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Karl Walsh, Ioannis Goutos, Baljit Dheansa
Acute acalculous cholecystitis (AAC) is an acute inflammatory disorder of the gallbladder, which can complicate the recovery of burn patients. No formal literature review has been performed about this uncommon but potentially fatal complication in burn care. A Pubmed search from 1950 to 2015 was performed using MESH terms: "acalculous cholecystitis," "burns or thermal injuries or thermal damage," and "cholecystitis or gallbladder inflammation." The articles were analyzed and data collected individually on the incidence, presenting symptoms or signs, risk factors, investigations, and treatment modalities used...
February 9, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
Joseph Sujka, Leo Andrew Benedict, Jason D Fraser, Pablo Aguayo, Daniel L Millspaugh, Shawn D St Peter
PURPOSE: Pain is the main factor that determines the postoperative course for patients undergoing pectus bar placement. Cryoablation of the intercostal nerves has been suggested to mitigate this pain. We instituted a protocol for using intercostal cryoablation and report our early results compared to our immediately previous cohort. MATERIALS AND METHODS: A retrospective study was conducted on patients undergoing minimally invasive repair for pectus excavatum between January 1, 2017, and August 21, 2017...
June 21, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Héctor César Durán-Vega, Arturo Ramírez-Montañana, Octavio Gonzalez Galindo, Andrés Medina Gutierrez, Adriana Zapata González, Evangelina Gonzalez Galindo, Iván Arturo Arellano Silva
Background: Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours...
May 2018: Plastic and Reconstructive Surgery. Global Open
Deborah C Mash, Linda Duque, Bryan Page, Kathleen Allen-Ferdinand
Ibogaine may be effective for transitioning opioid and cocaine dependent individuals to sobriety. American and European self-help groups provided public testimonials that ibogaine alleviated drug craving and opioid withdrawal symptoms after only a single dose administration. Preclinical studies in animal models of addiction have provided proof-of-concept evidence in support of these claims. However, the purported therapeutic benefits of ibogaine are based on anecdotal reports from a small series of case reports that used retrospective recruitment procedures...
2018: Frontiers in Pharmacology
Sanya Virani, Elie G Aoun, Nicholas Genova, Navjot Brainch, Camila Albuquerque Gomes, Saeed Ahmed, Brian Hurley, Lama Bazzi
This column describes the Internet System for Tracking Over-Prescribing (I-STOP), New York State's prescription monitoring program, and its compatibility with HIPAA and Part 2 of Volume 42 of the Code of Federal Regulations (CFR). The authors review use of information that is permitted by I-STOP and CFR for health care operations, including disclosure, and present information from the state Bureau of Narcotics Enforcement about appropriate use of the program. Physicians are permitted, for example, to contact other prescribers in I-STOP, even without explicit permission from the patient, an area in which physicians need more training...
June 20, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Jong Jin Hyun, Richard A Kozarek
PURPOSE OF REVIEW: To review important manuscripts published over the previous 2 years relative to sphincter of Oddi dysfunction (SOD). RECENT FINDINGS: The long-term outcomes of the Evaluating Predictors and Interventions of SOD (EPISOD) trial further substantiated results from the initial EPISOD study, reinforcing that neither endoscopic retrograde cholangiopancreatography-manometry nor endoscopic sphincterotomy are appropriate for SOD type III. Pain management in the latter patients has reverted to neuromodulating agents, and recent studies have suggested a role for duloxetine and potentially acupuncture...
June 16, 2018: Current Opinion in Gastroenterology
Kristin E Rojas, Donna-Marie Manasseh, Peter L Flom, Solomon Agbroko, Nicole Bilbro, Charusheela Andaz, Patrick I Borgen
BACKGROUND: The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control. METHODS: A pilot observational study included patients with and without cancer undergoing lumpectomy...
