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https://read.qxmd.com/read/30768457/perioperative-epidural-use-and-risk-of-delirium-in-surgical-patients-a-secondary-analysis-of-the-podcast-trial
#1
Phillip E Vlisides, Aleda Thompson, Bryan S Kunkler, Hannah R Maybrier, Michael S Avidan, George A Mashour, Apakama G P, Arya V K, Ben Abdallah A, Bottros M, Downey R, Emmert D A, Escallier K, Fritz B A, Fardous H, Girardi L N, Grocott H, Gruber A T, Hudetz J, Inouye S K, Ivascu N S, Jacobsohn E, Jayant A, Kashani H H, Kavosh M S, Lenze E, McKinney A S, McKinnon S, Mickle A M, Muench M R, Murphy M, Pagel P, Pryor K O, Redko M, Rogers E M, Schmitt E, Steinkamp M L, Tellor B, Upadhyayula R, Veselis R A, Waszynski C, Wildes T, Yulico H
BACKGROUND: Postoperative delirium is an important public health concern without effective prevention strategies. This study tested the hypothesis that perioperative epidural use would be associated with decreased risk of delirium through postoperative day 3. METHODS: This was a secondary, observational, nonrandomized analysis of data from The Prevention of Delirium and Complications Associated With Surgical Treatments Trial (PODCAST; NCT01690988). The primary outcome of the current study was the incidence of delirium (ie, any positive delirium screen, postanesthesia care unit through postoperative day 3) in surgical patients (gastrointestinal, hepatobiliary-pancreatic, gynecologic, and urologic) receiving postoperative epidural analgesia compared to those without an epidural...
February 12, 2019: Anesthesia and Analgesia
https://read.qxmd.com/read/30762694/what-pain-levels-do-tsa-patients-experience-when-given-a-long-acting-nerve-block-and-multimodal-analgesia
#2
Jacques T YaDeau, David M Dines, Spencer S Liu, Michael A Gordon, Enrique A Goytizolo, Yi Lin, Aaron A Schweitzer, Kara G Fields, Lawrence V Gulotta
BACKGROUND: The pain experience for total shoulder arthroplasty (TSA) patients in the first 2 weeks after surgery has not been well described. Many approaches to pain management have been used, with none emerging as clearly superior; it is important that any approach minimizes postoperative opioid use. QUESTIONS/PURPOSES: (1) With a long-acting nerve block and comprehensive multimodal analgesia, what are the pain levels after TSA from day of surgery until postoperative day (POD) 14? (2) How many opioids do TSA patients take from the day of surgery until POD 14? (3) What are the PainOUT responses at POD 1 and POD 14, focusing on side effects from opioids usage? METHODS: From January 27, 2017 to December 6, 2017, 154 TSA patients were identified as potentially eligible for this prospective, institutional review board-approved observational study...
March 2019: Clinical Orthopaedics and related Research
https://read.qxmd.com/read/30758893/evaluating-contemporary-pain-management-practices-in-thyroid-and-parathyroid-surgery-a-national-survey-of-head-and-neck-endocrine-surgeons
#3
Jay K Ferrell, Michael C Singer, D Gregory Farwell, Brendan C Stack, Maisie Shindo
BACKGROUND: There is currently a lack of evidence-based guidelines regarding postoperative opioids after thyroid and parathyroid surgery. This study aimed to objectively characterize contemporary postoperative pain management practices via a national survey of head and neck endocrine surgeons. METHODS: A standardized electronic survey was distributed to the membership of the American Head and Neck Society's Endocrine section. RESULTS: A total of 102 surgeons completed the survey representing a 34% response rate...
February 13, 2019: Head & Neck
https://read.qxmd.com/read/30747631/short-term-outcomes-with-robotic-right-colectomy
#4
Scott R Kelley, Emilie Duchalais, David W Larson
Few series have reported on the impact of robotic right colectomy compared with conventional laparoscopy. Even fewer have reported on the outcomes of intracorporeal anastomoses. The aim of our study was to determine the impact of robotic surgery on short-term operative outcomes in patients undergoing right colectomy with intracorporeal anastomosis. One hundred and fourteen consecutive patients who underwent a right colectomy by two colorectal surgeons between 2012 and 2017 were included. Patients were separated into two groups: laparoscopic technique with extracorporeal anastomosis (n = 87) and robotic technique with intracorporeal anastomosis (n = 27)...
