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https://www.readbyqxmd.com/read/28397700/narcotic-bowel-syndrome
#1
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
#2
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
#3
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
https://www.readbyqxmd.com/read/28375887/randomized-controlled-trial-of-interscalene-block-compared-with-injectable-liposomal-bupivacaine-in-shoulder-arthroplasty
#4
RANDOMIZED CONTROLLED TRIAL
Surena Namdari, Thema Nicholson, Joseph Abboud, Mark Lazarus, Dean Steinberg, Gerald Williams
BACKGROUND: Shortcomings of interscalene brachial plexus blockade include technical failure and rebound pain. Bupivacaine liposome injectable suspension, a sustained release preparation, is used for surgical-site administration. The purpose of this study was to evaluate these 2 postoperative pain management strategies in patients undergoing shoulder arthroplasty. METHODS: In a non-blinded, randomized controlled trial of participants undergoing primary shoulder arthroplasty, patients were randomized to interscalene brachial plexus blockade or intraoperative soft-tissue infiltration of bupivacaine liposome injectable suspension...
April 5, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28373906/a-meta-analysis-of-palliative-treatment-of-pancreatic-cancer-with-high-intensity-focused-ultrasound
#5
Susan Dababou, Cristina Marrocchio, Jarrett Rosenberg, Rachelle Bitton, Kim Butts Pauly, Alessandro Napoli, Joo Ha Hwang, Pejman Ghanouni
BACKGROUND: Pancreatic adenocarcinoma is currently the fourth-leading cause of cancer-related death. Up to 60-90% of patients with advanced disease suffer cancer-related pain, severely impacting their quality of life. Current management involves primarily pharmacotherapy with opioid narcotics and celiac plexus neurolysis; unfortunately, both approaches offer transient relief and cause undesired side-effects. High intensity focused ultrasound (HIFU) is a non-invasive thermal ablation technique that has been used to treat pancreatic cancer...
2017: Journal of Therapeutic Ultrasound
https://www.readbyqxmd.com/read/28367289/comparison-of-single-dose-nalbuphine-versus-tramadol-for-postoperative-pain-management-in-children-a-randomized-controlled-trial
#6
Naeem Liaqat, Sajid Hameed Dar
BACKGROUND: Acute postoperative pain control in children is an essential component of postoperative care, particularly in daycare procedures. Giving patients continuous narcotic analgesics can be risky; however, a single dose may be sufficient. METHODS: This study used a prospective, randomized controlled design and was conducted at the Pediatric Surgery Unit, Services Hospital, Lahore. In total, 150 patients who underwent inguinal herniotomy (age range: 1-12 years) were randomly assigned to two groups: group A (nalbuphine) and group B (tramadol)...
April 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28331362/anesthesia-for-the-patient-undergoing-total-knee-replacement-current-status-and-future-prospects
#7
REVIEW
Zachary A Turnbull, Dahniel Sastow, Gregory P Giambrone, Tiffany Tedore
Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28292629/the-5-clinical-pillars-of-value-for-total-joint-arthroplasty-in-a-bundled-payment-paradigm
#8
Kelvin Kim, Richard Iorio
BACKGROUND: Our large, urban, tertiary, university-based institution reflects on its 4-year experience with Bundled Payments for Care Improvement. We will describe the importance of 5 clinical pillars that have contributed to the early success of our bundled payment initiative. We are convinced that value-based care delivered through bundled payment initiatives is the best method to optimize patient outcomes while rewarding surgeons and hospitals for adapting to the evolving healthcare reforms...
February 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28292504/pharmacists-perceptions-regarding-the-impact-of-hydrocodone-rescheduling-on-prescription-volume-workflow-management-and-patient-outcomes
#9
Tyler J Varisco, Motolani E Ogunsanya, Jamie C Barner, Marc L Fleming
OBJECTIVES: To determine (1) pharmacists' perceptions of how rescheduling of hydrocodone combination products (HCPs) from Drug Enforcement Agency (DEA) Schedule III to DEA Schedule II has influenced prescription volume and revenue, pharmacy workflow management, and patient outcomes; and (2) whether perceptions differed between pharmacists who support versus those who oppose HCP rescheduling. DESIGN: A cross-sectional mail survey. SETTING: Texas community pharmacies from October to December 2015...
