scholarly journals Lidocaine Infusion as a Rescue Analgesic in the Perioperative Setting

2008 ◽  
Vol 13 (5) ◽  
pp. 421-423 ◽  
Author(s):  
C Clarke ◽  
I McConachie ◽  
R Banner
Keyword(s):  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Case Series ◽  
Economic Benefits ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Pharmacokinetic Studies ◽  
Optimum Technique ◽  
Analgesic Technique ◽  
Type Of Surgery

In the present case series, three patients for whom regional anesthesia may have been the optimum technique for controlling postoperative pain are discussed. However, due to prevailing circumstances, regional anesthesia could not be provided. An intravenous infusion of lidocaine at 4 mg/min was administered perioperatively as an alternative ‘rescue’ analgesic technique. This infusion rate, based on previous extensive pharmacokinetic studies, is widely considered to be safe. Postoperative pain was lower than expected for the type of surgery. Anecdotal experience suggests that hospital length of stay may also be reduced, with both patient and economic benefits.

Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain

2017 ◽  
Vol 51 (10) ◽  
pp. 834-839 ◽  
Author(s):  
Ryan N. Hansen ◽  
An T. Pham ◽  
Belinda Lovelace ◽  
Stela Balaban ◽  
George J. Wan
Keyword(s):  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Obstetrics And Gynecology ◽  
Opioid Use ◽  
Cesarean Section Delivery ◽  
Hospitalization Costs ◽  
The Difference ◽  
Multivariable Regression Models

Background: Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Objective: Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. Methods: We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. Results: We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = −$760.4 to −$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = −10.0 to −6.4), whereas the difference in LOS was not significant, at −0.09 days (95% CI = −0.19 to 0.01; P = 0.07). Conclusion: Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

scholarly journals Abordaje laparoscópico simultáneo del cáncer de colon con metástasis hepáticas

2019 ◽  
Vol 111 (4) ◽  
pp. 245-267
Author(s):  
Rafael J. Maurette ◽  
◽  
Marcos D. García Ejarque ◽  
Hernán Ruiz ◽  
Mariano L. Bregante ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Primary Tumor ◽  
Laparoscopic Resection ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Major Complication ◽  
Hospital Length ◽  
Colon Resection ◽  
Hospital Length Of Stay ◽  
Morbidity Rate

Background: In patients with colorectal cancer with synchronous liver metastases (CLM), complete resection of the primary tumor with the metastases is the only option for curative treatment. Several case series have been reported but no randomized controlled trials have been published. Objective: The aim was to evaluate if the simultaneous laparoscopic resection of the primary colon tumor and liver metastases is feasible and safe. Material and methods: A retrospective study was conducted with patients with suspected CLM sche- duled for simultaneous laparoscopic resection of the primary tumor of the colon and liver metastases. The preoperative and operative variables, short- and long-term outcomes and pathological variables were analyzed. Results: A total of 89 laparoscopic liver resections (LLR) were performed during the study period. In 28 patients, LLR was simultaneous with other procedures, 21 of which corresponded to laparoscopic colon resection. Mean surgical time for both procedures was 407 minutes. Mean hospital length of stay was 8 days. None of the patients died and overall morbidity rate was 71% with only one major complication. Overall survival and relapse-free survival at three years was 55.2% and 16.3%, respectively. Conclusion: This is the first publication analyzing this approach in our country. In well selected cases, the simultaneous laparoscopic approach is feasible, with low morbidity and mortality and acceptable oncological results.

scholarly journals LAPAROSCOPIC LIVER RESECTION (literature review)

2014 ◽  
Vol 5 (2) ◽  
pp. 54-60 ◽  
Author(s):  
G B Aleksanyan
Keyword(s):  
Liver Resection ◽  
Postoperative Pain ◽  
Open Surgery ◽  
Postoperative Morbidity ◽  
Vascular Reconstruction ◽  
Infectious Complications ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surgical Trauma ◽  
Recovery Times

Laparoscopic in comparison to open surgery reduces surgical trauma, the inflammatory response and infectious complications and minimizes immunosuppression. Large sizes of tumors, biliary or vascular reconstruction are the only obstacles to the widespread use of laparoscopic liver resections. Numerous clinical studies have demonstrated a significant reduction in postoperative pain, hospital length of stay, postoperative morbidity and recovery times.

scholarly journals Pull-through Procedure for Hirschsprung’s Disease with Simultaneous Stoma Closure: Insights for Limited-Resource Settings from Mbarara, Uganda

2021 ◽  
Author(s):  
Felix Oyania ◽  
Meera Kotagal ◽  
Anne Shikanda Wesonga ◽  
Stella Alice Nimanya ◽  
martin Samuel Situma
Keyword(s):  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Case Series ◽  
Limited Resource ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Stoma Closure ◽  
Resource Limited ◽  
Pull Through ◽  
Diverting Colostomy

