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Narcotics management

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https://www.readbyqxmd.com/read/29317354/laccase-catalyzed-elimination-of-morphine-from-aqueous-systems
#1
Daniela Huber, Klaus Bleymaier, Alessandro Pellis, Robert Vielnascher, Andreas Daxbacher, Katrin J Greimel, Georg M Guebitz
Pharmaceuticals contaminate the environment for several reasons, including metabolic excretion after intake, industrial waste and improper disposal. The narcotic drug morphine is commonly utilized for chronic pain management, and the distribution of morphine in aqueous systems and in waste waters is of high concern. Here. the removal of morphine by a laccase from Myceliophthora thermophila both in its free form as well as immobilized on Accurel MP1000 beads was investigated. Complete morphine elimination was achieved within 30 min for the free and the immobilized enzyme (70% bound protein) for concentrations between 1 and 1,000 mg L-1 according to LC-TOF mass spectrometry analysis...
January 6, 2018: New Biotechnology
https://www.readbyqxmd.com/read/29289751/patient-selection-for-total-pancreatectomy-with-islet-autotransplantation-in-the-surgical-management-of-chronic-pancreatitis
#2
Katherine A Morgan, William P Lancaster, Stefanie M Owczarski, Hongjun Wang, Jeffrey Borckardt, David B Adams
BACKGROUND: Best practice to select patients with chronic pancreatitis for surgical management with total pancreatectomy with islet autotransplantation (TPIAT) is in evolution as new discoveries are made in the pathogenesis of chronic pancreatitis. METHODS: A prospectively maintained database of patients undergoing TPIAT is reviewed. Islet function is inferred from daily insulin requirement. Pain relief is evaluated by healthcare utilization and narcotic use. Quality of life (QOL) is measured with SF-12...
December 28, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29289394/laparoscopic-guided-abdominal-wall-nerve-blocks-in-the-pediatric-population-a-novel-technique-with-comparison-to-ultrasound-guided-blocks-and-local-wound-infiltration-alone
#3
Alessandra Landmann, Mihaela Visoiu, Marcus M Malek
BACKGROUND: Abdominal wall nerve blocks have been gaining popularity for the treatment of perioperative pain in children. Our aim was to compare a technique of surgeon-performed, laparoscopic abdominal wall nerve blocks to anesthesia-placed, ultrasound-guided abdominal wall nerve blocks and the current standard of local wound infiltration. METHODS: After institutional review board approval was obtained, a retrospective chart review was performed of pediatric patients treated at a single institution during a 2-year period...
December 27, 2017: Surgery
https://www.readbyqxmd.com/read/29249547/current-pain-prescribing-habits-for-common-shoulder-operations-a-survey-of-the-american-shoulder-and-elbow-surgeons-membership
#4
K Linnea Welton, Matthew J Kraeutler, Eric C McCarty, Armando F Vidal, Jonathan T Bravman
BACKGROUND: Orthopedic surgeons are among the highest prescribers of narcotic pills, and no guidelines currently exist for appropriate management of postoperative pain within this field. The purpose of this study was to gain understanding of the current pain management strategies used perioperatively and postoperatively among orthopedic shoulder surgeons. METHODS: Members of the American Shoulder and Elbow Surgeons were e-mailed an online survey regarding methods for managing pain in the perioperative and postoperative setting for total shoulder arthroplasty, labral and capsular stabilization procedures, and rotator cuff repair...
December 14, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29224770/pain-control-following-tonsillectomy-in-children-a-survey-of-patients
#5
Philip R Persino, Lena Saleh, David L Walner
OBJECTIVE: This prospective study aimed to survey pediatric patients and their parents after tonsillectomy to assess their pain management utilization and satisfaction. INTRODUCTION: Tonsillectomy is the second most common surgical procedure performed in pediatric patients. Postoperative recovery is often associated with high levels of pain and severe functional limitations. There is currently no consensus on pain control regimens. Additionally, a recent FDA Black Box Warning on narcotic use has caused more uncertainty in appropriate pain control regimens...
December 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29210330/subcutaneous-local-anesthetic-infusion-could-eliminate-use-of-epidural-analgesia-after-the-nuss-procedure
#6
Sandra K Kabagambe, Laura F Goodman, Y Julia Chen, Benjamin A Keller, James C Becker, Gary W Raff, Rebecca A Stark, Jacob T Stephenson, Amy Rahm, Diana L Farmer, Shinjiro Hirose
AIM: To compare outcomes of continuous subcutaneous infusion of local anesthetic and epidural analgesia following the Nuss procedure. PATIENTS & METHODS: A retrospective chart review compared patients managed with subcutaneous local anesthetic infusion (n = 12) versus thoracic epidural (n = 19) following the Nuss procedure from March 2013 to June 2015. RESULTS: There was no difference in hospital length of stay or days on intravenous narcotics...
