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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
Mariela M Lopez, Derrick Zech, Judith L Linton, Steven J Blackwell
OBJECTIVE: Dexmedetomidine is a parenteral agent that combines the benefits of cooperative sedation, anxiolysis, and analgesia without the risks of respiratory depression. Off-label use has been reported in children. We have introduced dexmedetomidine for use in patients having undergone alveolar bone graft (ABG). The objective is to demonstrate the value and safety of postoperative dexmedetomidine infusion in a non-ICU setting following ABG. DESIGN: A retrospective review was performed on patients who underwent ABG by the senior author...
January 1, 2018: Cleft Palate-craniofacial Journal
Ying-Buh Liu, Chih-Chin Yu, Chao-Chuan Wu, Chia-Da Lin, Shih-Chieh Chueh, Yao-Chou Tsai
Background: Several studies of hernia registries have revealed that elderly patients have higher perioperative complication rates compared with younger patients. However, the incidence of hernia increases with the aging process. To evaluate the feasibility and safety of laparoscopic hernia repair in elderly patients (≥75 years), we conducted a prospective case-matched control study to compare perioperative outcomes between patients older and younger than 75 years. Methods: Between September 2008 and July 2015, 572 consecutive patients undergoing endoscopic hernia repair were included in this prospective study...
2018: Clinical Interventions in Aging
Morteza Gholami, Sedigheh Esmaeilzadeh Bahabadi
Khat (Catha edulis Forsk) is a narcotic plant which contains significant amounts of amphetamines, like alkaloids. Herein, analysis of the essential oil composition showed that Khat has useful volatile chemicals in addition to its alkaloids. Results indicated that among 35 identified constituents including mono and sesquiterpenes, the diterpene kaurene, comprises the major part of the essential oil, around 50 percent of total. Kaurene is known as a potent biological agent for the treatment of cancer patients...
February 13, 2018: Natural Product Research
Kurt D Piggott, Jaqueline Babb, Sylvia Yong, Harun Fakioglu, Carlos Blanco, William DeCampli, Kamal Pourmoghadam
OBJECTIVES: Neonates with single ventricle heart disease frequently suffer from poor oral feeding and inconsistent weight gain, often requiring gastrostomy tube (gtube) placement. We sought to identify risk factors for g-tube placement in neonates following the Norwood procedure at our institution. METHODS: We retrospectively reviewed multiple preoperative, operative and postoperative variables in neonates <30 days with single ventricle heart disease following the Norwood procedure...
February 9, 2018: Seminars in Thoracic and Cardiovascular Surgery
Ernane C de Souza, Dalyara M Matos, Milainy R Viana, Marcela C O Alvim, Herval L Bonfante, Alexandre F Pinto, Jorge W L Nascimento
BACKGROUND: Dipyrone is a non-narcotic analgesic/antipyretic widely used in some countries but prohibited in others due to suspected risk of agranulocytosis. The primary goal of this study was to evaluate hematological alterations in healthy adult volunteers after treatment with dipyrone. METHODS: The study enrolled 30 healthy volunteers of both genders, aged 19-37 years. They received tablets containing 500 mg of dipyrone sodium to be used four times daily for 7 consecutive days...
February 13, 2018: Journal of Basic and Clinical Physiology and Pharmacology
Heather Nolan, Joshua Glenn
BACKGROUND: Pediatric laparoscopic cholecystectomy is the current standard of care for gallbladder pathology. Single-incision and multiport procedures, as well as robotic and minimally invasive platforms, have been described; however, there is no head-to-head assessment of these interventions in the existing literature. The purpose of our study was to directly compare the minimally invasive cholecystectomy techniques of laparoscopic multiport (LMP), laparoscopic single incision (LSI), robotic multiport (RMP), and robotic single incision (RSI)...
February 12, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
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
Andrew D Jung, Vikrom K Dhar, Richard S Hoehn, Sarah J Atkinson, Bobby L Johnson, Teresa Rice, Jonathan R Snyder, Janice F Rafferty, Michael J Edwards, Ian M Paquette
BACKGROUND: Enhanced recovery pathways (ERPs) aim to reduce length of stay without adversely affecting short-term outcomes. High pharmaceutical costs associated with ERP regimens, however, remain a significant barrier to widespread implementation. We hypothesized that ERP would reduce hospital costs following elective colorectal resections despite the use of more expensive pharmaceutical agents. STUDY DESIGN: An ERP was implemented in January 2016 at our institution...
