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Narcotics management

Isabel Atencio, Max Beushausen, John J Kowalczyk, Andres Flores-Hidalgo, Nora Fitzgerald, Dale A Baur
PURPOSE: Currently, there is a concern at the national level of the overuse of both prescription and nonprescription opioid use. The purpose of this study was to identify whether the use of the intravenous (IV) formulation of acetaminophen (Ofirmev; Mallinckrodt Pharmaceuticals, Staines-upon-Thames, United Kingdom) is an effective tool in the reduction of postoperative pain, with a secondary goal of reduction of postoperative narcotic use. MATERIALS AND METHODS: A total of 72 patients with previously diagnosed either partial bony or complete bony impacted third molars were selected with care to avoid long-acting local anesthetics or dissociative anesthetic agents...
February 20, 2018: Journal of Oral and Maxillofacial Surgery
Stephen Yu, John Dundon, Olga Solovyova, Joseph Bosco, Richard Iorio
BACKGROUND: TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. QUESTIONS/PURPOSES: (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? METHODS: We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA...
January 2018: Clinical Orthopaedics and related Research
Michael J Moses, Jared C Tishelman, Saqib Hasan, Peter L Zhou, Ioanna Zevgaras, Justin S Smith, Aaron J Buckland, Yong Kim, Afshin Razi, Themistocles S Protopsaltis
STUDY DESIGN: Cross-Sectional Study. OBJECTIVE: The goal of this study is to investigate how surgeons differ in collar and narcotic use, as well as return to driving recommendations following cervical spine surgeries and the associated medico-legal ramifications of these conditions. SUMMARY OF BACKGROUND DATA: Restoration of quality of life is one of the main goals of cervical spine surgery. Patients frequently inquire when they may safely resume driving after cervical spine surgery...
March 9, 2018: Spine
Marko Tomov, Kevin Tou, Rose Winkel, Ross Puffer, Mohamad Bydon, Ahmad Nassr, Paul Huddleston, Michael Yaszemski, Bradford Currier, Brett Freedman
Study Design: Retrospective case-control study using prospectively collected data. Purpose: Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF). Overview of Literature: Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain...
February 2018: Asian Spine Journal
Ellen M Raney, Harold J P van Bosse, Kevin G Shea, Joshua M Abzug, Richard M Schwend
INTRODUCTION: The opioid epidemic in the United States has reached crisis proportions. Urgent response is needed. Hydrocodone in combination with acetaminophen is the most prescribed drug in the United States. The most common source of opioids available for misuse is the unused portions of postoperative prescriptions. Among high school seniors, 80% of those who reported nonmedical use of prescription opioids previously had legitimate prescriptions but recreationally used leftover doses...
February 27, 2018: Journal of Pediatric Orthopedics
Mark R Jones, Alan D Kaye, Laxmaiah Manchikanti, Joshua A Hirsch
PURPOSE OF REVIEW: The prevalence of chronic pain and prescription opioid abuse has resulted in epidemic problems for patients and clinicians. The consequences are taking a heavy toll on patients, physicians, and society. Specific to radiology, a significant need exists for best practice assessment and treatment approaches for pain management, as patients with chronic pain often undergo radiological tests of unclear clinical relevance. RECENT FINDINGS: The USA is amid an opioid-prescribing epidemic and resultant overdose public health emergency...
February 23, 2018: Current Pain and Headache Reports
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND: Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS: A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
February 16, 2018: Journal of Reconstructive Microsurgery
Elmang Nchako, Scottie Bussell, Carlos Nesbeth, Chisom Odoh
Africans endure a high burden of pain and suffering from HIV/AIDS and cancer, yet receive a meager amount of the world's pain medication. This tragedy occurs needlessly, given that inexpensive, effective and easily administered interventions are available. WHO has a 'three-step analgesic ladder' framework for managing cancer pain. This widely adopted clinical practice guideline is an integral part of palliative care programs and has also been applied to non-cancer pain. However, untreated pain is a major public health problem due to the discordance between scientific evidence and public policy...
