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https://www.readbyqxmd.com/read/29661495/narcotics-reduction-quality-and-safety-in-gynecologic-oncology-surgery-in-the-first-year-of-enhanced-recovery-after-surgery-protocol-implementation
#1
Jennifer E Bergstrom, Marla E Scott, Yewande Alimi, Ting-Tai Yen, Deborah Hobson, Karime K Machado, Edward J Tanner, Amanda N Fader, Sarah M Temkin, Stephanie Wethington, Kimberly Levinson, Sam Sokolinsky, Brandyn Lau, Rebecca L Stone
OBJECTIVES: Enhanced Recovery After Surgery (ERAS) programs are mechanisms for achieving value-based improvements in surgery. This report provides a detailed analysis of the impact of an ERAS program on patient outcomes as well as quality and safety measures during implementation on a gynecologic oncology service at a major academic medical center. METHODS: A retrospective review of gynecologic oncology patients undergoing elective laparotomy during the implementation phase of an ERAS program (January 2016 through December 2016) was performed...
April 13, 2018: Gynecologic Oncology
https://www.readbyqxmd.com/read/29658090/bimodal-electrical-properties-of-rat-major-artery-segment-in-situ
#2
S V Revenko, L N Tikhomirova, A V Nesterov, I A Tarakanov
In experiments on narcotized rats, BP in the left femoral artery as well as local electrical potential and electrical impedance of the symmetric segment of the right femoral artery were simultaneously recorded in situ with two extracellular nonpolarizable Ag/AgCl electrodes located along the artery at a distance of 3 mm from each other. The pulsatile arterial electrical potentials with amplitude of 100-200 μV and duration of about 50 msec were recorded, which coincided with the front of BP wave corrected for a 10-msec delay of the pressure transducer...
April 16, 2018: Bulletin of Experimental Biology and Medicine
https://www.readbyqxmd.com/read/29657697/characterizing-mortality-from-substance-abuse-in-iran-an-epidemiological-study-during-march-2014-to-february-2015
#3
Fatemeh Shahbazi, Seyed Davood Mirtorabi, Mohammad Reza Ghadirzadeh, Seyed Saeed Hashemi-Nazari, Abdolrazagh Barzegar
Background: Drug abuse is a severe and chronic disorder that leaves morbidity, disability and premature mortality in the society. The study of death due to substance abuse provides useful information for local, national and international administrators. Thus, by identifying the factors that have an impact on overdose-related mortality we can provide suitable intervention for vulnerable groups. The aim of this study was an investigation of mortality rate caused by consumption of narcotic and psychoactive substances in Iran...
July 2017: Addiction & Health
https://www.readbyqxmd.com/read/29656977/liposomal-bupivacaine-vs-plain-bupivacaine-in-periarticular-injection-for-control-of-pain-and-early-motion-in-total-knee-arthroplasty-a-randomized-prospective-study
#4
Jason P Zlotnicki, Brian R Hamlin, Anton Y Plakseychuk, Timothy J Levison, Scott D Rothenberger, Kenneth L Urish
BACKGROUND: The use of multimodal pain regimens has been shown to be an effective technique for the treatment of postoperative pain after total knee arthroplasty. Periarticular injections, of both short-acting and long-acting anesthetics, have emerged as an additional method of providing significant improvement in postoperative pain relief. The purpose of this study is to compare the efficacy of periarticular injection using long-acting vs short-acting preparations. METHODS: A randomized, prospective study of 80 consecutive patients was performed comparing liposomal bupivacaine vs plain bupivacaine periarticular injection...
