Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

Microtia Reconstruction and Erector Spinae Block in Children: A Case Series With Chart Review

2021 ◽  
pp. 019459982110183
Author(s):  
Gabriel Gomez ◽  
Beth Osterbauer ◽  
Robert Nguyen ◽  
Choo Phei Wee ◽  
Amit Kochhar ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Stay ◽  
Chart Review ◽  
Case Series ◽  
Hospital Length ◽  
Erector Spinae ◽  
Hospital Length Of Stay ◽  
Block Group ◽  
Opioid Use ◽  
Pain Scores

Objectives Autologous reconstruction of microtia is advantageous due to its inherent biocompatibility and long-term stability, but postoperative pain associated with costal harvest is a significant issue. A well-planned pain management approach is imperative. Our objective is to introduce the novel application of erector spinae block anesthesia in pediatric microtia reconstruction and evaluate its impact on pain scores, use of opioids, and hospital length of stay. Study Design Case series with chart review. Setting Patients undergoing stage 1 microtia reconstruction at a tertiary pediatric hospital. Methods Data collected included demographics, opioid amounts, Wong-Baker FACES Pain Rating Scale scores, opioid-related side effects, and hospital length of stay. We used generalized estimating equations to examine the effect of erector spinae block use on total opioid use and pain scores and a linear regression model to assess the effect on hospital stay. Results Forty-seven patients were included: 14 in the erector spinae block group and 33 in the continuous wound pump group. The mean age was 8.3 years (SD, 2; range, 6-13), and 13 (32%) were female. Patients in the erector spinae block group had a 65.44% decrease in adjusted total opioid use (95% CI, –79.72% to –41.10%; P < .0001), a decrease in length of hospital stay (β = −1.69 [95% CI, −2.11 to −1.26], P < .0001), and no difference in reported pain scores when compared with patients in the continuous wound pump group. Conclusions This study demonstrates that early experience with an erector spinae block resulted in decreased opioid use and shorter hospital stay as compared with continuous wound infiltration with local anesthetic.

Transcervical Drainage for Descending Necrotizing Mediastinitis May Be Sufficient

2011 ◽  
Vol 145 (5) ◽  
pp. 742-747 ◽  
Author(s):  
Ruey-Fen Hsu ◽  
Pei-Yin Wu ◽  
Chi-Kung Ho
Keyword(s):  
Mortality Rate ◽  
Hospital Stay ◽  
Chart Review ◽  
Medical Center ◽  
Case Series ◽  
Descending Necrotizing Mediastinitis ◽  
Group I ◽  
Significant Difference ◽  
Mediastinal Drainage ◽  
Group Ii

Objective. Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors’ experience and characterizes the surgical strategies and treatment outcomes of patients with DNM. Study Design. Case series with chart review. Setting. A tertiary referral medical center. Subjects and Methods. This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II). Results. There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I. Conclusion. Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.

scholarly journals Hyperglycemia and Its Impact on Length of Stay in Patients Hospitalized with Community-Acquired Pneumonia

Esculapio ◽  
2020 ◽  
Vol 16 (03, july 2020-Septmber 2020) ◽  
Author(s):  
Muhammad Nazeer ◽  
Muhammad Naeem Afzal ◽  
Tabish Raza ◽  
Sidra Rasheed ◽  
Tariq Suleman ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Age Groups ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Health Concern ◽  
High Blood Glucose ◽  
Equal Distribution ◽  
Significant Difference

Objectives: 1. To determine the frequency of hyperglycemia in hospitalized patients with community acquired pneumonia 2. To compare mean hospital stay in patients with and without hyperglycemia admitted with CAP. Methods: It was a descriptive, case series done at Department of Medicine, Services Hospital, Lahore, in 2016. With non-probability, consecutive sampling technique a sample size of 150 cases is calculated with 95% confidence level, 8% margin of error and talking expected percentage of hyperglycemia as 38.2% in hospitalized patients with community acquired pneumonia. Results: Out of total 150 cases of CAP there were 85 (56.67%) males with mean age of 47.61±14.66 years. Hyperglycemia was seen in 46 (30.67%) patients with CAP. There was equal distribution of hyperglycemia with respect to gender and age groups with p= 0.56 and 0.24 respectively. Hyperglycemia was more in those having temperature more than 101oF however this difference was not significant with p= 0.32. There was significant difference seen in terms of length of hospital stay,4.07±1.51 days in hyperglycemic and 2.85±1.31 days in normoglycemics with p= 0.001. The length of hospital stay was near significant high in males,4.31±1.56 days (p= 0.08), while non -significant in females with p= 0.30. There was no significant difference in terms of age groups in cases with or without hyperglycemia with p= 0.56 and 0.78. The length of hospital stay was longer in those that had temperature more than 101oF,4.29±1.26 days with hyperglycemia as compared to 2.88±1.34 days in normoglycemics with p= 0.13. Conclusion: Community acquired pneumonia is an important infectious health concern. It is associated with high blood glucose and the length of hospital stay is found significantly high in cases of hyperglycemia. Key words: Community acquired pneumonia, Hyperglycemia, hospital stay