January 2018: Pain Management
https://www.readbyqxmd.com/read/29179909/surgical-interns-preparedness-for-opioid-prescribing-before-and-after-a-training-intervention
#7
Michael J Nooromid, Neel A Mansukhani, Benjamin W Deschner, Simon Moradian, Nabil Issa, Karen J Ho, Jonah J Stulberg
INTRODUCTION: Exposure to pain management curriculum in medical school is currently variable. This paper reports on formal prescribing education, self-perceived prescribing readiness, and prescribing practices among incoming surgical residents before and after a pain management training session. METHODS: Pre-residency survey of thirty surgical interns at a single urban medical center, followed by a repeat survey after an educational session on prescription writing and opioid abuse...
November 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/29160727/a-review-of-perioperative-complications-of-outpatient-total-ankle-arthroplasty
#8
Todd R Borenstein, Kapil Anand, Quanlin Li, Timothy P Charlton, David B Thordarson
BACKGROUND: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. METHODS: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed...
November 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29160561/can-overnight-stenting-be-safely-eliminated-following-a-pharyngeal-flap-a-matched-comparison-study
#9
Andre M Wineland, Jareen Meinzen-Derr, Paul Willging
OBJECTIVE: Determine if overnight stenting is warranted after pharyngeal flap for management of velopharyngeal insufficiency (VPI) in pediatric patients METHODS: This is a retrospective age-matched cohort study from a single tertiary pediatric facility. Patients who underwent a posterior pharyngeal flap for VPI from January 1, 2013, to December 31, 2016, were included. Two equal groups were constructed based on when their nasal stents were removed, that is, postoperative day (POD) 0 or POD 1...
November 21, 2017: Laryngoscope
https://www.readbyqxmd.com/read/29145989/pain-management-strategies-in-shoulder-arthroplasty
#10
REVIEW
Jason L Codding, Charles L Getz
Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain...
January 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29139482/opioid-misuse-in-gastroenterology-and-non-opioid-management-of-abdominal-pain
#11
REVIEW
Eva Szigethy, Mitchell Knisely, Douglas Drossman
Opioids were one of the earliest classes of medications used for pain across a variety of conditions, but morbidity and mortality have been increasingly associated with their chronic use. Despite these negative consequences, chronic opioid use is increasing worldwide, with the USA and Canada having the highest rates. Chronic opioid use for noncancer pain can have particularly negative effects in the gastrointestinal and central nervous systems, including opioid-induced constipation, narcotic bowel syndrome, worsening psychopathology and addiction...
November 15, 2017: Nature Reviews. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29131328/headache-education-active-waiting-directive-a-program-to-enhance-well-being-during-long-referral-wait-times
#12
Ana Marissa Lagman-Bartolome, Valerie Lawler, Christine Lay
OBJECTIVE: The aim of this initiative was to evaluate the clinical impact, patient acceptability, and sustainability of implementing a newly developed evidence-guided migraine education program in an academic headache center. BACKGROUND: Headache is the fifth most common reason for emergency department (ED) visits and accounts for more than 10 million physician visits annually. Successful management of headaches presents a challenge to both primary care providers and neurologists...
November 12, 2017: Headache
https://www.readbyqxmd.com/read/29121158/opioid-use-by-patients-after-rhinoplasty
#13
Sagar Patel, Angela Sturm, Michael Bobian, Peter F Svider, Giancarlo Zuliani, Russell Kridel
Importance: Given the increase in opioid addiction and overdose in the United States, reasoned opioid use after outpatient surgery may affect prescription medication abuse. Objectives: To examine patient use of opioids after rhinoplasty and establish an optimal postrhinoplasty pain management regimen. Design, Setting, and Participants: In this case series, opioid use was evaluated in 62 patients who underwent rhinoplasty performed by 3 fellowship-trained facial plastic surgeons, 2 in private practice in Texas and 1 in an academic setting in Michigan, from February 2016 to September 2016...