March 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28291185/efficacy-of-surgical-site-multimodal-drug-injection-following-operative-management-of-femoral-fractures-a-randomized-controlled-trial
#10
RANDOMIZED CONTROLLED TRIAL
Daniel Koehler, J Lawrence Marsh, Matthew Karam, Catherine Fruehling, Michael Willey
BACKGROUND: Multimodal analgesia inclusive of periarticular injection with a local anesthetic agent has been rapidly assimilated, with demonstrated safety and efficacy, into the care of patients undergoing elective lower-extremity arthroplasty. The present study was performed to evaluate the efficacy and safety of a surgical-site, multimodal drug injection for postoperative pain control following operative management of femoral fractures. METHODS: There were 102 patients undergoing operative intervention (plate fixation, intramedullary device, or arthroplasty) for a broad range of femoral fracture patterns who were prospectively randomized either to receive an intraoperative, surgical-site injection into the superficial and deep tissues containing ropivacaine, epinephrine, and morphine or to receive no injection...
March 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28290530/identifying-life-threatening-admissions-for-drug-dependence-or-abuse-iliadda-derivation-and-validation-of-a-model
#11
Tri-Long Nguyen, Thierry Boudemaghe, Géraldine Leguelinel-Blache, Céline Eiden, Jean-Marie Kinowski, Yannick Le Manach, Hélène Peyrière, Paul Landais
Given that drug abuse and dependence are common reasons for hospitalization, we aimed to derive and validate a model allowing early identification of life-threatening hospital admissions for drug dependence or abuse. Using the French National Hospital Discharge Data Base, we extracted 66,101 acute inpatient stays for substance abuse, dependence, mental disorders or poisoning associated with medicines or illicit drugs intake, recorded between January 1(st), 2009 and December 31(st), 2014. We split our study cohort at the center level to create a derivation cohort and a validation cohort...
March 14, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28281740/comparison-of-laparoendoscopic-single-site-less-and-multiport-laparoscopic-radical-nephrectomy-for-clinical-t1b-and-t2a-renal-masses
#12
Abd-El R Hassan, Omer A Raheem, Sean Berquist, Alp T Beksac, Aaron Bloch, Charles Field, Hak J Lee, Reza Mehrazin, Marc Holden, Michelle McDONALD, Zachary Hamilton, Michael Liss, Ithaar H Derweesh
BACKGROUND: To compare outcomes of Laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) Radical Nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses. METHODS: Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. 63 patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway...
March 10, 2017: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/28263128/predictors-of-narcotic-use-after-percutaneous-nephrolithotomy
#13
Nazih Khater, Mohamed Keheila, Michelle Lightfoot, Jim Shen, Samuel Abourbih, Muhannad Alsyouf, Roger Li, D Duane Baldwin
INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is associated with significant variability in postoperative pain and subsequent narcotic use. The purpose of this study was to determine the factors associated with high narcotic use following PCNL. MATERIALS AND METHODS: A single-center retrospective review of patients undergoing initial PCNL between 2004 and 2014 was performed. Preoperative, intraoperative and postoperative factors associated with postoperative narcotic usage were analyzed...
February 2017: Canadian Journal of Urology
https://www.readbyqxmd.com/read/28258773/efficacy-of-celecoxib-for-early-postoperative-pain-management-in-hip-arthroscopy-a-prospective-randomized-placebo-controlled-study
#14
Cynthia A Kahlenberg, Ronak M Patel, Michael Knesek, Vehniah K Tjong, Kevin Sonn, Michael A Terry
PURPOSE: To determine whether 400 mg of celecoxib administered 1 hour before hip arthroscopy surgery would reduce pain, provide reduction in overall narcotic consumption, and lead to more rapid discharge from recovery rooms. METHODS: Ninety-eight patients were randomized to either the celecoxib group (n = 50) or the placebo group (n = 48). An a priori power analysis was done set to detect a difference of 0.50 on the visual analog scale (VAS), based on the senior author's preference...