November 1, 2018: American Surgeon
https://read.qxmd.com/read/30746233/impact-of-intercostal-nerve-blocks-using-liposomal-versus-standard-bupivacaine-on-length-of-stay-in-minimally-invasive-thoracic-surgery-patients
#5
Dana A Dominguez, Sora Ely, Cynthia Bach, Tina Lee, Jeffrey B Velotta
Background: Postsurgical pain control can have a significant impact on patient outcomes and hospital-associated costs. We sought to evaluate the effect of intercostal nerve blocks using liposomal bupivacaine on length of stay (LOS) in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods: We retrospectively reviewed outcomes in 80 patients undergoing VATS wedge resection, VATS lobectomy, or minimally-invasive esophagectomy (MIE). Patients received either liposomal bupivacaine (n=40) or standard-release bupivacaine with epinephrine (n=40) via intercostal nerve block...
December 2018: Journal of Thoracic Disease
https://read.qxmd.com/read/30743271/preoperative-chronic-opioid-use-and-its-effects-on-total-knee-arthroplasty-outcomes
#6
Kelvin Kim, Kevin Chen, Afshin A Anoushiravani, Mackenzie Roof, William J Long, Ran Schwarzkopf
Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution...
February 11, 2019: Journal of Knee Surgery
https://read.qxmd.com/read/30741813/intravenous-acetaminophen-before-pelvic-organ-prolapse-repair-a-randomized-controlled-trial
#7
Lindsay C Turner, Halina M Zyczynski, Jonathan P Shepherd
OBJECTIVE: To compare the effect of preoperative intravenous (IV) acetaminophen compared with placebo on pain scores after pelvic organ prolapse surgery. METHODS: This double-blind placebo-controlled multicenter trial randomized women undergoing prolapse surgery to IV acetaminophen (1,000 mg) or preoperative saline stratified by surgical route (laparoscopic or vaginal). The primary outcome was the change from baseline in patient-reported visual analog scale pain scores at 24 hours after surgery...
February 4, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30738410/an-institutional-intervention-to-modify-opioid-prescribing-practices-after-lumbar-spine-surgery
#8
Francis Lovecchio, Jeffrey G Stepan, Ajay Premkumar, Michael E Steinhaus, Maria Sava, Peter Derman, Han Jo Kim, Todd Albert
OBJECTIVEPatients with lumbar spine pathology are at high risk for opioid misuse. Standardizing prescribing practices through an institutional intervention may reduce the overprescribing of opiates, leading to a decrease in the risk for opioid misuse and the number of pills available for diversion. Without quantitative data on the "minimum necessary quantity" of opioids appropriate for postdischarge prescriptions, the optimal method for changing existing prescribing practices is unknown. The purpose of this study was to determine whether mandatory provider education and prescribing guidelines could modify prescriber behavior and lead to a decreased amount of opioids prescribed at hospital discharge following lumbar spine surgery...
February 5, 2019: Journal of Neurosurgery. Spine
https://read.qxmd.com/read/30737785/surgeon-perception-versus-reality-opioid-use-after-breast-cancer-surgery
#9
Ko Un Park, Kristin Kyrish, John Terrell, Min Yi, Abigail S Caudle, Kelly K Hunt, Henry M Kuerer, Isabelle Bedrosian, Alastair Thompson, Sarah M DeSnyder
BACKGROUND: Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. METHODS: Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference...
February 8, 2019: Journal of Surgical Oncology
https://read.qxmd.com/read/30737764/analgesic-requirements-in-adolescents-undergoing-bariatric-surgery-an-observational-study
#10
Janelle D Vaughns, Elaine F Williams, Eleanor R Mackey, Jane C Muret, John van den Anker, Evan P Nadler, Zenaide M Quezado
AIM: To examine the impact of preexisting psychiatric/psychological diagnoses on perioperative analgesic requirements in adolescents with morbid obesity undergoing bariatric surgery. METHODS: A retrospective cohort study of adolescents with morbid obesity undergoing bariatric surgery. Primary and secondary outcomes included perioperative analgesic intake and pain scores (Numerical Rating Scale (0-10) NRS) throughout the hospital stay. RESULTS: From our Bariatric Surgery Research Registry, we identified 17 adolescents with psychiatric/psychological diagnoses prior to undergoing bariatric surgery...