November 9, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/29084006/review-and-update-on-postoperative-opioid-use-after-nasal-and-sinus-surgery
#14
Sophia D Becker, Daniel G Becker
PURPOSE OF REVIEW: We examine the current literature on pain management after sinus and nasal surgery. The goal after surgery is to provide effective pain management without having too many 'leftovers', as leftover medications are an important source of opioids that are fueling the current prescription narcotic epidemic in the United States. There are more than 250 000 sinus operations and 260 000 septoplasties performed annually, and surgeons commonly prescribe a narcotic pain medication for postoperative pain management...
October 27, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29078677/uniportal-video-assisted-thoracoscopic-surgery-vats-technique-is-associated-with-decreased-narcotic-usage-over-traditional-vats-lobectomy
#15
Scott Gregory Louis, William James Gibson, Chase Lynn King, Nirmal Kumar Veeramachaneni
BACKGROUND: Uniportal video-assisted thoracoscopic surgery (VATS) is gaining popularity internationally, but remains an uncommon practice in the United States. One proposed benefit is a decrease in narcotic usage and peri-operative pain when compared to traditional multiple incision VATS. The purpose of this study was to determine the post-operative narcotic usage between patients undergoing anatomic lobectomy via traditional VATS as compared to patients undergoing uniportal VATS. METHODS: All consecutive patients undergoing anatomic lobectomy for presumed malignancy by a single surgeon at an academic medical institution were recorded between July 2013 and September 2015...
2017: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29078056/pain-management-after-outpatient-foot-and-ankle-surgery
#16
Akash Gupta, Kanupriya Kumar, Matthew M Roberts, Austin E Sanders, Mackenzie T Jones, David S Levine, Martin J O'Malley, Mark C Drakos, Andrew J Elliott, Jonathan T Deland, Scott J Ellis
BACKGROUND: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe...
October 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29077663/anesthetic-management-of-a-patient-with-de-novo-hereditary-sensory-and-autonomic-neuropathy-type-vii-a-case-report
#17
Lorenzo Rafer, James Mooney
An 18-month-old patient with hereditary sensory and autonomic neuropathy, type VII undergoing general anesthesia for Nissen fundoplication and gastrostomy tube is presented. This is the first reported case of a patient with this particular genetic mutation receiving general anesthesia. We presented the major intraoperative events during the procedure. The anesthetic considerations and implications of caring for a patient with this particular mutation and patients with other variations of hereditary sensory and autonomic neuropathy are also discussed...
October 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29073780/continuous-wound-infiltration-after-hallux-valgus-surgery
#18
Matthias Braito, Dietmar Dammerer, Andreas Schlager, Jürgen Wansch, Caroline Linhart, Rainer Biedermann
BACKGROUND: Hallux valgus surgery is associated with significant early postoperative pain. The aim of this study was to investigate the use of continuous wound infiltration (CWI) with ropivacaine for pain management after hallux valgus surgery. METHODS: In this prospective, randomized, double-blind, and placebo-controlled single-center trial, 50 patients undergoing distal metatarsal osteotomy for idiopathic hallux valgus were allocated to CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h or placebo for 24 hours postoperatively...
October 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29073739/association-of-early-outpatient-rehabilitation-with-health-service-utilization-in-managing-medicare-beneficiaries-with-nontraumatic-knee-pain-retrospective-cohort-study
#19
Joel M Stevans, G Kelley Fitzgerald, Sara R Piva, Michael Schneider
Background: Nontraumatic knee pain (NTKP) is highly prevalent in adults 65 years of age and older. Evidence-based guidelines recommend early use of rehabilitation; however, there is limited information comparing differences in health care utilization when rehabilitation is included in the management of NTKP. Objectives: To describe the overall health care utilization associated with the management of NTKP; estimate the proportion of people who receive outpatient rehabilitation services; and evaluate the timing of outpatient rehabilitation and its association with other health care utilization...
June 1, 2017: Physical Therapy
https://www.readbyqxmd.com/read/29061282/analgesic-efficacy-of-laparoscopic-guided-transverse-abdominis-plane-block-using-liposomal-bupivacaine-in-bariatric-surgery
#20
Avinash Bhakta, Owen Glotzer, Ashar Ata, Marcel Tafen, Steven C Stain, Paul T Singh
BACKGROUND: Postoperative pain management is a major contributor to recovery and discharge in bariatric surgery. Local anesthetic agents are of particular interest: they're non-sedating and may reduce postoperative pain and hospital length of stay (LOS). DESIGN: Researchers queried the Bariatric Surgery Service Database for patients undergoing laparoscopic weight loss surgery from January 2012-December 2014. Patients were divided between those who did and did not receive liposomal bupivacaine intra-operatively...
September 20, 2017: American Journal of Surgery
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