladze, Zurab A Beriashvili, Teimuraz U Tabucadze, Giorgi A Datuashvili
The aim of the present study is to analyze outcomes after laparoscopic cholecystectomy (LC) and minilaparotomy cholecystectomy (MC) for gallstone disease and determine the algorithm of treatment for different groups of patients according to the age, severity of disease and comorbid conditions. This is a multicenter retrospective review of 2997 patients who underwent LC or MC between January 1, 2002 and December 31, 2008. The patients were categorized into LC (1479) and MC (1518) groups. When preoperative examination data were not reliable, we performed abdominal wall lifting with the retractors to visualise abdominal cavity with laparoscope during minilaparotomy...
2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28564673/postoperative-multimodal-analgesia-pain-management-with-nonopioid-analgesics-and-techniques-a-review
#6
Elizabeth C Wick, Michael C Grant, Christopher L Wu
Importance: Amid the current opioid epidemic in the United States, the enhanced recovery after surgery pathway (ERAS) has emerged as one of the best strategies to improve the value and quality of surgical care and has been increasingly adopted for a broad range of complex surgical procedures. The goal of this article was to outline important components of opioid-sparing analgesic regimens. Observations: Regional analgesia, acetaminophen, nonsteroidal anti-inflammatory agents, gabapentinoids, tramadol, lidocaine, and/or the N-methyl-d-aspartate class of glutamate receptor antagonists have been shown to be effective adjuncts to narcotic analgesia...
May 31, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28554207/provider-type-and-management-of-common-visits-in-primary-care
#7
Douglas W Roblin, Hangsheng Liu, Lee F Cromwell, Michael Robbins, Brandi E Robinson, David Auerbach, Ateev Mehrotra
OBJECTIVES: Debate continues on whether nurse practitioners (NPs) and physician assistants (PAs) are more likely to order ancillary services, or order more costly services among alternatives, than primary care physicians (PCPs). We compared prescription medication and diagnostic service orders associated with NP/PA versus PCP visits for management of neck or back (N/B) pain or acute respiratory infection (ARI). STUDY DESIGN: Retrospective, observational study of visits from January 2006 through March 2008 in the adult primary care practice of Kaiser Permanente in Atlanta, Georgia...
April 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28533997/metoclopramide-for-acute-migraine-treatment-in-the-emergency-department-an-effective-alternative-to-opioids
#8
REVIEW
Mejdi Najjar, Tyler Hall, Blanca Estupinan
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings...
April 20, 2017: Curēus
https://www.readbyqxmd.com/read/28533058/music-therapy-for-symptom-management-after-autologous-stem-cell-transplantation-results-from-a-randomized-study
#9
Debbie Bates, Brian Bolwell, Navneet S Majhail, Lisa Rybicki, Melissa Yurch, Donna Abounader, Joseph Kohuth, Shannon Jarancik, Heather Koniarczyk, Linda McLellan, Jane Dabney, Christine Lawrence, Lisa Gallagher, Matt Kalaycio, Ronald Sobecks, Robert Dean, Brian Hill, Brad Pohlman, Betty K Hamilton, Aaron T Gerds, Deepa Jagadeesh, Hien D Liu
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is frequently performed in patients with hematologic malignancies. ASCT can result in significant nausea, pain, and discomfort. Supportive care has improved, and pharmacologic therapies are frequently used, but with limitations. Music has been demonstrated to improve nausea and pain in patients undergoing chemotherapy, but little data are available regarding the effects of music therapy in the transplantation setting. In a prospective study, patients with lymphoma or multiple myeloma undergoing ASCT were randomized to receive either interactive music therapy with a board-certified music therapist or no music therapy...
May 19, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28507969/core-decompression-with-synthetic-grafting-as-a-joint-preservation-strategy-in-humeral-avascular-necrosis-due-to-sickle-cell-anemia-a-case-report
#10
Andrew M Steffensmeier, Karen Kirkham, John M Wiemann
INTRODUCTION: Avascular necrosis (AVN) of the femoral or humeral heads in patients with sickle cell anemia is a common and painful condition. There is currently no gold standard treatment protocol for this condition. Typically, the pain is managed with narcotics and activity restriction until there has been collapse of the subchondral bone with a degree of arthrosis sufficient to warrant total joint arthroplasty. This method entails prolonged pain for the patient and decreases the ability to function occupationally and recreationally...
November 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28496355/cannabis-as-a-substitute-for-prescription-drugs-a-cross-sectional-study
#11
James M Corroon, Laurie K Mischley, Michelle Sexton
BACKGROUND: The use of medical cannabis is increasing, most commonly for pain, anxiety and depression. Emerging data suggest that use and abuse of prescription drugs may be decreasing in states where medical cannabis is legal. The aim of this study was to survey cannabis users to determine whether they had intentionally substituted cannabis for prescription drugs. METHODS: A total of 2,774 individuals were a self-selected convenience sample who reported having used cannabis at least once in the previous 90 days...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28479443/postoperative-pain-management-following-thoracic-outlet-decompression
#12
Mathew Wooster, Dana Reed, Adam Tanious, Karl Illig
BACKGROUND: Thoracic outlet decompression (TOD) is associated with significant postoperative pain often leading to hospital length of stay out of proportion to the risk profile of the operation. We seek to describe the improvement in hospital length of stay and patient pain control with an improved multiagent pain management regimen. METHODS: We retrospectively reviewed the hospital length of stay, medication regimen/usage, operative details, and operative indications for all patients undergoing TOD from January 2012 through June 2015...