February 9, 2019: Obesity Surgery
https://read.qxmd.com/read/30735622/risk-of-prolonged-opioid-use-among-opioid-na%C3%A3-ve-patients-after-common-shoulder-arthroscopy-procedures
#11
Joseph A Gil, Vidhya Gunaseelan, Steven F DeFroda, Chad M Brummett, Asheesh Bedi, Jennifer F Waljee
BACKGROUND: Opioid-related morbidity and mortality are major public health concerns, and the risk of long-term opioid use after shoulder arthroscopy is not well defined. HYPOTHESIS: Substance abuse disorders, pain disorders, and psychiatric conditions increase the risk for prolonged opioid use. STUDY DESIGN: Case-control study, Level of evidence, 3. METHODS: Insurance claims data from the Truven Health MarketScan Research Databases was used to identify patients who underwent shoulder arthroscopy between January 1, 2010, and March 31, 2015...
February 8, 2019: American Journal of Sports Medicine
https://read.qxmd.com/read/30733071/intranasal-low-dose-dexmedetomidine-reduces-postoperative-opioid-requirement-in-patients-undergoing-hip-arthroplasty-under-general-anesthesia
#12
Panu Uusalo, Henrik Jätinvuori, Eliisa Löyttyniemi, Jussi Kosola, Teijo I Saari
BACKGROUND: Patients undergoing total hip arthroplasty (THA) need substantial amount of opioids for postoperative pain management, which necessitates opioid-sparing modalities. Dexmedetomidine is a novel alpha-2-adrenoceptor-activating drug for procedural sedation. In addition to its sedative effect, dexmedetomidine has analgesic and antiemetic effects. We evaluated retrospectively the effect of intraoperatively administered intranasal low-dose dexmedetomidine on postoperative opioid requirement in patients undergoing THA...
January 7, 2019: Journal of Arthroplasty
https://read.qxmd.com/read/30733025/adductor-canal-nerve-versus-femoral-nerve-blockade-for-pain-control-and-quadriceps-function-following-acl-reconstruction-with-patellar-tendon-autograft-a-prospective-randomized-trial
#13
Lane Bailey, Joshua Griffin, Mark Elliott, Jennifer Wu, Thanos Papavasiliou, Christopher Harner, Walter Lowe
PURPOSE: To compare femoral nerve blockade (FNB) versus adductor canal nerve blockade (ACB) for postoperative pain control and quadriceps muscle function in patients undergoing anterior cruciate ligament (ACL) reconstruction with patellar tendon autograft. METHODS: A randomized therapeutic trial of 90 patients undergoing ACL reconstruction with patellar tendon autograft was conducted comparing ACB versus FNB at 24 hours, 2 and 4 weeks, and 6 months postsurgery...
February 4, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://read.qxmd.com/read/30723060/transversus-abdominis-plane-block-reduces-pain-and-narcotic-consumption-after-robot-assisted-distal-pancreatectomy
#14
Monica A Solis-Velasco, Ana S Ore Carranza, Kathryn A Stackhouse, Koen Verkoulen, Ammara A Watkins, Vimal Akhouri, Mark P Callery, Tara S Kent, A James Moser
BACKGROUND: Minimizing pain and disability are key postoperative objectives of robot-assisted distal pancreatectomy (RADP). This study tested effects of bupivacaine transversus abdominis plane (TAP) block on opioid consumption and pain after RADP. METHODS: Retrospective case-control study (June 2012 -Oct 2017) evaluating bilateral intraoperative bupivacaine TAP block as an interrupted time series. Linear regression evaluated opioid consumption in terms of intravenous (IV) morphine milligram equivalents (MME) and controlled for preoperative morbidity...
February 2, 2019: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
https://read.qxmd.com/read/30717042/promis-physical-function-for-prediction-of-postoperative-pain-narcotics-consumption-and-patient-reported-outcomes-following-minimally-invasive-transforaminal-lumbar-interbody-fusion
#15
Dil V Patel, Mundeep S Bawa, Brittany E Haws, Benjamin Khechen, Andrew M Block, Sailee S Karmarkar, Eric H Lamoutte, Kern Singh
OBJECTIVEThis study aimed to determine if the preoperative Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF) score is predictive of immediate postoperative patient pain and narcotics consumption or long-term patient-reported outcomes (PROs) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospectively maintained database was retrospectively reviewed. Patients who underwent primary, single-level MIS TLIF for degenerative pathology were identified and grouped by their preoperative PROMIS PF scores: mild disability (score 40-50), moderate disability (score 30-39...