June 18, 2018: Breast Cancer Research and Treatment
Amrat Anand, Collin J Sprenker, Rachel Karlnoski, James Norman, Branko Miladinovic, Bruce Wilburn, Roger A Southall, Devanand Mangar, Enrico Camporesi
Background and methods Minimally invasive parathyroidectomy requires limited analgesia and short recovery times. The preferred post-operative analgesic regimen for this patient population has not been established but non-narcotic components would be quite appropriate. The aim of the study was to determine whether intravenous (IV) acetaminophen (1 g) or ketorolac (30 mg) provide better pain control after parathyroidectomy. A parallel, randomized, double blind, comparative study was completed on 180 patients scheduled for outpatient parathyroidectomy utilizing general anesthesia...
December 29, 2017: Scandinavian Journal of Pain
Thema Nicholson, Mitchell Maltenfort, Charles Getz, Mark Lazarus, Gerald Williams, Surena Namdari
Background: Our institution's traditional pain management strategy after shoulder arthroplasty has involved the utilization of postoperative patient-controlled narcotic analgesia. More recently, we have implemented a protocol (TLC) that utilizes a multimodal approach. The purpose of this study was to determine whether this change has improved pain control and decreased narcotic utilization. Methods: Patients undergoing primary total shoulder or reverse arthroplasty were retrospectively studied...
May 2018: Archives of Bone and Joint Surgery
Timothy E Hereford, Kipp A Cryar, Paul K Edwards, Eric R Siegel, C Lowry Barnes, Simon C Mears
BACKGROUND: Patients taking narcotics chronically are more likely to have worse outcomes after total joint arthroplasty. These negative outcomes may be avoided when modifiable risk factors such as narcotic use are identified and improved before elective joint replacement. An accurate assessment of narcotic use is needed to identify patients before surgery. This study examines the amount of reported narcotic use in patients with hip or knee osteoarthritis and compares this with the narcotic prescriptions recorded in our state's drug prescription monitoring database...
May 29, 2018: Journal of Arthroplasty
Derrick J Sanderson, Rohnn Sanderson, Dana Cleason, Catherine Seaman, Ali Ghomi
Clinical practice has drastically changed following the 2014 U.S. Food and Drug Administration (FDA) warning statement regarding power morcellation during laparoscopic hysterectomy and myomectomy. Despite investigation into alternative tissue extraction techniques, there remain a paucity of data associated with contained manual morcellation techniques. The goal of this study was to investigate the associated perioperative outcomes of contained manual morcellation compared to power morcellation in women undergoing robotic myomectomy...
June 15, 2018: Journal of Robotic Surgery
Katarzyna Kuczyńska, Piotr Grzonkowski, Łukasz Kacprzak, Jolanta B Zawilska
Fentanyl is a potent synthetic opioid used as a narcotic analgesic supplement in general and regional anesthesia as well as in management of persistent, severe chronic pain. Alarming epidemiological and forensic medicine reports, accumulated mainly during the last two decades, point to a growing increase in illicit use of fentanyl, mainly in North America and Europe. Toxicological data indicates that fentanyl use is inextricably linked with polydrug use. There are two main sources of fentanyl on the "recreational" drug market...
June 2, 2018: Forensic Science International
Nicholas B Frisch, Brian Darrith, Dane C Hansen, Adrienne Wells, Sheila Sanders, Richard A Berger
Background: With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty...
June 2018: Arthroplasty Today
Katherine M Fischer, Michael Louie, Phillip Mucksavage
PURPOSE OF REVIEW: Ureteral stent placement is a very common urologic procedure and a necessary component of many minimally invasive surgeries including ureteroscopy. Despite its widespread use, stent placement results in bothersome urinary symptoms and pain in approximately 80% of patients. This review discusses the proposed mechanisms underlying ureteral stent-related symptoms and current approaches to symptom management and the evidence to support them. RECENT FINDINGS: Though it has been extensively studied, the exact cause of stent-related symptoms remains unknown but is likely related to irritation of the bladder by the distal curl of the stent and reflux of urine through the stent up to the renal pelvis and transmission of high pressures associated with this...
