Rotation of narcotics

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) can be associated with significant postoperative pain. Concern for opioid abuse has led surgeons to identify alternative, efficacious methods of postoperative analgesia. To determine whether transcutaneous electrical nerve stimulation (TENS) can have a similarly beneficial effect after shoulder procedures, we conducted a prospective double-blinded randomized trial in patients undergoing outpatient ARCR. METHODS: All patients undergoing ARCR of a full-thickness rotator cuff tear by the senior authors were identified...

PURPOSE: Rising perioperative opioid use in the United States is of increasing concern. The purposes of this study were (1) to define opioid consumption after rotator cuff repair (RCR) in the United States and (2) to evaluate patient factors that may be associated with prolonged opioid use after arthroscopic RCR. METHODS: All arthroscopic RCRs performed between 2007 and 2014 were identified by use of Current Procedural Terminology code (29,827). Patients who filled opioid prescriptions preoperatively were divided into those who filled prescriptions at 1 to 3 months preceding RCR and those who filled opioid prescriptions only in the 1 month preceding RCR...

BACKGROUND: Sleep disturbance is a major complaint of patients with rotator cuff disease that often leads them to seek treatment. The authors previously reported a prospective analysis of patients who underwent rotator cuff repair and found that sleep disturbance significantly improved at 3 months after surgery. That improvement in sleep was maintained at 6 months. HYPOTHESIS: In the current study, the authors sought to gain medium-term data on this same population at greater than 2 years...

Background: Professional responsibilities are guided by laws and ethics that must be introduced and mastered within pharmaceutical sciences training. Instructional design to teaching typically introduces concepts in a traditional didactic approach and requires student memorization prior to application within practice settings. Additionally, many centers rely on best practices from abroad, due to lack of locally published laws and guidance documents. Objectives: The aim of this paper was to summarize and critically evaluate a professional skills laboratory designed to enhance learning through diversity in instructional methods relating to pharmacy law and best practices regarding narcotics, controlled medications, and benzodiazepines...

The use of opioids for the treatment of chronic non-cancer pain is growing at an alarming rate. Opioid-induced bowel dysfunction (OBD) is a common adverse effect of long-term opioid treatment manifesting as constipation, nausea, and vomiting. These effects are primarily mediated by peripheral μ-opioid receptors with resultant altered GI motility and function. As a result, patients may present with opioid-induced constipation (OIC), opioid-induced nausea and vomiting (OINV), and/or narcotic bowel syndrome (NBS)...

BACKGROUND: The rate of rotator cuff repair failure is between 13% and 67%. Porcine small intestine submucosa (SIS) may be suitable to augment the repair. METHODS: There were 62 patients with moderate and large cuff tears randomized to repair alone (control) or augmentation with SIS (Restore Orthobiologic Implant; DePuy, Warsaw, IN, USA). Primary outcome was repair failure using magnetic resonance arthrography. Randomization occurred on completion of the repair...

The goal of this study was to identify supracondylar fracture patterns that were predictive of adverse events and poor outcomes. The study consisted of a retrospective review of patients admitted for surgical treatment of a supracondylar humerus fracture between June 2008 and August 2010. Preoperative radiographs were assessed based on appearance (simple vs oblique vs comminuted), coronal plane displacement (angulated, posterior, posteromedial vs posterolateral), and rotation (rotation vs no rotation). Logistic regression models were used to examine the relationship between fracture pattern and clinical outcome parameters in 373 patients who were followed for 4 weeks or more postoperatively...

This survey investigated patients' return to driving after rotator cuff surgery, to determine whether pain, weakness, sling use, and narcotics correlate with self-assessed safety and maneuvering. Fifty-four patients (80.6% of those eligible) were surveyed 4 months after surgery. Return to driving ranged widely from same day to 4 months, with two not driving at 4 months; 12% reported narcotics use and 33% reported sling use. Drivers reporting weakness were more likely to feel unsafe (p = .02) and more likely to report difficulty maneuvering (p <...

The usual treatment of venous ulcers may be associated with statins intake. Antibiotics have only marginal utility in acute bronchitis. The prescription of paracetamol seems to have no benefit in the treatment of acute lower back pain. The absence of antithrombotic prophylaxis for distal fractures of the lower limbs seems to be safe for patients' health. The treatment of atraumatic lesions of the rotator cuff in patients >55 years should remain conservative. Arthroscopic surgery of non-traumatic tear of the medial meniscus seems to have no benefit...

