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Multimodal anesthesia

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https://www.readbyqxmd.com/read/28634091/a-simple-method-associated-with-reduced-opioid-consumption-after-total-knee-arthroplasty
#1
Alfred C Kuo, Eva Grotkopp
BACKGROUND: Most patients experience moderate to severe pain after total knee arthroplasty (TKA). We hypothesized that intraoperative treatment of cut bone surfaces with local anesthetic (preimplantation immersion anesthesia, PIA) would lead to decreased postoperative pain and opioid consumption. METHODS: Records of 76 patients who underwent unilateral, cemented TKA were retrospectively reviewed. For PIA patients, surgical wounds were immersed in local anesthetic solution immediately prior to component implantation...
May 22, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28625307/postcesarean-delivery-analgesia
#2
REVIEW
Brendan Carvalho, Alexander J Butwick
Effective pain management should be a key priority in women undergoing cesarean delivery. Suboptimal perioperative pain management is associated with chronic pain, greater opioid use, delayed functional recovery, impaired maternal-fetal bonding, and increased postpartum depression. Severe acute postoperative pain is also strongly associated with persistent pain after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery pain management. The use of neuraxial morphine and opioid-sparing adjuncts such as scheduled nonsteroidal anti-inflammatory medications and acetaminophen is recommended for all women undergoing cesarean delivery with neuraxial anesthesia unless contraindicated...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28624427/a-case-grafted-with-polyglycolic-acid-sheets-and-fibrin-glue-for-protection-after-temporary-resection-of-a-metastatic-cervical-skin-tumor
#3
Takashi Matsuzuka, Masahiro Suzuki, Masakazu Ikeda, Kaoru Sato, Junko Fujimoto, Rumi Hosaka, Yuko Tanji, Shu Soeda, Shigeyuki Murono
The aim of this case report was to evaluate the usefulness of a grafting with polyglycolic acid sheet and a fibrin glue spray (PGA sheet grafting) after resection of a cervical skin tumor. A 61-year-old woman presented with left cervical skin tumor resistance to chemo-radiotherapy. She had been undergoing multimodal therapy for ovarian serous papillary adenocarcinoma for the previous six years. Although she had a poor general condition and a cervical skin tumor of 9cm in diameter, which was painful and easy bleeding, had offensive smell, she hoped to return to her job...
June 14, 2017: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/28624028/impact-of-long-acting-local-anesthesia-on-clinical-and-financial-outcomes-in-laparoscopic-colorectal-surgery
#4
Deborah S Keller, Rodrigo Pedraza, Reena N Tahilramani, Juan R Flores-Gonzalez, Sergio Ibarra, Eric M Haas
BACKGROUND: Our objective was to assess clinical and financial outcomes with long-acting liposomal bupicavaine (LB) in laparoscopic colorectal surgery. METHODS: Patients that received local infiltration with LB were strictly matched to a control group, and compared for postoperative pain, opioid use, length of stay (LOS), hospital costs, and complication, readmission, and reoperation rates. RESULTS: A total of 70 patients were evaluated in each cohort...
July 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28622969/probability-of-undiagnosed-obstructive-sleep-apnea-does-not-correlate-with-adverse-pulmonary-events-nor-length-of-stay-in-hip-and-knee-arthroplasty-using-intrathecal-opioid
#5
Matthew J Thompson, Bryce N Clinger, Robert M Simonds, Camille J Hochheimer, Laura A Lahaye, Gregory J Golladay
BACKGROUND: Recent emphasis on bundled payments and outcomes tracking has increased the focus on preoperative optimization in patients undergoing elective lower extremity arthroplasty. Since patients with obstructive sleep apnea (OSA) have an increased risk of adverse perioperative pulmonary events, screening for undiagnosed OSA is sometimes included as part of preoperative risk assessment. However, there are limited data regarding quantification of OSA risk in lower extremity arthroplasty patients, and little is known about the utility of quantitative OSA screening and the risk of pulmonary complications in hip and knee arthroplasty patients who receive intrathecal morphine anesthetic...
April 14, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28621258/evaluation-of-pain-assessment-techniques-and-analgesia-efficacy-in-a-female-guinea-pig-cavia-porcellus-model-of-surgical-pain
#6
Vanessa L Oliver, Stephanie Athavale, Katherine E Simon, Lon V Kendall, Jean A Nemzek, Jennifer L Lofgren
Guinea pigs (Cavia porcellus) are a frequently used species in research, often involving potentially painful procedures.Therefore, evidence-based recommendations regarding analgesia are critically needed to optimize their wellbeing. Ourlaboratory examined the efficacy of carprofen and extended-release (ER) buprenorphine, alone and as a multimodal combination,for relieving postsurgical pain in guinea pigs. Animals were assessed by using evoked (mechanical hypersensitivity),nonevoked (video ethogram, cageside ethogram, time-to-consumption test), and clinical (weight loss) measurements for 96 h during baseline, anesthesia-analgesia, and hysterectomy conditions...
