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https://www.readbyqxmd.com/read/28333299/bilateral-breast-reduction-without-opioid-analgesics-a-comparative-study
#1
Fereydoun Don Parsa, Justin Cheng, Brad Stephan, Nikki Castel, Leslie Kim, Daniel Murariu, Alan A Parsa
Background: Breast reduction has traditionally been performed under general anesthesia with adjunct opioid use. However, opioids are associated with a wide variety of adverse effects, including nausea, vomiting, constipation, postoperative sedation, dizziness, and addiction. Objectives: This study compares bilateral breast reduction using a multimodal opioid-free pain management regimen vs traditional general anesthesia with adjunct opioids. Methods: A total of 83 female patients were enrolled in this study...
March 3, 2017: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/28331362/anesthesia-for-the-patient-undergoing-total-knee-replacement-current-status-and-future-prospects
#2
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/28326850/multimodal-analgesia-in-moderate-to-severe-pain-a-role-for-a-new-fixed-combination-of-dexketoprofen-and-tramadol
#3
Giustino Varrassi, Magdi Hanna, Giorgos Macheras, Antonio Montero, Antonio Montes Perez, Winfried Meissner, Serge Perrot, Carmelo Scarpignato
Untreated and undertreated pain represent one of the most pervasive health problems, which is worsening as the population ages and accrues risk for pain. Multiple treatment options are available, most of which have one mechanism of action, and cannot be prescribed at unlimited doses due to the ceiling of efficacy and/or safety concerns. Another limitation of single-agent analgesia is that, in general, pain is due to multiple causes. Combining drugs from different classes, with different and complementary mechanism(s) of action, provides a better opportunity for effective analgesia at reduced doses of individual agents...
March 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28318860/a-prospective-randomized-trial-comparing-liposomal-bupivacaine-vs-fascia-iliaca-compartment-block-for-postoperative-pain-control-in-total-hip-arthroplasty
#4
Molly A McGraw-Tatum, Michael T Groover, Nicole E George, John S Urse, Victor Heh
BACKGROUND: Increasing demand for total hip arthroplasty (THA) in a climate of increasing focus on clinical outcomes, patient satisfaction, and cost has created a need for better acute postoperative pain control for patients. An ideal pain control method would have few side effects, decreased opioid consumption, improved pain control, early ambulation, and decreased hospital length of stay (LOS). METHODS: We performed a prospective randomized, controlled study involving 79 patients undergoing elective THA between June 2015 and February 2016...
February 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28303297/acute-calcific-tendinopathy-of-the-popliteus-tendon-a-rare-case-diagnosed-using-a-multimodality-imaging-approach-and-treated-conservatively
#5
Cédric Doucet, Akshat Gotra, Santhosh Mauvva Venkatesh Reddy, Mathieu Boily
Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues...
March 16, 2017: Skeletal Radiology
https://www.readbyqxmd.com/read/28299313/perioperative-factors-contributing-the-post-craniotomy-pain-a-synthesis-of-concepts
#6
REVIEW
Tumul Chowdhury, Rakesh Garg, Veena Sheshadri, Lakshmi Venkatraghavan, Sergio Daniel Bergese, Ronald B Cappellani, Bernhard Schaller
The perioperative management of post-craniotomy pain is controversial. Although the concept of pain control in non-neurosurgical fields has grown substantially, the understanding of neurosurgical pain and its causative factors in such a population is inconclusive. In fact, the organ that is the center of pain and its related mechanisms receives little attention to alleviate distress during neurosurgical procedures. In contrast to the old belief that pain following intracranial surgery is minimal, recent data suggest the exact opposite...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28298041/randomized-double-blinded-placebo-controlled-trial-comparing-two-multimodal-opioid-minimizing-pain-management-regimens-following-transsphenoidal-surgery
#7
Deborah M Shepherd, Heidi Jahnke, William L White, Andrew S Little
OBJECTIVE Pain control is an important clinical consideration and quality-of-care metric. No studies have examined postoperative pain control following transsphenoidal surgery for pituitary lesions. The study goals were to 1) report postoperative pain scores following transsphenoidal surgery, 2) determine if multimodal opioid-minimizing pain regimens yielded satisfactory postoperative pain control, and 3) determine if intravenous (IV) ibuprofen improved postoperative pain scores and reduced opioid use compared with placebo...