March 16, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29655490/effect-of-changing-postoperative-pain-management-on-bleeding-rates-in-tonsillectomy-patients
#5
Alexandra C G Fonseca, Margaret I Engelhardt, Zhen J Huang, Zi Yang Jiang, Sancak Yuksel, Soham Roy
PURPOSE: To review rates of post-tonsillectomy hemorrhage (PTH) at a quaternary medical center, including the impact of narcotic versus nonsteroidal anti-inflammatory drug (NSAID) postoperative pain management. MATERIALS AND METHODS: A retrospective review was performed of tonsillectomies conducted at a single institution between 1/1/2013 and 1/1/2017. The rates of PTH and subsequent intervention were calculated. These were categorized into patients having surgery pre- and post-July 1, 2015, the former group receiving narcotics and the latter ibuprofen with acetaminophen...
April 5, 2018: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/29653244/opioid-utilization-following-cervical-spine-surgery-trends-and-factors-associated-with-long-term-use
#6
Andrew J Pugely, Nicholas A Bedard, Piyush Kalakoti, Nathan R Hendrickson, Jamal N Shillingford, Joseph L Laratta, Comron Saifi, Ronald A Lehman, K Daniel Riew
BACKGROUND CONTEXT: Limited or no data exist evaluating risk-factors associated with prolonged opioid use following cervical arthrodesis. PURPOSE: To assess trends in post-operative narcotic use amongst preoperative opioid users (OU) versus non-opioid users (NOU), and identify factors associated with postoperative narcotic use at 1-year following cervical arthrodesis. STUDY DESIGN/SETTING: Retrospective, observational study. PATIENT SAMPLE: 17,391 patients (OU: 52...
April 10, 2018: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/29630033/a-randomized-comparison-between-interscalene-and-small-volume-supraclavicular-blocks-for-arthroscopic-shoulder-surgery
#7
Julián Aliste, Daniela Bravo, Diego Fernández, Sebastián Layera, Roderick J Finlayson, De Q Tran
BACKGROUND AND OBJECTIVES: This randomized trial compared ultrasound (US)-guided interscalene block (ISB) and small-volume supraclavicular block (SCB) for arthroscopic shoulder surgery. We hypothesized that SCB would provide equivalent analgesia to ISB 30 minutes after surgery without the risk of hemidiaphragmatic paralysis (HDP). METHODS: All patients received an US-guided intermediate cervical plexus block. In the ISB group, US-guided ISB was performed with 20 mL of levobupivacaine 0...
April 6, 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29629980/development-of-an-enhanced-recovery-protocol-for-children-undergoing-gastrointestinal-surgery
#8
Mehul V Raval, Kurt F Heiss
PURPOSE OF REVIEW: Enhanced recovery protocols (ERPs) have been adopted for a variety of adult surgical conditions and resulted in markedly improved outcomes, including decreased length of stays, complications, costs, and narcotic utilization. In this review, we describe the development and implementation of an ERP for children undergoing gastrointestinal surgery. RECENT FINDINGS: Existing ERP components from adult and pediatric surgical populations were reviewed and modified through an iterative process that included literature review, a national survey of practicing pediatric surgeons, and appropriateness assessment by a multidisciplinary expert panel...
April 7, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29628584/evaluation-of-the-hemodynamic-response-of-intravenous-clonidine-versus-ropivacaine-scalp-block-to-insertion-of-scalp-pins-in-neurosurgical-patients
#9
Saraswathi Nagappa, Sandhya Kalappa, Raghavendra Biligiri Sridhara
Background: The application of the skull-pin head-holder, used to stabilize the head during neurosurgical procedures, produces an intense nociceptive stimulus and results in abrupt increases in blood pressure and cerebral blood flow under general anesthesia. Different anesthetic and pharmacologic techniques, including local anesthetics, narcotics, antihypertensives, and deepening of anesthesia with inhalation anesthetics, have been used to blunt this deleterious effect with variable success...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29628196/effectiveness-of-novel-adjuncts-in-pain-management-following-total-knee-arthroplasty-a-randomized-clinical-trial
#10
Juan C Suarez, Ahmed A Al-Mansoori, Sumit Kanwar, Jesus M Villa, Colin A McNamara, Preetesh D Patel
BACKGROUND: Total knee arthroplasty (TKA) can be associated with significant pain which can negatively impact outcomes. Multiple strategies have been employed to reduce pain. The aim of this study is to compare the effectiveness of 3 different pain management modalities after TKA that included (1) our standardized knee injection cocktail and oral acetaminophen, (2) liposomal bupivacaine periarticular injection and oral acetaminophen, and (3) our standardized knee injection cocktail and intravenous (IV) acetaminophen...