May 4, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28479257/liposomal-bupivacaine-versus-indwelling-interscalene-nerve-block-for-postoperative-pain-control-in-shoulder-arthroplasty-a-prospective-randomized-controlled-trial
#13
Jeffrey T Abildgaard, Keith T Lonergan, Stefan J Tolan, Michael J Kissenberth, Richard J Hawkins, Richard Washburn, Kyle J Adams, Catherine D Long, E Carlisle Shealy, Jay R Motley, John M Tokish
BACKGROUND: Pain management strategies following shoulder arthroplasty vary significantly. Liposomal bupivacaine (LB) is an extended-release delivery of a phospholipid bilayer encapsulating bupivacaine that can result in drug delivery up to 72 hours. Prior studies in lower extremity surgery demonstrated efficacy of LB in comparison to a single-shot peripheral nerve block; however, no study has investigated LB in a total shoulder arthroplasty population. Therefore, this study compared LB vs...
May 4, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28478713/continuous-infusion-ketorolac-for-postoperative-analgesia-following-unilateral-total-knee-arthroplasty
#14
Amy J Schwinghammer, Alex N Isaacs, Rodney W Benner, Heather Freeman, Jacob A O'Sullivan, Sarah A Nisly
BACKGROUND: Previous clinical trials have demonstrated benefit with the addition of continuous infusion (CI) ketorolac to a multimodal pain regimen in surgical patients. Data following major orthopedic surgery are minimal and conflicting. OBJECTIVES: To evaluate CI ketorolac use following unilateral total knee arthroplasty (TKA) through assessment of patient-reported pain scores, opioid consumption, and safety outcomes. METHODS: This was a retrospective, open-label cohort study that included patients undergoing unilateral TKA at a single-center teaching hospital...
June 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28474487/medication-safety-and-the-usability-of-electronic-prescribing-as-perceived-by-physicians-a-semistructured-interview-among-primary-health-care-physicians-in-finland
#15
Hanna Kauppinen, Riitta Ahonen, Pekka Mäntyselkä, Johanna Timonen
RATIONALE, AIMS AND OBJECTIVES: In Finland, a fully operational and nationwide electronic prescription (ePrescription) system was implemented by law in 2012 to 2015. From 2017, all prescriptions have to be electronic. ePrescriptions are intended to facilitate prescribing and to improve medication safety in Finnish health care. In this study, the aim was to explore physicians' experiences with the impacts of ePrescriptions on prescribing and medication safety in Finland. METHOD: Data were collected by conducting 42 interviews among primary health care physicians in spring 2015...
May 4, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28455162/the-episod-study-long-term-outcomes
#16
Peter B Cotton, Qi Pauls, Jamila Keith, Andre Thornhill, Douglas Drossman, April Williams, Valerie Durkalski-Mauldin
BACKGROUND AND AIMS: The EPISOD (Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction) study randomized patients with post-cholecystectomy pain, and little or no objective evidence for biliary obstruction, to sphincterotomy or sham intervention. Results at 1 year showed no benefit for the active treatment. We now report the outcomes at up to 5 years. METHODS: One hundred three patients completing 1 year, and still blinded to treatment allocation, were enrolled and followed by phone every 6 months for a median of 58 months (range, 17-71 months)...
April 25, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28449307/the-efficacy-of-non-narcotic-analgesics-on-post-operative-endodontic-pain-a-systematic-review-and-meta-analysis-the-efficacy-of-non-steroidal-anti-inflammatory-drugs-and-or-paracetamol-on-post-operative-endodontic-pain
#17
REVIEW
A Shirvani, S Shamszadeh, M J Eghbal, S Asgary
The objective of this review was to evaluate the efficacy of non-narcotic analgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post-operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta-regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta-analysis was performed using a random-effect inverse variance method...
April 27, 2017: Journal of Oral Rehabilitation
https://www.readbyqxmd.com/read/28397700/narcotic-bowel-syndrome
#18
REVIEW
Adam D Farmer, Jayne Gallagher, Caroline Bruckner-Holt, Qasim Aziz
Narcotic bowel syndrome is characterised by worsening abdominal pain in the context of escalating or continuous opioid therapy. Although narcotic bowel syndrome is rarely diagnosed, given the current epidemic of opioid use, it is likely to be under-recognised. The underlying pathophysiological mechanisms of narcotic bowel syndrome are incompletely understood; however, opioid-induced hyperalgesia is likely to be a central facet. The putative mechanisms of hyperalgesia include activation of bimodal opioid regulatory systems, counter-regulatory mechanisms, neuroinflammation, opioid facilitation, and interactions of the N-methyl D-aspartate receptor with opioids at the level of the spinal cord...
May 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28375992/pain-agitation-and-delirium-guidelines-interprofessional-perspectives-to-translate-the-evidence
#19
Juliane Jablonski, Jaime Gray, Todd Miano, Gretchen Redline, Heather Teufel, Tara Collins, Jose Pascual-Lopez, Martha Sylvia, Niels D Martin
BACKGROUND: Societal guidelines exist for the management of pain, agitation, and delirium (PAD) in critically ill patients. This contemporary practice aims for a more awake and interactive patient. Institutions are challenged to translate the interrelated multivariable concepts of PAD into daily clinical practice and to demonstrate improvement in quality outcomes. An interdisciplinary goal-directed approach shows outcomes in high-acuity surgical critical care during the early stages of implementation...
May 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28375914/low-back-pain
#20
Jinny O Tavee, Kerry H Levin
PURPOSE OF REVIEW: This article provides an overview of evaluating and treating low back pain in the outpatient setting. RECENT FINDINGS: As most cases of acute low back pain have a favorable prognosis, current guidelines on imaging studies recommend conservative treatment for 6 weeks prior to obtaining an MRI if no red flags are present. Of these red flags, a prior history of cancer is the strongest risk factor for a malignant etiology and requires urgent evaluation with MRI...
April 2017: Continuum: Lifelong Learning in Neurology
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