March 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28296770/evaluation-of-intrathecal-drug-delivery-system-for-intractable-pain-in-advanced-malignancies-a-prospective-cohort-study
#8
Shuyue Zheng, Liangliang He, Xiaohui Yang, Xiuhua Li, Zhanmin Yang
Pain is prevalent in advanced malignancies; however, some patients cannot get adequate pain relief by conservative routes of analgesic administration or experience serious side effects related to high dose of opioids. For those who have exhausted multimodal conservative analgesic, intrathecal drug delivery is an alternative intervention for truly effective pain management. The objective of this study was to evaluate the clinical efficacy and safety of intrathecal drug delivery system (IDDS) for the treatment of intractable pain in advanced cancer patients...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28292629/the-5-clinical-pillars-of-value-for-total-joint-arthroplasty-in-a-bundled-payment-paradigm
#9
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/28291192/intraoperative-injection-significantly-reduces-postoperative-pain-in-trauma-patients-too-commentary-on-an-article-by-daniel-koehler-md-et-al-efficacy-of-surgical-site-multimodal-drug-injection-following-operative-management-of-femoral-fractures-a-randomized
#10
https://www.readbyqxmd.com/read/28291185/efficacy-of-surgical-site-multimodal-drug-injection-following-operative-management-of-femoral-fractures-a-randomized-controlled-trial
#11
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/28291143/the-role-of-multimodal-analgesia-in-spine-surgery
#12
Mark F Kurd, Tyler Kreitz, Gregory Schroeder, Alexander R Vaccaro
Optimal postoperative pain control allows for faster recovery, reduced complications, and improved patient satisfaction. Historically, pain management after spine surgery relied heavily on opioid medications. Multimodal regimens were developed to reduce opioid consumption and associated adverse effects. Multimodal approaches used in orthopaedic surgery of the lower extremity, especially joint arthroplasty, have been well described and studies have shown reduced opioid consumption, improved pain and function, and decreased length of stay...
April 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/28283811/techniques-to-optimize-multimodal-analgesia-in-ambulatory-surgery
#13
REVIEW
Amit Prabhakar, John N Cefalu, Josef S Rowe, Alan D Kaye, Richard D Urman
PURPOSE OF REVIEW: Ambulatory surgery has grown in popularity in recent decades due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. We review common approaches to multimodal analgesia. RECENT FINDINGS: A multimodal approach can help reduce perioperative opioid requirements and improve patient recovery. Analgesic options may include NSAIDs, acetaminophen, gabapentinoids, corticosteroids, alpha-2 agonists, local anesthetics, and the use of regional anesthesia...
May 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28277866/treatment-for-chronic-low-back-pain-the-focus-should-change-to-multimodal-management-that-reflects-the-underlying-pain-mechanisms
#14
Gerhard Müller-Schwefe, Bart Morlion, Karsten Ahlbeck, Eli Alon, Stefano Coaccioli, Flaminia Coluzzi, Frank Huygen, Wolfgang Jaksch, Eija Kalso, Magdalena Kocot-Kępska, Hans-Georg Kress, Ana Cristina Mangas, Cesar Margarit Ferri, Philippe Mavrocordatos, Andrew Nicolaou, Concepción Pérez Hernández, Joseph Pergolizzi, Michael Schaefer, Patrick Sichère
Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed...
February 22, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28277593/pain-management-with-adductor-canal-blockade-or-multimodal-periarticular-analgesia-in-elderly-total-knee-arthroplasty-patients
#15
Chukwuweike U Gwam, Nequesha Mohamed, Jaydev B Mistry, Melbin Thomas, Morad Chughtai, Sabahat Khan, Anton Khlopas, Michael A Mont, Ronald E Delanois
INTRODUCTION: Post-operative pain management in elderly total knee arthroplasty (TKA) patients has traditionally included opioids, epidurals, and femoral nerve blocks. Although these modalities are effective, they are often associated with adverse side effects, which may have a greater impact on this population. Alternative modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA) have demonstrated great efficacy with a low side effect profile. However, it is unknown if one modality is advantageous over the other in the elderly...