March 12, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29619347/enhanced-recovery-after-surgery-eras-protocol-enables-safe-same-day-discharge-after-alloplastic-breast-reconstruction
#11
Danielle O Dumestre, Jennifer Redwood, Carmen E Webb, Claire Temple-Oberle
Background: To compare enhanced recovery after surgery (ERAS) with traditional recovery after surgery (TRAS) for patients undergoing alloplastic breast reconstruction. Methods: A retrospective chart review of 2 patient groups (ERAS and TRAS) undergoing alloplastic breast reconstruction was performed. Data were collected from 2012 to 2013 (TRAS) and from 2013 to 2016 (ERAS). The ERAS protocol included day surgery, multimodal analgesia, and preoperative anti-emetic...
November 2017: Plastic Surgery
https://www.readbyqxmd.com/read/29619219/examining-the-social-status-risk-factors-and-lifestyle-changes-of-tuberculosis-patients-in-sri-lanka-during-the-treatment-period-a-cross-sectional-study
#12
Madapathage Gayan Buddhika Senanayake, Sumudu Indika Wickramasinghe, Sudath Samaraweera, Pubudu De Silva, Sisira Edirippulige
Background: Tuberculosis (TB) is a major global health problem, commonly seen in underdeveloped countries. The probability of contracting the disease is significantly higher among the economically vulnerable and the socially disadvantaged. Risk factors associated with TB can also change over time. In the Sri Lankan context, no study has explored how these factors impact patients. Therefore, we aimed to explore social status, associated risk factors and lifestyle changes during the treatment period of TB patients attending a tertiary respiratory center in Colombo, Sri Lanka...
2018: Multidisciplinary Respiratory Medicine
https://www.readbyqxmd.com/read/29618226/the-effect-of-rectus-muscle-re-approximation-at-cesarean-delivery-on-pain-perceived-after-operation-a-randomized-control-trial
#13
Eman F Omran, Hadeer Meshaal, Sarah M Hassan, Amira S Dieb, Hala Nabil, Hani Saad
BACKGROUND: Cesarean section rate has increased dramatically worldwide but there is still debate about the optimum operative technique of cesarean section. OBJECTIVE: The purpose of this study was to assess the effect of rectus muscle reapproximation at cesarean delivery on the postoperative pain. METHODS: This study was a prospective, double-blind, randomized controlled trial. It included 280 primigravidas, with a singleton pregnancy, who underwent elective lower segment cesarean section at term...
April 4, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29618150/a-meta-analysis-comparing-liposomal-bupivacaine-and-traditional-periarticular-injection-for-pain-control-after-total-knee-arthroplasty
#14
Hao Sun, Zhiyu Huang, Zhiqi Zhang, Weiming Liao
Liposomal bupivacaine is a novel method for pain control after total knee arthroplasty (TKA), but recent studies showed no advantage for patients undergoing TKA compared with traditional periarticular injection (PAI). The purpose of this analysis was to compare the clinical outcomes between liposomal bupivacaine treatment and traditional PAI. We retrospectively reviewed data from 16 clinical trials in published databases from their inception to June 2017. The primary outcome was postoperative Visual Analogue Scale (VAS) score and secondary outcomes included opiate usage, narcotic consumption, range of motion, and length of stay...
