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Multimodal anesthesia

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https://www.readbyqxmd.com/read/29049123/impact-of-enhanced-recovery-after-surgery-and-opioid-free-anesthesia-on-opioid-prescriptions-at-discharge-from-the-hospital-a-historical-prospective-study
#1
Delara Brandal, Michelle S Keller, Carol Lee, Tristan Grogan, Yohei Fujimoto, Yann Gricourt, Takashige Yamada, Siamak Rahman, Ira Hofer, Kevork Kazanjian, Jonathan Sack, Aman Mahajan, Anne Lin, Maxime Cannesson
BACKGROUND: The United States is in the midst of an opioid epidemic, and opioid use disorder often begins with a prescription for acute pain. The perioperative period represents an important opportunity to prevent chronic opioid use, and recently there has been a paradigm shift toward implementation of enhanced recovery after surgery (ERAS) protocols that promote opioid-free and multimodal analgesia. The objective of this study was to assess the impact of an ERAS intervention for colorectal surgery on discharge opioid prescribing practices...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29049119/a-review-of-opioid-sparing-modalities-in-perioperative-pain-management-methods-to-decrease-opioid-use-postoperatively
#2
Kanupriya Kumar, Meghan A Kirksey, Silvia Duong, Christopher L Wu
There is an epidemic of opioid use, abuse, and misuse in the United States, which results in significant morbidity and mortality. It may be difficult to reduce perioperative opioid use given known acute surgical trauma and resultant pain; however, the discrete and often limited nature of postoperative pain also may make management easier in part by utilizing nonopioid modalities, such as regional anesthesia/analgesia, and multimodal analgesia, which may decrease the need for powerful opioids. This article reviews the relevant literature describing the use of adjunct medications, regional anesthesia and analgesic techniques, and regional block additives in the context of providing adequate pain control while lessening opioid use...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29033729/use-of-rocuronium-and-sugammadex-under-neuromuscular-transmission-monitoring-in-a-patient-with-multiple-sclerosis
#3
Chryssoula Staikou, Martina Rekatsina
Multiple sclerosis (MS) is a potentially disabling disease characterized by demyelinating lesions in the central nervous system. One of the anesthetic challenges encountered in surgical patients with MS is the management of neuromuscular blockade (NMB) and its reversal. We report a case of a 31-year-old female patient suffering from MS, who underwent gynecological surgery under general anesthesia with sevoflurane, fentanyl, and rocuronium which was successfully reversed with sugammadex. Neuromuscular transmission (NMT) monitoring was used to guide the intraoperative doses of rocuronium and also the reversal of NMB by the use of sugammadex to ensure a safe tracheal extubation...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/29031866/connectivity-changes-after-laser-ablation-resting-state-fmri
#4
Varina L Boerwinkle, Aditya Vedantam, Sandi Lam, Angus A Wilfong, Daniel J Curry
Resting-state functional magnetic resonance imaging (rsfMRI) is emerging as a useful tool in the multimodal assessment of patients with epilepsy. In pediatric patients who cannot perform task-based fMRI, rsfMRI may present an adjunct and alternative. Although changes in brain activation during task-based fMRI have been described after surgery for epilepsy, there is limited data on the role of postoperative rsfMRI. In this short review, we discuss the role of postoperative rsfMRI after laser ablation of seizure foci...
September 28, 2017: Epilepsy Research
https://www.readbyqxmd.com/read/29027773/perioperative-pain-management-in-cardiac-surgery-a-systematic-review
#5
Elena Bignami, Alberto Castella, Vincenzo Pota, Francesco Saglietti, Antonio Scognamiglio, Cinzia Trumello, Maria C Pace, Massimo Allegri
BACKGROUND: Every year, more than 1.5 million patients, who undergo cardiac surgery worldwide, are exposed to a series of factors that can trigger acute postoperative pain associated with hemodynamic instability, respiratory complications, and psychological disorders. Through an evaluation of literature data about postoperative pain in cardiac surgery we define unmet needs and potential objectives for future research on this often underestimated problem. METHODS: Following PRISMA Guidelines, a systematic literature search was carried out by two independent researchers on Scopus, CINAHL, the Cochrane Library, and PubMed using the keywords: [(perioperative OR postoperative) analgesia AND "cardiac surgery"]...
October 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28971169/evaluation-of-analgesic-regimens-in-total-knee-arthroplasty-retrospective-study
#6
Serkan Tulgar, Onur Selvi, Ozgur Senturk, Talat Ercan Serifsoy, Selim Sanel, Sertac Meydaneri
OBJECTIVE: Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA). METHODS: The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated...