June 15, 2017: Journal of the American Association for Laboratory Animal Science: JAALAS
https://www.readbyqxmd.com/read/28620916/ketamine-does-not-enhance-the-quality-of-recovery-following-laparoscopic-cholecystectomy-a-randomized-controlled-trial
#7
E T Moro, I M P S S Feitosa, R G de Oliveira, G F P Saraiva, R Rosalino, V P Marossi, J A Bloomstone, L H C Navarro
BACKGROUND: Ketamine has been used as part of the multimodal analgesia technique in the acute perioperative period. The effect of perioperative intravenous small-dose ketamine on the quality of recovery from the patient point-of-view has not been assessed. We hypothesized that low-dose ketamine would enhance recovery following laparoscopic cholecystectomy under total intravenous anesthesia. METHODS: One hundred thirty five patients undergoing laparoscopic cholecystectomy were enrolled in this randomized, double-blind placebo-controlled trial...
June 15, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28619696/postoperative-pain-management-in-spanish-hospitals-a-cohort-study-using-the-pain-out-registry
#8
Mauricio Polanco-García, Jaume García-Lopez, Neus Fàbregas, Windfried Meissner, Margarita M Puig
Pain after surgery remains a problem worldwide, though there is no published data on postoperative outcomes in Spain. We evaluated 2922 patients in the first day after surgery in thirteen tertiary care Spanish Hospitals, using the PAIN-OUT questionnaire. Aims were to: assess postoperative outcomes, and anesthetic/analgesic management in orthopedics (ORT) and general (GEN) surgery patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management by surgical procedure...
June 12, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28617687/preoperatively-assessable-clinical-and-pathological-risk-factors-for-parametrial-involvement-in-surgically-treated-figo-stage-ib-iia-cervical-cancer
#9
Emel Canaz, Eser Sefik Ozyurek, Baki Erdem, Merve Aldikactioglu Talmac, Ipek Yildiz Ozaydin, Ozgur Akbayir, Ceyhun Numanoglu, Volkan Ulker
OBJECTIVE: Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. METHODS: A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015...
June 14, 2017: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/28615506/modified-protocol-for-enhanced-recovery-after-surgery-is-beneficial-for-chinese-cancer-patients-undergoing-pancreaticoduodenectomy
#10
Xiaxing Deng, Xi Cheng, Zhen Huo, Yuan Shi, Zhijian Jin, Haoran Feng, Yue Wang, Chenlei Wen, Hao Qian, Ren Zhao, Weihua Qiu, Baiyong Shen, Chenghong Peng
Radical surgical resection remains the only effective treatment for advanced pancreatic cancer. Effective protocols for recovery from post-operative complications that result in high rates of morbidity and mortality are therefore essential. The enhanced recovery after surgery (ERAS) protocol is an interdisciplinary multimodal concept based on modern anesthesia and analgesia combined with other fast rehabilitation parameters. It was first applied in the field of elective colorectal surgery, and eventually extended to several surgical diseases...
May 23, 2017: Oncotarget
https://www.readbyqxmd.com/read/28601480/the-trajectory-of-postoperative-pain-following-mastectomy-with-and-without-paravertebral-block
#11
Rochelle Wynne, Natalie Lui, Kristen Tytler, Carol Koffsovitz, Victor Kirwa, Bernhard Riedel, Shane Ryan
Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB...
June 7, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/28590258/opioid-induced-hyperalgesia-in-clinical-anesthesia-practice-what-has-remained-from-theoretical-concepts-and-experimental-studies
#12
Lena Weber, David C Yeomans, Alexander Tzabazis
PURPOSE OF REVIEW: This article reviews the phenomenon of opioid-induced hyperalgesia (OIH) and its implications for clinical anesthesia. The goal of this review is to give an update on perioperative prevention and treatment strategies, based on findings in preclinical and clinical research. RECENT FINDINGS: Several systems have been suggested to be involved in the pathophysiology of OIH with a focus on the glutaminergic system. Very recently preclinical data revealed that peripheral μ-opioid receptors (MORs) are key players in the development of OIH and acute opioid tolerance (AOT)...
June 5, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28558866/potential-clinical-utility-and-feasibility-of-combined-left-atrial-appendage-closure-and-positioning-of-miniaturized-pacemaker-through-a-single-right-femoral-vein-access
#13
François Regoli, Marco Araco, Tiziano Moccetti, Maria Luce Caputo, Giulio Conte, Angelo Auricchio, Marco Moccetti
This study assessed the clinical utility and feasibility of concomitant of combined left atrial appendage (LAA) closure and positioning of miniaturized pacemaker (Micra TPS). All consecutive patients who underwent VVI-PM implant from November 2015 to October 2016 were considered. VVI-PM implant was conducted either using transvenous approach or by positioning Micra TPS. In selected patients with concomitant contraindication to OAC, Micra TPS was combined with LAA occlusion ("combined approach"), performed in general anesthesia and guided by multimodality imaging; procedural and follow-up data of these specific patients were registered...