January 4, 2018: Journal of the American College of Surgeons
J Alex Sielatycki, Silky Chotai, Joseph Wick, Ahilan Sivaganesan, Clinton J Devin
STUDY DESIGN: Retrospective review of prospective patient outcomes and cost data OBJECTIVE.: To analyze the contribution of surgeon-specific variability in cost and patient-reported outcomes (PROs) to overall variability in anterior cervical discectomy and fusion (ACDF), while adjusting for patient comorbidities. SUMMARY OF BACKGROUND DATA: Cost reduction in surgical care has received increased attention. Patient factors contributing to cost variability in ACDF have been described, however inter-surgeon cost and outcome variability has received less attention in the literature...
February 6, 2018: Spine
Sara H Farsi
Intrathecal narcotics have proven to be invaluable in providing pain relief following a cesarean section. They also aid in earlier mobilization. Unfortunately, they come at the risk of delayed apnea requiring close monitoring for a prolonged period of time. Physicians may sometimes underestimate the risk of these delayed complications. This especially a big concern in hospitals that cannot provide the necessary postoperative monitoring required for these women. I present a case where it took more than 6 h after injection of narcotics before the complication occurred...
January 2018: Saudi Journal of Anaesthesia
Caitlin Stafford, Todd Francone, Patricia L Roberts, Rocco Ricciardi
BACKGROUND: Opioid-related deaths have increased substantially over the last 10 years placing clinician's prescription practices under intense scrutiny. Given the substantial risk of opioid dependency after colorectal surgery, we sought to analyze risk of postoperative prolonged opioid use after colorectal resections. METHODS: Between 2008 and 2014, patients undergoing abdominopelvic procedure with intestinal resection at a tertiary care facility were retrospectively identified...
February 6, 2018: Surgical Endoscopy
Daniel L Riddle, Gregory J Golladay
OBJECTIVE: The primary purpose was to identify preoperative risk factors associated with post-hospitalization falls over an approximate 2-year postoperative period in patients undergoing hip and knee arthroplasty. DESIGN: The study utilized a longitudinal cohort design. SETTING: Participants were recruited from communities surrounding four urban university-based medical centers. PARTICIPANTS: All participants underwent hip or knee arthroplasty over a 9-year study period and were followed yearly in the Osteoarthritis Initiative study...
January 30, 2018: Archives of Physical Medicine and Rehabilitation
Corey Lyon, Susan Piggott, Shannon Langner, Kristen DeSanto
Nonsteroidal anti-inflammatory drugs (NSAIDs) are at least as effective as other oral analgesics (opioids, acetaminophen) in relieving pain in the first few days after an acute musculoskeletal injury. Evidence also indicates that using NSAIDs results in fewer adverse events than using narcotics (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs], as well as individual RCTs).
February 2018: Journal of Family Practice
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
Reza Ghanbari, Susan Sumner
Drug addiction has been associated with an increased risk for cancer, psychological complications, heart, liver, and lung disease, as well as infection. While genes have been identified that can mark individuals at risk for substance abuse, the initiation step of addiction is attributed to persistent metabolic disruptions occurring following the first instance of narcotic drug use. Advances in analytical technologies can enable the detection of thousands of signals in body fluids and excreta that can be used to define biochemical profiles of addiction...
January 31, 2018: Trends in Molecular Medicine
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
Alireza Jahangirifard, Mohammadreza Razavi, Zargham Hosein Ahmadi, Mohammad Forozeshfard
The aim of this study was to determine the effect of electrical nerve stimulation on pain intensity and pulmonary function in patients undergoing coronary artery bypass surgery. In a randomized clinical trial, a total of 100 patients undergoing coronary artery bypass surgery at Masih Daneshvari Hospital, Tehran, Iran, from February to May 2014, were divided into two groups. In the intervention group (n = 50), patients received routine care along with transcutaneous electrical nerve stimulation (TENS) immediately after admission to the intensive care unit (ICU)...
January 21, 2018: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
Hannes Hagström, Tomas Hemmingsson, Andrea Discacciati, Anna Andreasson
BACKGROUND & AIMS: High alcohol consumption is associated with an increased risk of severe liver disease. Current recommendations suggest it is safe for men to consume 30 grams of alcohol per day. We investigated the association between alcohol consumption early in life and later development of severe liver disease. METHODS: We used data on alcohol consumption at conscription to military service from 43,296 men (18-20 years) in Sweden between 1969 and 1970. Outcomes were defined as incident diagnoses of severe liver disease from systematic national registration of clinical events until the end of 2009...
January 12, 2018: Journal of Hepatology
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