April 4, 2018: Journal of Knee Surgery
https://www.readbyqxmd.com/read/29608639/transition-to-nonopioid-analgesia-does-not-impair-pain-control-after-major-aesthetic-plastic-surgery
#15
Thu-Hoai C Nguyen, Nicholas F Lombana, Dmitry Zavlin, Clayton L Moliver
Background: Multimodal analgesic protocols are increasingly favored over traditional opioid regimens due to decreased adverse side effects and reduced opioid consumption. Concomitant use of selective cyclooxygenase (COX)-2 inhibitor celecoxib and anticonvulsant gabapentin have been proposed to adequately control acute postoperative pain. Objectives: To determine efficacy of postoperative pain control using nonopioid pain regimen vs traditional opioids for all aesthetic plastic surgery procedures...
March 28, 2018: Aesthetic Surgery Journal
https://www.readbyqxmd.com/read/29607171/enhanced-recovery-after-thoracic-surgery-reduces-discharge-on-highly-dependent-narcotics
#16
Min P Kim, Edward Y Chan, Leonora M Meisenbach, Razvan Dumitru, Jessica K Brown, Faisal N Masud
Background: There is large prescription drug epidemic in United States. We want to determine if ERATS (enhanced recovery after thoracic surgery) program can reduce discharge on highly dependent narcotics. Methods: We performed a retrospective analysis of prospectively collected data on patients who underwent lung resection and foregut procedures on thoracic surgery service over an 8-month time period. Patients underwent preoperative conditioning instructions, multimodal non-narcotic pharmaceutical usage, total intravenous anesthesia (TIVA) and minimizing highly addictive narcotics during the post-operative period...
February 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29605354/trends-in-the-management-of-secondary-post-tonsillectomy-hemorrhage-in-children
#17
Christine M Clark, Jane R Schubart, Michele M Carr
OBJECTIVE: To define current practices in management of secondary post-tonsillectomy hemorrhage (PTH) in children by pediatric and general otolaryngologists. INTRODUCTION: Bleeding after tonsillectomy is common. Our goal was to describe management methods across the U.S. METHODS: Questions regarding perioperative management and treatment in response to three hypothetical cases featuring secondary post-tonsillectomy bleeding were posed via REDCap survey...
May 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29605272/title-impact-of-ambiguous-and-restrictive-regulations-on-opioid-prescribing-practice-in-georgia
#18
Pati Dzotsenidze, Tamar Lekashvili, Nino Chikhladze, Maka Jorbenadze, Ioseb Abesadze, Dimitri Kordzaia
CONTEXT: Chronic pain management with opioids in incurable patients remains a challenge of modern medicine regardless of the evidence-based effectiveness of opioids and recommendations of authorities such as the World Health Organization (WHO) and International Narcotics Control Board (INCB). Many countries, including Georgia, maintain overly restrictive regulations that contribute to inadequate pain management. OBJECTIVE: To identify barriers to pain management in Georgia caused by legislation, administrative issues and physicians' lack of knowledge and understanding of legislative aspects governing opioid use, and their impact on opioid-prescribing practice...
March 29, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29599038/neer-award-2018-the-effect-of-preoperative-education-on-opioid-consumption-in-patients-undergoing-arthroscopic-rotator-cuff-repair-a-prospective-randomized-clinical-trial
#19
Usman Ali M Syed, Alexander W Aleem, Charles Wowkanech, Danielle Weekes, Mitchell Freedman, Fotios Tjoumakaris, Joseph A Abboud, Luke S Austin
BACKGROUND: Opioids are commonly administered for the treatment of acute and chronic pain symptoms. The current health care system is struggling to deal with increasing medication abuse and rising mortality rates from overdose. Preoperative patient-targeted education on opioid use is an avenue yet to be explored. The purpose of the study was to determine whether preoperative narcotics education reduces consumption after arthroscopic rotator cuff repair (ARCR). METHODS: Patients undergoing primary ARCR at our institution were randomized to receiving opioid-related preoperative education or not...
March 26, 2018: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29596705/evaluation-of-a-pain-management-education-program-and-operational-guideline-on-nursing-practice-attitudes-and-pain-management
#20
Sara L Bonkowski, Jennie C De Gagne, Makia B Cade, Sally A Bulla
Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys...
April 1, 2018: Journal of Continuing Education in Nursing
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