February 13, 2018: International Health
Chandrakanth Boddu, Ashley Genza, Peter D McCann
BACKGROUND: We report our experience with a bridging multimodal pain management program that provides comprehensive 48-hour pain control in patients undergoing total shoulder replacement (TSR). METHODS: The study included all patients undergoing unilateral TSR by 1 surgeon between May 2015 and April 2017. There were 62 patients (23 men, 39 women) with an average age of 68 years (range 38-92 years). Of these, 31 underwent standard nonconstrained TSR and 31 underwent reverse TSR...
February 7, 2018: Journal of Shoulder and Elbow Surgery
Michael K Urban, Kristy M Labib, Shane C Reid, Amanda K Goon, Valeria Rotundo, Frank P Cammisa, Federico P Girardi
Background: The treatment of postoperative pain is a challenge after posterior spinal fusions. Pain management using predominantly opioids is often associated with multiple adverse effects, while multimodal postoperative analgesia may provide adequate pain relief with fewer opioid side effects. Questions/Purposes: The purpose of this review is to determine whether addition of 150 mg pregabalin daily would reduce narcotic requirements and improve outcomes after posterior lumbar fusion (PLF)...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Tyler C Friske, Richard Sola, Yangyang R Yu, Abdur R Jamal, Eric Rosenfeld, Huirong Zhu, Mark V Mazziotti, Shawn D St Peter, Sohail R Shah
BACKGROUND: High narcotic requirements after minimally invasive repair of pectus excavatum (MIRPE) can increase the risk of urinary retention. Placement of intraoperative Foley catheters to minimize this risk is variable. This study determines the rate of urinary retention in this population to guide future practice. MATERIALS AND METHODS: We reviewed retrospectively all patients who underwent MIRPE from January 2012 to July 2016 at 2 academic children's hospitals...
January 31, 2018: Surgery
Sven Schmidt, Joerg Franke, Michael Rauschmann, Dieter Adelt, Matteo Mario Bonsanto, Steffen Sola
OBJECTIVE Surgical decompression is extremely effective in relieving pain and symptoms due to lumbar spinal stenosis (LSS). Decompression with interlaminar stabilization (D+ILS) is as effective as decompression with posterolateral fusion for stenosis, as shown in a major US FDA pivotal trial. This study reports a multicenter, randomized controlled trial in which D+ILS was compared with decompression alone (DA) for treatment of moderate to severe LSS. METHODS Under approved institutional ethics review, 230 patients (1:1 ratio) randomized to either DA or D+ILS (coflex, Paradigm Spine) were treated at 7 sites in Germany...
January 26, 2018: Journal of Neurosurgery. Spine
Kirsten Wiese Simonsen, Kristian Linnet, Brian Schou Rasmussen
OBJECTIVES: The objective of this study was to examine the frequency of psychoactive drugs and alcohol in drivers under suspicion of driving under the influence of drugs and alcohol in 2015 and 2016 in the eastern part of Denmark. The trends in the number of traffic cases sent for drug analysis since 2000 and alcohol analysis since 2011 are also discussed. METHODS: Blood samples from drivers suspected of being under the influence of alcohol and/or medication and/or illicit drugs in 2015 and 2016 were investigated as requested by the police...
January 25, 2018: Traffic Injury Prevention
Jessica G Fried, Angeline S Andrew, Natalie Y Ring, David A Pastel
Purpose To determine whether inclusion of an epidemiologic statement in radiology reports of lumbar magnetic resonance (MR) imaging influences downstream health care utilization in the primary care population. Materials and Methods Beginning July 1, 2013, a validated epidemiologic statement regarding prevalence of common findings in asymptomatic patients was included in all lumbar MR imaging reports at a tertiary academic medical center. Data were collected from July 1, 2012, through June 30, 2014, and retrospective analysis was completed in September 2016...
January 22, 2018: Radiology
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
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
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...
March 2018: Surgery
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
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
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
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