BACKGROUND: Sleep disturbance is a common complaint of patients with a rotator cuff tear. Inadequate and restless sleep, along with pain, is often a driving symptom for patients to proceed with rotator cuff repair. To date, no studies have examined sleep disturbance in patients undergoing rotator cuff repair, and there is no evidence that surgery improves sleep disturbance. HYPOTHESIS: Sleep disturbance is prevalent in patients with a symptomatic rotator cuff tear, and sleep disturbance improves after arthroscopic rotator cuff repair...

INTRODUCTION: Cancer pain is one of the most important symptoms of malignant disease, which has a major impact on the quality of life of cancer patients. Therefore, it needs to be treated appropriately after a careful assessment of the types and causes of pain. AREAS COVERED: The mainstay of cancer pain management is systemic pharmacotherapy. This is, in principle, still based on the WHO guidelines initially published in 1986. Although these have been validated, they are not evidence-based...

BACKGROUND: Rotator cuff repair is a successful treatment in terms of patient satisfaction and pain relief regardless of the repair method. Although arthroscopic repair is commonly thought to be less painful than open or miniopen repair, studies disagree on this point. QUESTIONS/PURPOSES: We wished to compare the results of patient-reported postoperative pain after open versus arthroscopic rotator cuff repair and to identify any predictors of various pain outcomes in these groups...

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BACKGROUND: Opioid switching or rotation is reported to be a common practice in palliative care. Published tables of opioid conversion ratios have been found to vary in their recommendations, potentially leading to significant differences in clinical practice. AIMS: To identify common practices in the calculation of opioid equianalgesia by specialist palliative medicine practitioners and trainees. METHOD: An anonymous, cross-sectional, online survey completed by 85 Australian palliative care specialists or advanced trainees...

We report three cases of successful treatment of intractable delirium associated with cancer pain with continuous dexmedetomidine (DEX) infusion. Case 1 : An 83-year-old man receiving oral oxycodone for lung cancer pain developed delirium. He was resistant to haloperidol infusion, oral quetiapine, and opioid rotation. DEX infusion was administered at 0.4 microg kg-1 hr-1, and his delirium resolved. Case 2: A 50-year-old woman with cervical cancer of the uterus suffered from sepsis but could not take oral oxycodone...

BACKGROUND: We performed this randomized trial to compare the recovery profile of patients receiving single injection (SISB) and continuous interscalene brachial plexus block (CISB) or general anesthesia (GA) for arthroscopic rotator cuff repair surgery through the first postoperative week. Our primary hypothesis was that the highest pain numeric rating scale (NRS) (worst pain score) at the end of the study week would be lower for patients in the CISB group than for patients in the SISB or GA groups...

OBJECTIVE: The present study aims to find a convenient, rapid, and stable method to establish bladder tumor in mice. METHODS: Female Balb/C-nu-nu nude mice (or female T739 mice) were narcotized by sodium pentobarbital at a dosage of 60 mg/kg. The stylet of the 24# venous retention needles was bent in a 5° to 7° angle at a distance of 15 mm from the needlepoint to form a circle with 2.61 mm to 3.66 mm radius when the stylet is rotated. The pipe casing was lubricated with liquid paraffin, and inserted into the bladder cavity...

BACKGROUND AND HYPOTHESIS: Arthroscopic rotator cuff repair can be a painful outpatient procedure. The purpose of this study was to evaluate the efficacy of continuous subacromial bupivacaine infusion to relieve pain after arthroscopic rotator cuff repair. We hypothesized that patients receiving continuous subacromial bupivacaine infusions after arthroscopic rotator cuff repair will have less postoperative pain in the early postoperative period than placebo and control groups. MATERIALS AND METHODS: Eighty-eight patients undergoing arthroscopic rotator cuff repair were randomized in a blinded fashion into 1 of 3 groups...

It is established that rotation and immobilization stress produces bidirectional effect on AFC number in spleen and on proliferative response of splenocytes. The rotation stress results in augmentation of AFC formation and promotion of spontaneous proliferative activity of splenocytes. The micro-opioid receptor blockade with naloxone, but not delta-receptor blockade with naltrindole, abolished the effects of rotation. In contrast, the immobilization stress caused the suppression of the parameters of humoral immune response and lowered spontaneous and induced proliferative activity of splenocytes...

The purpose of this study was to investigate deltoid compartment pressures during arthroscopic rotator cuff repair using modern pressure pumps to achieve visualization. Twelve patients undergoing arthroscopic rotator cuff repairs were monitored for deltoid compartment pressure changes intraoperatively. Pre-, intra-, and postoperative intramuscular pressures were recorded. All patients demonstrated varying degrees of swelling due to fluid extravasation. Swelling was qualified as mild, moderate, or severe by clinical assessment and quantified objectively using a pressure monitor to record deltoid compartment pressures...