June 11, 2018: Current Urology Reports
Surajudeen Bolarinwa, Aaron A Casp, Jourdan M Cancienne, Brian C Werner, James A Browne
BACKGROUND: The purpose of this study is to: (1) characterise risk factors for prolonged narcotic use following total hip arthroplasty (THA); (2) examine preoperative and prolonged postoperative narcotic use as independent risk factors for complications following THA. METHODS: A national database identified primary THA patients from 2007-2015. Preoperative (POU) and prolonged postoperative narcotics users (PPU) were identified. A multivariable logistic regression analysis was utilised to identify any patient-related risk factors for prolonged use, and examined POU and PPU as risk factors for complications following THA...
June 1, 2018: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Erchao Li, Derek G Bolser, Kevin J Kroll, Erica K Brockmeier, Francesco Falciani, Nancy D Denslow
Phenols are classified as polar narcotics, which are thought to cause toxicity by non-specific mechanisms, possibly by disrupting membrane structure and function. Here we test three phenolic chemicals, phenol, 2,4-dichlorphenol and pentachlorophenol on embryo development, heartbeat rate and mitochondrial respiration in fathead minnow (Pimephales promelas). While these chemicals have been used on isolated mitochondria, they have not yet been used to verify respiration in intact embryos. Mitochondrial respiration in intact embryos was measured after optimizing the Seahorse XFe24 Extracellular Flux Analyzer...
May 29, 2018: Aquatic Toxicology
Ara A Salibian, Jordan D Frey, Vishal D Thanik, Nolan S Karp, Mihye Choi
BACKGROUND: Transversus abdominis plane (TAP) blocks are increasingly being utilized in microvascular breast reconstruction. The implications of TAP blocks on specific reconstructive, patient and institutional outcomes remain to be fully elucidated. METHODS: Patients undergoing abdominally-based microvascular breast reconstruction from 2015-2017 were reviewed. Length of stay, complications, narcotic consumption, donor-site pain and hospital expenses were compared between patients that did and those that did not receive TAP blocks with liposomal bupivacaine...
June 2, 2018: Plastic and Reconstructive Surgery
Alexandra M Hart, Justine Broecker, Leslieann Kao, Albert Losken
PURPOSE: The increasing rate of opioid abuse warrants standardization of postoperative pain management. The purpose of this study is to analyze the use of opioids in pain control and patient satisfaction following ambulatory breast surgery. METHODS: This is a prospective study of a consecutive series of patients undergoing secondary breast reconstruction [SBR: n=60)] or breast reduction [BR:n=35]. All patients were given a pain questionnaire preoperatively. Postoperatively, women received 30 tablets of oxycodone 5...
June 2, 2018: Plastic and Reconstructive Surgery
Rachel Mack
BACKGROUND AND PURPOSE: In 2013, the Advisory Committee of the Food and Drug Administration determined hydrocodone combination medications (HCMs) needed tighter regulation due to high abuse potential; they recommended upscheduling HCMs from Schedule III to II. The purpose of this study was to examine the effect of upscheduling of HCMs on pain management practices of advanced practiced registered nurses (APRNs) in Oklahoma. METHODS: In this qualitative study, 25 participants described their primary care experiences after the upscheduling...
June 2018: Journal of the American Association of Nurse Practitioners
Roopinder K Sandhu, Kenneth K Quadros, Yan Yun Liu, Michael Glikson, Valentina Kutyifa, Phillipe Mabo, Stefan Hohnloser, Gilles O'Hara, Liselot VanErven, Jorg Neuzner, Josef Kautzner, Frederik Gadler, Xavier Vinolas, Ursula Appl, Stuart J Connolly, Jeff S Healey
Aims: No standard practice exists with respect to anaesthesiologist-directed sedation (ADS) vs. sedation by proceduralist (PDS) for defibrillation threshold (DT) testing. We aimed to evaluate adverse events and safety outcomes with ADS vs. PDS for DT testing. Methods and results: A post hoc analysis of the Shockless Implant Evaluation (SIMPLE) study was performed among the 1242 patients who had DT testing (624 ADS and 618 PDS). We evaluated both intraoperative and in-hospital adverse composite events and two safety composite outcomes at 30-days of the main trial...
June 6, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
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