scholarly journals Conventional Thermal versus Water-Cooled Genicular Nerve Radiofrequency Lesioning: A Retrospective Chart Review

2019 ◽  
pp. 16-172
Author(s):  
Cristina Shea
Keyword(s):  
Knee Pain ◽  
Chart Review ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Pain Clinic ◽  
Fisher Exact Test ◽  
Pain Scores ◽  
Chronic Knee Pain ◽  
Significant Difference

Background: Genicular nerve radiofrequency lesioning (RFL) is an interventional approach to chronic knee pain. It is currently unknown whether conventional thermal RFL (CT-RFL) or watercooled RFL (WC-RFL) yields better outcomes. Objective: The objective of this research was to analyze and compare outcomes of genicular nerve conventional thermal radiofrequency lesioning (CT-RFL) vs water-cooled radiofrequency lesioning (WC-RFL) for the treatment of chronic knee pain. Study Design: We used retrospective chart review. Setting: The research took place in an outpatient pain clinic at a large academic medical center. Methods: Patients who participated in the study were those aged 18 and older who received genicular nerve RFL for chronic knee pain between January 1, 2014 and December 31, 2016. Random intercepts models were used to examine Visual Analog Scale (VAS) pain scores across the first year of follow-up, adjusting for age, gender, and prior history of knee surgery. Results: Overall, VAS scores were significantly reduced from baseline (mean = 6.66, standard deviation [SD] = 1.36) by 1.46 points during the first follow-up month (95% confidence interval [CI], 0.6-2.3, P = .001), 2.22 points during the second follow-up month (95% CI, 1.4-3.1, P = < .001), and 1.24 points during the sixth follow-up month (95% CI, 0.1-2.4, P = .035) but were not significantly reduced at other months during the one-year followup time period. There was no statistically significant difference in follow-up pain scores (mean difference = 0.73, 95% CI, -0.14-1.59, P = .116) or rates of complications (P = .10, 2-tailed Fisher exact test) between RFL types. Limitations: Study shortcomings include patient loss to follow-up, heterogeneity of CT-RFL techniques, and heterogeneity of study patients. Conclusions: Genicular RFL is a promising strategy for long-term management of treatment-resistant chronic knee pain. In this study, no significant difference in outcomes was detected between CT-RFL and WC-RFL techniques. Larger prospective studies are warranted to compare outcomes of these techniques and guide future care. Key words: Radiofrequency lesioning, knee pain, chronic pain, osteoarthritis, genicular, cooled radiofrequency lesioning, water-cooled radiofrequency lesioning, conventional radiofrequency lesioning

A retrospective chart review of a symptom-triggered alcohol withdrawal protocol versus previous standard of care at a veterans hospital

2013 ◽  
Vol 3 (4) ◽  
pp. 174-179
Author(s):  
Katy L. Zeier ◽  
Robert Connell ◽  
William Resch ◽  
Stephen Todd Hanson ◽  
Christopher J. Thomas
Keyword(s):  
Hospital Stay ◽  
Alcohol Withdrawal ◽  
Chart Review ◽  
Rating Scale ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
The Body ◽  
Fixed Dose ◽  
Medication Regimen

Alcohol is a commonly abused substance, and it is important that healthcare facilities properly manage alcohol withdrawal. Studies have found that the most efficient way to manage alcohol withdrawal is to use a symptom-triggered approach and only administer medications if symptoms surpass a specific threshold determined by a clinician administered rating scale. Alternatively, a standard fixed-dose medication regimen can be utilized. This study assessed if a new symptom-triggered protocol, utilizing the Clinical Institute Withdrawal for Alcohol, Revised (CIWA-Ar) scale for the assessment of symptoms, resulted in the anticipated patient outcomes of decreased length of hospital stay, less benzodiazepine administered per patient, and a shorter administration time from first dose of benzodiazepine given to last dose, when compared to the previous standard of care. A retrospective chart review was performed for 70 patients who had been treated for alcohol withdrawal. Patients who were treated with the symptom-triggered protocol had a decreased length of hospital stay when compared to the previous standard of care (−2.62 days, p = 0.0054). Both secondary efficacy outcomes were also statistically significant in favor of the symptom-triggered group. This retrospective chart review adds to the body of evidence supporting the use of symptom-triggered protocols as opposed to fixed-dose protocols in the management of alcohol withdrawal.