July 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28551059/-post-operative-pain-after-ultrasound-transversus-abdominis-plane-block-versus-trocar-site-infiltration-in-laparoscopic-nephrectomy-a-prospective-study
#14
Ana M Araújo, Joana Guimarães, Catarina S Nunes, Paula S Couto, Eduarda Amadeu
BACKGROUND: Transversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery. METHODS: A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction...
May 24, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28534815/multispectral-fluorescent-and-photoplethysmographic-imaging-for-remote-skin-assessment
#15
REVIEW
Janis Spigulis
Optical tissue imaging has several advantages over the routine clinical imaging methods, including non-invasiveness (it does not change the structure of tissues), remote operation (it avoids infections) and the ability to quantify the tissue condition by means of specific image parameters. Dermatologists and other skin experts need compact (preferably pocket-size), self-sustaining and easy-to-use imaging devices. The operational principles and designs of ten portable in-vivo skin imaging prototypes developed at the Biophotonics Laboratory of Institute of Atomic Physics and Spectroscopy, University of Latvia during the recent five years are presented in this paper...
May 19, 2017: Sensors
https://www.readbyqxmd.com/read/28532200/spinal-analgesia-improves-surgical-outcome-after-open-nephrectomy-for-renal-cell-carcinoma-a-randomized-controlled-study
#16
Mascha Thurm, Britt-Inger Kröger Dahlin, Ola Winsö, Börje Ljungberg
OBJECTIVE: This study evaluated whether more effective perioperative analgesia can be part of a multimodal approach to minimizing morbidity and improving postoperative management after the open surgical approaches frequently used in the treatment of renal cell carcinoma (RCC). The aim of the study was to determine whether spinal anesthesia with clonidine can enhance postoperative analgesia, speed up mobilization and reduce the length of hospital stay (LOS). MATERIALS AND METHODS: Between 2012 and 2015, 135 patients with RCC were randomized, in addition to general anesthesia, to receive either spinal analgesia with clonidine or epidural analgesia, stratified to surgical technique...
May 22, 2017: Scandinavian Journal of Urology
https://www.readbyqxmd.com/read/28476369/editorial-commentary-pain-and-stress-response-after-shoulder-arthroscopic-rotator-cuff-repair-does-interscalene-block-make-a-clinically-important-difference
#17
EDITORIAL
Michael J Rossi
Pain control after arthroscopic rotator cuff repair will invariably encompass a multimodal approach which will include, in some form, an anesthetic block. The authors of "Effects of a Single-Dose Interscalene Block on Pain and Stress Biomarkers in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial" demonstrate better pain control and a decrease in levels of the stress biomarker insulin with the use of a single-dose interscalene block (SISB) and general anesthesia compared to general anesthesia alone...
May 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28455600/protective-multimodal-analgesia-with-etoricoxib-and-spinal-anesthesia-in-inguinal-hernia-repair-a-randomized-controlled-trial
#18
Mostafa Somri, Nasir Hawash, Christopher Hadjittofi, Marlain Ghantous-Toukan, Riad Tome, Marina Yodashkin, Ibrahim Matter
BACKGROUND: Inguinal hernia repair is a common procedure, and can be performed under spinal anesthesia. Although adequate analgesia is crucial to postoperative recovery, the optimal protective analgesic regimen remains to be established. PURPOSE: To investigate the effects of preoperative etoricoxib within a protective multimodal analgesic regimen with respect to pain control following open inguinal hernia repair. METHODS: Sixty adult patients undergoing open inguinal hernia repair participated in a single-center, randomized, double-blinded, placebo-controlled trial in a general academic medical center...
April 28, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28416174/-ultrasound-guided-quadratus-lumborum-block-for-analgesia-after-cesarean-delivery-case-series
#19
Ilana Sebbag, Fatemah Qasem, Shalini Dhir
INTRODUCTION: The majority of women having planned cesarean section receive spinal anesthesia for the procedure. Typically, spinal opioids are administered during the same time as a component of multimodal analgesia to provide pain relief in the 16-24h period postoperatively. The quadratus lumborum block is a regional analgesic technique that blocks T5-L1 nerve branches and has an evolving role in postoperative analgesia for lower abdominal surgeries and may be a potential alternative to spinal opioids...
April 14, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28408986/pain-management-using-acetaminophen-throughout-postoperative-course-of-laparoscopic-colorectal-surgery-a-case-matched-control-study
#20
Masanori Naito, Takeo Sato, Takatoshi Nakamura, Takahiro Yamanashi, Hirohisa Miura, Atsuko Tsutsui, Masahiko Watanabe
BACKGROUD: The main advantage of laparoscopic surgery is that it is minimally invasive because of the use of small incisions. An approach using small incisions offers many benefits including attenuation of surgical wound pain. However, the presence of postoperative pain may undermine the advantages of laparoscopic surgery as a minimally invasive technique. In addition, perioperative pain management is an important factor affecting recovery after surgery. This study investigated the usefulness of a multimodal approach to postoperative pain management with acetaminophen as a baseline analgesic after minimally invasive laparoscopic colorectal surgery...
May 2017: Annals of Medicine and Surgery
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