March 9, 2017: Surgical Technology International
https://www.readbyqxmd.com/read/28267070/adherence-to-a-multimodal-analgesic-clinical-pathway-a-within-group-comparison-of-staged-bilateral-knee-arthroplasty-patients
#16
Rachel C Steckelberg, Natasha Funck, T Edward Kim, Tessa L Walters, Gregory Milo Lochbaum, Stavros G Memtsoudis, Nicholas J Giori, Pier F Indelli, Lorrie J Graham, Edward R Mariano
BACKGROUND AND OBJECTIVES: Multimodal analgesic clinical pathways for joint replacement patients often include perineural catheters, but long-term adherence to these pathways has not yet been investigated. Our primary aim was to determine adherence rate to a knee arthroplasty clinical pathway for patients undergoing staged bilateral procedures. METHODS: This study was performed at a hospital with a Perioperative Surgical Home program and knee arthroplasty clinical pathway using multimodal analgesia and adductor canal catheters...
March 6, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28265859/new-cancer-pain-treatment-options
#17
REVIEW
Kenneth D Candido, Teresa M Kusper, Nebojsa Nick Knezevic
PURPOSE OF REVIEW: Cancer pain is often incapacitating and discouraging to patients; is demoralizing to family members and care takers; and is taxing and difficult to subdue for the pain specialists. The consequences of implementing suboptimal treatment are far-reaching; therefore, effective treatment methods are in a great demand. The face of cancer pain management has changed in considerable ways, and interventional procedures have become an integral part of providing multimodal analgesia in cancer pain treatment...
February 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28262481/development-of-a-guided-internet-based-psycho-education-intervention-using-cognitive-behavioral-therapy-and-self-management-for-individuals-with-chronic-pain
#18
Jennifer Perry, Elizabeth G VanDenKerkhof, Rosemary Wilson, Dean A Tripp
Evidence-based chronic pain treatment includes nonpharmacologic therapies. When addressing barriers to treatment, there is a need to deliver these therapies in a way that is accessible to all individuals who may benefit. To develop a guided Internet-based intervention for individuals with chronic pain, program content and sequence of evidence-based treatments for chronic pain, traditionally delivered via in-person sessions, were identified to be adapted for Internet delivery. With consideration to historical barriers to treatment, and through use of a concept map, therapeutic components and educational material were situated, in an ordered sequence, into six modules...
March 2, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/28255955/parecoxib-provides-analgesic-and-opioid-sparing-effects-following-major-orthopedic-surgery-a-subset-analysis-of-a-randomized-placebo-controlled-clinical-trial
#19
Efrain Diaz-Borjon, Armando Torres-Gomez, Margaret Noyes Essex, Patricia Salomon, Chunming Li, Raymond Cheung, Bruce Parsons
INTRODUCTION: Orthopedic surgeries are among the most common and most painful surgeries performed. A multimodal analgesic approach is recommended to reduce opioid consumption, provide effective pain relief, and improve outcomes following surgery. This study examined the efficacy and opioid-sparing effects of parecoxib following major orthopedic surgery. METHODS: This subset analysis of a large, multicenter, randomized, double-blind, placebo-controlled study of parecoxib examined treatment effects on postoperative pain severity, pain interference with function, opioid consumption, occurrence of opioid-related symptoms, safety, and patient satisfaction following major orthopedic surgery...
March 2, 2017: Pain and Therapy
https://www.readbyqxmd.com/read/28255509/palliative-management-of-nonoperative-femoral-neck-fractures-with-continuous-peripheral-pain-catheters-20-patient-case-series
#20
Christopher H Rashidifard, Nicholas M Romeo, Paul Muccino, Mark Richardson, Thomas G DiPasquale
INTRODUCTION: To identify the success of pain catheters in the management of pain in nonoperatively treated femoral neck fractures (FNFs) in supplement to current multimodal protocols for end-of-life pain management. METHODS: Twenty patients aged older than 50 years with FNFs were selected in a retrospective fashion at a level 1 trauma center. These patients were treated nonoperatively with indwelling continuous peripheral pain catheters to palliate pain. Adjunctive pain control for patients undergoing nonoperative management of FNFs was provided with an indwelling continuous intra-articular/peripheral nerve ropivacaine pain catheters...
March 2017: Geriatric Orthopaedic Surgery & Rehabilitation
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