The effect of a scheduled regimen of acetaminophen and ibuprofen on opioid use following cesarean delivery

2020 ◽  
Vol 48 (2) ◽  
pp. 153-156
Author(s):  
Dijana Poljak ◽  
Joseph Chappelle
Keyword(s):  
Cesarean Delivery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Time Intervals ◽  
Pain Scores ◽  
Pain Medications ◽  
Post Operative Pain

AbstractObjectiveThe primary objective was to evaluate if the administration of ibuprofen and acetaminophen at regularly scheduled intervals impacts pain scores and total opioid consumption, when compared to administration based on patient demand.MethodsA retrospective chart review was performed comparing scheduled vs. as-needed acetaminophen and ibuprofen regimens, with 100 women included in each arm. Demographics and delivery characteristics were collected in addition to pain scores and total ibuprofen, acetaminophen and oxycodone use at 24, 48 and 72 h postoperatively.ResultsThe scheduled dosing group was found to have a statistically significant decrease in pain scores at all time intervals. Acetaminophen and ibuprofen usage were also noted to be higher in this group while narcotic use was reduced by 64%.ConclusionScheduled dosing of non-narcotic pain medications can substantially decrease opioid usage after cesarean delivery and improve post-operative pain.

Earlier Initiation of Postoperative Physical Therapy Decreases Opioid Use after Total Knee Arthroplasty

2020 ◽  
Author(s):  
Tal Frenkel Rutenberg ◽  
Haim Izchak ◽  
Yoav Rosenthal ◽  
Uri Barak ◽  
Shai Shemesh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Therapy ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Osteoarthritis Of The Knee ◽  
Opioid Use ◽  
Significant Difference ◽  
Total Knee ◽  
The Impact

AbstractFor patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.

scholarly journals Effect of IV Acetaminophen Usage on Opioid Requirements, Outcomes and Costs of Care for Postoperative Children in a Pediatric Intensive Care Unit

2020 ◽  
Vol 25 (6) ◽  
pp. 514-520
Author(s):  
Brock M. Taylor ◽  
Shawn R. Chakraborty ◽  
Aaron A. Harthan ◽  
Sandeep Tripathi ◽  
Huaping Wang ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Chart Review ◽  
Hospital Costs ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Total Hospital ◽  
Exclusion Criteria ◽  
X Ray ◽  
Significant Difference

OBJECTIVE Children admitted to the ICU are commonly treated with opioids for postoperative pain. We hypothesized that administration of IV acetaminophen in the immediate postoperative period is effective in lowering cumulative opioid use leading to other benefits. METHODS This was a retrospective chart review of patients admitted to the PICU between December 2016 and April 2019. For each patient, data including demographics, cumulative opioid usage per kilogram, oral or rectal acetaminophen, x-ray findings, hospital costs, and surgical procedure were collected. Cumulative opioid usage was determined by converting all opioids to morphine equivalents (MEs) per kg. Standard descriptive and comparative analyses were conducted using SAS 9.4 (SAS Institute, Inc, Cary, NC). RESULTS A total of 200 patients met inclusion and exclusion criteria (N = 92 in IV acetaminophen group and N = 108 in no IV acetaminophen group). There was no significant difference in ME per kilogram between the groups (0.3 ME/kg in IV acetaminophen group, IQR 0.5 ME/kg versus 0.4 ME/kg in no IV acetaminophen group, IQR 0.5 ME/kg, adjusted p = 0.38). Rate of atelectasis was not significant between the groups (47.8% in IV acetaminophen versus 45.4% in no acetaminophen group, p = 0.28). There was a significant difference in median total hospital costs between the groups ($22,456 in IV acetaminophen group, IQR $18,650 versus $18,552 in no IV acetaminophen group, IQR $13,361, adjusted p = 0.04). CONCLUSIONS IV acetaminophen in the immediate postoperative period did not lead to a decrease in cumulative opioid usage or rate of atelectasis. IV acetaminophen usage was associated with increase in overall hospital costs per patient.