February 28, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28249051/the-elements-of-pain-care-that-the-guidelines-don-t-address
#15
EDITORIAL
John Hickner
I have managed many patients with chronic pain who were already on hefty doses of narcotics when they became my patients. Rather than refuse to care for them, we should seek to understand their story, continuously try other medications and therapies, repeatedly attempt to reduce dosages, and frequently check substance databases.
March 2017: Journal of Family Practice
https://www.readbyqxmd.com/read/28243380/patient-reported-outcomes-from-sacroiliac-joint-fusion
#16
Vamsi K Kancherla, Shane M McGowan, Brittany N Audley, Gbolabo Sokunbi, Steven T Puccio
STUDY DESIGN: Retrospective, case series. PURPOSE: The purpose of this study is to determine morbidity, complications, and patient reported outcomes from minimally invasive sacroiliac joint (SIJ) fusion. OVERVIEW OF LITERATURE: Lumbar back pain emanating from the SIJ can be surgically treated via a percutaneous approach in the appropriately selected patient with minimal morbidity and acceptable functional outcomes. METHODS: Patients diagnosed by >2 physical examination maneuvers and subjective relief from a computed tomography-guided lidocaine-bupivacaine-steroid injection underwent SIJ fusion after failing conservative management with a combination of oral anti-inflammatory medications, physical therapy, and pelvic belt stabilization...
February 2017: Asian Spine Journal
https://www.readbyqxmd.com/read/28222918/receipt-of-pain-management-information-preoperatively-is-associated-with-improved-functional-gain-after-elective-total-joint-arthroplasty
#17
Celeste A Lemay, Courtland G Lewis, Jasvinder A Singh, Patricia D Franklin
BACKGROUND: Poorly controlled postoperative pain may adversely affect total joint arthroplasty (TJA) patients' outcomes and associated healthcare cost. Understanding effective pain management after surgery is important to patients, surgeons, and hospitals. We evaluated patient-reported receipt of preoperative pain management information in a national prospective cohort evaluating postoperative pain and function following elective TJA. METHODS: Preoperative and 2-week and 6-month postoperative survey data of 1609 TJA patients collected between June 2013 and December 2014 were analyzed...
January 26, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28214970/optimal-bowel-cleansing-for-colonoscopy-in-the-elderly-patient
#18
Samuel B Ho, Rita Hovsepians, Samir Gupta
Colonoscopy is an important diagnostic and screening tool for colorectal cancer detection and prevention, and adequate bowel preparation is critical for successful colonoscopy. Complications related to colonoscopy, either directly or indirectly related to the procedure, are increased in elderly patients, and the risks and benefits of colonoscopy procedures need to be carefully considered in these patients. Recent studies have shown that 4 L polyethylene glycol with a split preparation is safe and effective for elderly patients, and is the preferred preparation for patients with medical comorbidities...
March 2017: Drugs & Aging
https://www.readbyqxmd.com/read/28210646/pain-assessment-after-anterior-cruciate-ligament-reconstruction-bone-patellar-tendon-bone-versus-hamstring-tendon-autograft
#19
Kelechi R Okoroha, Robert A Keller, Edward K Jung, Lafi Khalil, Nathan Marshall, Patricia A Kolowich, Vasilios Moutzouros
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain. PURPOSE: To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone-patellar tendon-bone (BTB) versus hamstring tendon (HS) autograft. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate...
December 2016: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/28204979/one-year-swallowing-outcomes-in-patients-treated-with-prophylactic-gabapentin-during-radiation-based-treatment-for-oropharyngeal-cancer
#20
Heather M Starmer, WuYang Yang, Christine G Gourin, Rachit Kumar, Bronwyn Jones, Todd McNutt, Sierra Cheng, Harry Quon
Recent investigations by our study team have demonstrated patients using gabapentin for pain management during chemoradiotherapy (CRT) do well maintaining swallowing during treatment with less need for narcotic pain medication, PEG dependence, weight loss, and short-term swallowing morbidity. The purpose of this investigation was to characterize the long-term swallowing function of these patients 1-year following treatment. Sequential patients receiving CRT for oropharyngeal cancer and concurrent gabapentin were evaluated 1-year following treatment for swallowing outcomes...
February 15, 2017: Dysphagia
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