2017: Northern Clinics of Istanbul
https://www.readbyqxmd.com/read/28965444/intraoperative-neuromonitoring-alerts-in-a-pediatric-deformity-center
#7
Maria Zuccaro, James Zuccaro, Amer F Samdani, Joshua M Pahys, Steven W Hwang
OBJECTIVE Intraoperative neuromonitoring (IONM) involves the use of somatosensory evoked potentials (SSEPs) and transcranial electric motor evoked potentials (TceMEPs). In this retrospective study the authors examined the sensitivity and specificity of both SSEPs and TceMEPs during pediatric spinal deformity surgeries. METHODS The authors performed a retrospective quantitative analysis of data obtained in 806 patients (197 males and 609 females) treated from December 2011 until October 2015. All patients were diagnosed with scoliosis that was classified as one of the following: adolescent idiopathic scoliosis (AIS) (38%), congenital scoliosis (22%), or syndromic scoliosis (40%)...
October 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28964926/managing-postoperative-pain-after-minimally-invasive-gynecologic-surgery-in-the-era-of-the-opioid-epidemic
#8
REVIEW
Marron Wong, Stephanie Morris, Karen Wang, Khara Simpson
In this review, we examine the evidence behind non-opioid medication alternatives, peripheral nerve blocks, surgical techniques, and postoperative recovery protocols that can help minimize and effectively treat postoperative pain after minimally invasive gynecologic surgery (MIGS). Due to the depth and heterogeneity of the data, a narrative review was performed of reported interventions. A comprehensive review was performed of Pubmed, EMBASE, and the Cochrane Database with a focus on randomized controlled trials (RCT)...
September 27, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28964282/adherence-to-swedish-guidelines-for-pain-treatment-in-relation-to-pediatric-tonsil-surgery-a-survey-of-the-multidisciplinary-team
#9
F Alm, M Jaensson, S Lundeberg, E Ericsson
BACKGROUND: Pain management in children after tonsil surgery is essential, and optimal pain treatment has been discussed for many years. Data from the National Tonsil Register in Sweden (NTRS) and a national mapping have demonstrated the need for national pain treatment guidelines for pediatric tonsil surgery. As a result, Swedish national guidelines, together with updated patient information on the website tonsilloperation.se, were developed and implemented in 2013. OBJECTIVES: The objective of this study was to evaluate the professionals' opinions of and adherence to pain treatment guidelines for pediatric tonsil surgery patients in a two-year follow-up...
October 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28953489/effects-of-ketamine-on-pupillary-reflex-dilation-a-case-report
#10
Sérgio Vide, Catarina M Costa, Pedro L Gambus, Pedro P Amorim
Ketamine is an important component of multimodal treatment and a commonly used anesthetic drug. However, its analgesic effects have not been fully assessed intraoperatively because of difficulties in measuring this effect. In this case report, a woman underwent general anesthesia with ketamine and its pupillary reflexes were measured to detect autonomic changes in response to pain. With increasing doses of ketamine, the pupillary light reflex and the pupillary dilation response decreased. This could be caused by N-methyl-D-aspartate receptor antagonism in the pupillary reflexes pathway or by the analgesic effects of ketamine...
September 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28936915/review-of-the-evidence-best-analgesic-regimen-for-shoulder-surgery
#11
Yolanda Huang, Felicia Chiu, Christopher Aj Webb, Paul David Weyker
Multimodal pain management has been advocated in patients experiencing acute pain after surgical procedures due to tissue damage and the subsequent inflammatory response. For patients undergoing shoulder surgeries, studies have definitively shown that interscalene blocks (ISBs) via single-injection or continuous infusion can reduce the total opioid consumption and can lower pain scores after surgery. In some cases, ISBs can be used as the sole anesthetic during shoulder surgeries and spare patients of receiving general anesthesia...
September 2017: Pain Management
https://www.readbyqxmd.com/read/28928585/postoperative-analgesic-efficacy-of-bilateral-transversus-abdominis-plane-block-in-patients-undergoing-midline-colorectal-surgeries-using-ropivacaine-a-randomized-double-blind-placebo-controlled-trial
#12
Nahida Qazi, Wasim Mohammad Bhat, Malik Zaffar Iqbal, Anisur Rehman Wani, Showkat A Gurcoo, Sahir Rasool
BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. MATERIALS AND METHODS: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28928570/gabapentinoids-as-a-part-of-multi-modal-drug-regime-for-pain-relief-following-laproscopic-cholecystectomy-a-randomized-study
#13
Anjali Kochhar, Kanika Chouhan, Pratibha Panjiar, Homay Vajifdar
BACKGROUND: Gabapentinoids have been used as preemptive analgesics for pain management following laparoscopic cholecystectomy. Recently, multimodal analgesic techniques have been found superior to preemptive analgesia alone. AIM: The aim of this study is to evaluate and compare a single preoperative dose of pregabalin 150 mg and gabapentin 300 mg for pain relief following laparoscopic cholecystectomy as a part of multimodal drug regime. SETTINGS AND DESIGN: This randomized, single-blind study was conducted after Ethical Committee approval and written informed consent from the patients...