Long-term efficacy of 1–1.2 kHz subthreshold spinal cord stimulation following failed traditional spinal cord stimulation: a retrospective case series

2019 ◽  
Vol 44 (1) ◽  
pp. 107-110 ◽  
Author(s):  
Leonardo Kapural ◽  
Shervin Harandi
Keyword(s):  
Spinal Cord ◽  
Pain Relief ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Low Frequency ◽  
Opioid Use ◽  
Retrospective Case ◽  
Pain Scores ◽  
Significant Difference

Background and objectiveWe investigated whether an effective long-term pain relief could be achieved using subthreshold 1–1.2 kHz spinal cord stimulation (SCS) among patients who were initially implanted with traditional paresthesia-based SCS but who failed to maintain an adequate pain relief.MethodsRetrospective chart review was conducted of patients’ electronic records who underwent a trial of subthreshold 1–1.2 kHz SCS. One hundred and nine patients implanted and programmed at traditional paresthesia-based frequencies 40–90 Hz (low-frequency SCS) with unsatisfactory pain relief or unpleasant paresthesias were identified. Patients’ settings were switched to 1–1.2 kHz and 60–210 µs, and variable amplitude adjusted to subthreshold. Pain scores and medication usage were collected. Complete data are presented on 95 patients.ResultsData were collected from 36 men and 59 women who were converted from above-threshold 40–90 Hz SCS to 1–1.2 kHz SCS, with a minimum follow-up of 12  months. Nearly a third (63/95 or 66.3%) of the subjects deemed 1–1.2 kHz SCS ineffective and returned to low-frequency SCS within 1 week after switch, and one-sixth (16/95 or 16.8%) of the subjects returned to low-frequency SCS within 1 month. Only 13 (13.7%) subjects continued using 1–1.2 kHz subthreshold SCS for 3 months or longer and 2.1% (2/95) of subjects continued using it at 12 months. A comparison of their pain scores and opioid use before and during the time we used 1–1.2 kHz SCS revealed no significant difference.ConclusionThe results from our single center failed to show additional long-term clinical benefit of 1–1.2 kHz subthreshold SCS in patients with chronic pain failing traditional low-frequency SCS.

scholarly journals A Comparative Analysis of Laparoscopic Appendectomy in Relation to the Open Appendectomy in Children / Uporedna Analiza Laparoskopske Apendektomije U Odnosu Na Otvorenu Apendektomiju Kod Dece

2016 ◽  
Vol 17 (1) ◽  
pp. 49-53
Author(s):  
Irena Nikolic Mickovic ◽  
Zoran Golubovic ◽  
Sasa Mickovic ◽  
Dejana Vukovic ◽  
Sanja Trajkovic ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Laparoscopic Appendectomy ◽  
Medical Records ◽  
Acute Inflammation ◽  
Open Appendectomy ◽  
Length Of Hospital Stay ◽  
Surgical Methods ◽  
Significant Difference ◽  
Surgery Duration

Abstract Acute inflammation of the appendix in childhood usually requires an appendectomy. Surgical methods are open appendectomy (OA) and laparoscopic appendectomy (LA). Both have the same goal of removing the appendix. Data collected from the medical records of children who underwent hospitalization and operation for acute appendicitis have been retrospectively analysed and statistically processed. The patients underwent surgery in 2010 at University Children’s Hospital in Belgrade, and the methods that were used were open appendectomy (OA) and laparoscopic appendectomy (LA). The analysed data refer to gender, age, length of hospital stay, surgery duration, use of pain management therapy, and antibiotic therapy, complications during surgery, complications after surgery, re-hospitalizations, and reoperations. A total of 218 children underwent an appendectomy operation, of which 158 (72.5%) underwent OA and 60 (27.5%) underwent LA. The average age of patients who had OA was 11.44 years, and 10.87 years for those who underwent LA. The surgery duration was significantly longer for LA (45.3 vs. 42.1 minutes, p = 0.003). The total number of postoperative complications was lower in LA (1 vs. 12), but there was no statistically significant difference. The number of hospital stay days was significantly lower in LA (3.48 vs. 5.45 days), with a high statistical difference, p = 0.00. The advantages of LA compared with OA are shorter hospital stay, lower total number of intraoperative and postoperative complications, and fewer reoperations. The advantage of OA compared with LA is shorter surgery duration.

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