February 1, 2019: Journal of Neurosurgery. Spine
https://read.qxmd.com/read/30715186/quality-indicators-to-measure-the-effect-of-opioid-stewardship-interventions-in-hospital-and-emergency-department-settings
#16
Elsie Rizk, Joshua T Swan, Ohbet Cheon, A Carmine Colavecchia, Lan N Bui, Bita A Kash, Sagar P Chokshi, Hua Chen, Michael L Johnson, Michael G Liebl, Ezekiel Fink
Purpose: The purpose of this project was to develop a set of valid and feasible quality indicators used to track opioid stewardship efforts in hospital and emergency department settings. Methods: Candidate quality indicators were extracted from published literature. Feasibility screening excluded quality indicators that cannot be reliably extracted from the electronic health record or that are irrelevant to pain management in the hospital and emergency department settings...
February 1, 2019: American Journal of Health-system Pharmacy: AJHP
https://read.qxmd.com/read/30711124/wide-variation-in-opioid-prescribing-after-urological-surgery-in-tertiary-care-centers
#17
Matthew J Ziegelmann, Jason P Joseph, Amy E Glasgow, Mark D Tyson, Raymond W Pak, Halena M Gazelka, Ashton L Schatz, Bradley C Leibovich, Elizabeth B Habermann, Matthew T Gettman
OBJECTIVE: To describe postoperative opioid prescribing practices in a large cohort of patients undergoing urological surgery. PATIENTS AND METHODS: We identified 11,829 patients who underwent 21 urological surgical procedures at 3 associated facilities from January 1, 2015, through December 31, 2016. After converting opioids to oral morphine equivalents (OMEs), prescribing patterns were compared within and across procedures. Subgroup analysis for opioid-naive patients (those without a history of long-term opioid use) was performed...
February 2019: Mayo Clinic Proceedings
https://read.qxmd.com/read/30707239/pain-after-anatomic-total-shoulder-arthroplasty-versus-reverse-total-shoulder-arthroplasty
#18
Kelechi R Okoroha, Ravi B Patel, Toufic R Jildeh, Nathaniel Sanchez, Matthew C Sweet, Brian K Rill, Patricia A Kolowich, Stephanie J Muh
As anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) become increasingly common, differences between the 2 procedures are of importance. The purpose of this study was to determine differences in acute pain levels between patients undergoing aTSA and rTSA. Sixty patients undergoing aTSA or rTSA were assessed for participation. The primary outcome was postoperative daily visual analog scale scores, which were initially collected for 4 days postoperatively. Secondary outcomes included opioid consumption, length of stay, and complications...
January 30, 2019: Orthopedics
https://read.qxmd.com/read/30700616/association-between-perioperative-statin-use-and-postoperative-pain-after-total-knee-arthroplasty
#19
Tak Kyu Oh, Chong Bum Chang, Hyun-Jung Shin, Sunghee Han, Sang-Hwan Do, Hei-Jin Lee, Jung-Won Hwang
BACKGROUND AND OBJECTIVES: Data is insufficient to determine whether perioperative statin use increases or decreases postoperative pain. This study aimed to investigate the association between perioperative statin use and pain outcomes after total knee arthroplasty performed under spinal anesthesia. METHODS: This is a retrospective, observational study based on medical records from a tertiary hospital between January 2005 and October 2017. Medical records of patients who underwent elective total knee arthroplasty under spinal anesthesia as inpatients were analyzed...
February 2019: Regional Anesthesia and Pain Medicine
https://read.qxmd.com/read/30700073/oprm1-gene-interaction-with-sleep-in-chronic-pain-patients-treated-with-opioids
#20
Cesar Margarit, Purificacion Ballester, Maria-Del-Mar Inda, Reyes Roca, Luis Gomez, Beatriz Planelles, Raquel Ajo, Domingo Morales, Ana M Peiro
BACKGROUND: The experience of chronic non-cancer pain (CNCP) is one of the most common reasons individuals seek medical attention. Patients with CNCP frequently experience concomitant sleep-related problems. OBJECTIVES: The aim was to evaluate sleep problems in opioid naïve CNCP patients, before and after opioid titration, analyzing the influence of OPRM1 gene variants. STUDY DESIGN: A prospective, cohort, observational study. SETTING: This study was performed at the Pain Unit of the Alicante University General Hospital...
January 2019: Pain Physician
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