July 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28900843/pressurized-intraperitoneal-aerosol-chemotherapy-pipac-procedure-for-non-resectable-peritoneal-carcinomatosis-with-video
#14
Jean-Baptiste Cazauran, Mohammad Alyami, Antoinette Lasseur, Isabo Gybels, Olivier Glehen, Naoual Bakrin
BACKGROUND: Peritoneal carcinomatosis (PC) is a common evolution of abdominal cancers and is associated with poor prognosis in the absence of aggressive multimodal therapy.1 Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a safe and innovative approach, which enhances the effect of chemotherapy 2 without reported renal/hepatic toxicity.3,4 It requires mastery of technical aspects to reduce postoperative morbidity, increase effectiveness, and prevent caregiver chemotherapy exposure...
September 12, 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/28870309/multimodal-analgesia-in-foot-and-ankle-surgery
#15
REVIEW
Jessica M Kohring, Nathan G Orgain
Progress in surgical acute pain management has allowed most foot and ankle surgery to be performed in ambulatory outpatient surgical centers. Multimodal analgesia focuses on improving postoperative pain by combining pharmacologic and other modalities, addressing multiple pain mechanisms and receptor pathways while reducing adverse effects through lower doses of oral medications. Local anesthesia techniques provide excellent pain relief with few adverse events. Multimodal analgesia in foot and ankle surgery provides superior pain relief, and reduced opioid dependence and opioid-related side effects, improving patient satisfaction, safety, and timely return to function...
October 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28870306/pediatric-perioperative-pain-management
#16
REVIEW
Kaela H Frizzell, Priscilla K Cavanaugh, Martin J Herman
Effective perioperative pain control in pediatric patients undergoing orthopedic surgery remains a challenge. Developing a successful pain control regimen begins preoperatively with assessment of the patient and discussion with the patient and family regarding expectations. Perioperative pain control regimens are customized based on the type of surgery, patient characteristics, and anticipated severity and duration of the postoperative pain. Recent study focuses on multimodal strategies and regional anesthesia options, allowing for decreased opioid use...
October 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28870301/perioperative-pain-management-and-anesthesia-a-critical-component-to-rapid-recovery-total-joint-arthroplasty
#17
REVIEW
Matthew W Russo, Nancy L Parks, William G Hamilton
Multimodal pain management has become the standard of care following total hip and knee replacement. The advantages include decreasing opioid consumption and its associated side effects, facilitating earlier mobilization, and faster return to function. An effective rapid recovery protocol includes the use of multiple different types of medications targeting each area of the pain pathway, preemptive analgesia, regional nerve blockade, and local infiltration analgesia.
October 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28867907/preemptive-analgesia-in-thumb-basal-joint-arthroplasty-immediate-postoperative-pain-with-preincision-versus-postincision-local-anesthesia
#18
Joseph T Labrum, Asif M Ilyas
Purpose  Currently no guidelines exist for the timing of the injection of anesthetics in surgeries performed under general anesthesia to minimize postoperative pain. To better understand the role of timing of the injection of local anesthesia in hand surgery performed under general anesthesia, we evaluated the effect of pre- versus postincisional local analgesic injection on immediate postoperative pain experience. We hypothesize that the preincisional (preemptive) injection will result in decreased immediate postoperative pain experience and analgesic use when compared with postincisional injection...
August 2017: Journal of Hand and Microsurgery
https://www.readbyqxmd.com/read/28856631/implications-of-entropy-and-surgical-pleth-index-guided-general-anaesthesia-on-clinical-outcomes-in-critically-ill-polytrauma-patients-a-prospective-observational-non-randomized-single-centre-study
#19
Alexandru Florin Rogobete, Dorel Sandesc, Carmen Alina Cradigati, Mirela Sarandan, Marius Papurica, Sonia Elena Popovici, Corina Vernic, Ovidiu Horea Bedreag
Being highly unstable, the critically ill polytrauma patient represents a challenge for the anaesthesia team. The aim of this study was to compare the Entropy and Surgical Pleth Index (SPI)-guided general anaesthesia with standard haemodynamic monitoring methods used in the critically ill polytrauma patients and to evaluate the incidence of hemodynamic events, as well as the opioid and vasopressor demand. 72 patients were included in this prospective observational study, divided in two groups, the ESPI Group (N = 37, patients that benefited from Entropy and SPI monitoring) and the STDR Group (N = 35 patients that benefited from standard hemodynamic monitoring)...
August 30, 2017: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/28853044/consensus-statement-for-clinical-pathway-development-for-perioperative-pain-management-and-care-transitions
#20
REVIEW
Alan D Kaye, Erik M Helander, Nalini Vadivelu, Leandro Lumermann, Thomas Suchy, Margaret Rose, Richard D Urman
The perioperative surgical home (PSH) model has been created with the intention to reduce costs and to improve efficiency of care and patient experience in the perioperative period. The PSH is a comprehensive model of care that is team-based and patient-centric. The team in each facility should be multidisciplinary and include the input of perioperative services leadership, surgical services, and support personnel in order to provide seamless care for the patient from the preoperative period when decision to undergo surgery is initially made to discharge and, if needed after discharge from the hospital, until full recovery is achieved...
August 29, 2017: Pain and Therapy
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