Abstract Background: In many resource-limited settings, patients with Hirschsprung’s Disease (HD) undergo initial diverting colostomy, followed by pull-through, and lastly, colostomy closure. This approach allows for decompression of dilated and thickened bowel and improved patient nutritional status. However, this 3-stage approach prolongs treatment duration, with significant stoma morbidity, costs, and impact on quality of life (QOL).Aim: To determine whether pull-through for HD can safely be performed with simultaneous stoma closure, reducing treatment approach from three to two stages.Patients and Methods: Children with HD and diverting colostomy were prospectively followed as they underwent pull-through with simultaneous stoma closure. Their in-hospital course, and 3-month outpatient course, were assessed for postoperative complications. Patients with total colonic HD, redo pull-through, and residual dilated colon were excluded from the study. Results: Of the 20 children, seventeen were male (n = 17, 85%). All patients had rectosigmoid HD. The median weight, age at colostomy formation, and age at pull-through were 11.05 kg (interquartile range [IQR] 10-12.75), 0.9 years (IQR 0.25-2.8), and 2.08 years (IQR 1.28-2.75) respectively. Mean duration with colostomy before pull-through was 1.1 years (SD 1.51). Median hospital length of stay was 6 days (IQR 5-7). Early complications included anastomotic leak (n=1), perianal skin excoriation (n=2), surgical site skin infection (n=3_, and burst abdomen (n=1). Longer-term complications included stricture (n=1, 5%) and enterocolitis (n=2, 10%).Conclusion: In this small case series, we have demonstrated that pull-through with simultaneous stoma closure can be safely performed in resource-constrained settings. Further studies are needed to understand the QOL and economic impact of this change in management for HD patients.

scholarly journals MP033: The use of femoral nerve blocks in the emergency department for hip fracture patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S77-S77
Author(s):  
A. Sandre ◽  
C. Thompson ◽  
S.L. McLeod ◽  
B. Borgundvaag
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Regional Anesthesia ◽  
Management Strategy ◽  
Femoral Nerve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Physicians ◽  
Nerve Blocks ◽  
Pain Management Strategy

Introduction: Hip fractures affect over 30,000 Canadians each year. Delirium, or acute confusion, occurs in up to 62% of patients following a hip fracture. Delirium substantially increases hospital length of stay and doubles the risk of nursing home admissions and death. Previous studies have shown that regional anesthesia is the optimal pain management strategy for hip fracture patients and has been shown to independently reduce the rate, severity and duration of delirium. However, very few emergency physicians (EPs) have the necessary training and experience to use regional anesthesia for hip fracture in the emergency department (ED). The objective of this study was to determine the number of femoral nerve blocks performed within the ED for the management of hip fracture patients. Methods: This was a retrospective chart review of patients aged 65 years and older, presenting to an academic ED (annual census 60,000) with a discharge diagnosis of hip fracture from January 1st 2014 to July 31st 2015. Results: Of the 243 hip fractures included in this study, mean (SD) age was 82.9 (8.2) years and 187 (77.0%) were female. The majority (214, 88.1%) of patients arrived to the ED by ambulance and 182 (74.9%) were categorized as CTAS 3. The most common analgesics used in the ED were intravenous (IV) hydromorphone (51.4%), IV morphine (32.1%), or dual therapy with both IV hydromorphone and IV morphine (4.9%). Femoral nerve blocks were initiated for 13 (5.3%) patients and successfully completed in 12 (4.9%) patients in the ED. Median (IQR) ED and hospital length of stay was 5.0 (3.7, 6.6) hours and 6.0 (4.1, 10.2) days, respectively. Forty-three (17.7%) patients experienced in-hospital acute delirium. Conclusion: Despite evidence to suggest regional anesthesia may be the optimal pain management strategy for hip fracture patients, the use of femoral nerve blocks in the ED remains low. Future research should attempt to elucidate barriers to use of this procedure by emergency physicians.

Ketorolac for Patients Undergoing Implant-Based Breast Reconstruction: Impact on Hospital Length of Stay and Postoperative Narcotic Use

2019 ◽  
Author(s):  
Brittany N Nguyen ◽  
Ruth J Barta ◽  
Christine E Stewart ◽  
Matthew Wheelwright ◽  
Cherrie A Heinrich
Keyword(s):  
Postoperative Pain ◽  
Breast Reconstruction ◽  
Treatment Options ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Postoperative Pain Management ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Level Of Evidence ◽  
Control Regimen

Abstract Background Opioid drugs have been a mainstay medication for the management of postoperative pain for several decades; however, in recent years there has been a push towards investigating alternative treatment options. Although ketorolac has been widely used by other medical and surgical specialties for analgesia, its utilization in plastic surgery has been widely debated. Objectives The purpose of this study was to investigate the efficacy of ketorolac as an adjunct in postoperative pain management. Methods The authors performed a retrospective review of patients who underwent implant-based breast reconstruction after mastectomy between January 2012 and December 2016. Other risk factors, such as chronic anticoagulation, aspirin, or coagulopathies, were documented as well. Results There were 198 patients who met the inclusion criteria. The results demonstrated that patients who received ketorolac utilized significantly fewer narcotics than patients who did not: 80 mg vs 108.8 mg (P = 0.002), respectively. The results showed that patients who received ketorolac had a decreased length of hospitalization: 1.9 days vs 2.1 days (P = 0.04), respectively. Conclusions Generous narcotic prescribing has received greater scrutiny in recent years. Aside from the risk of increased narcotic availability in the community, the side effects of nausea, puritis, and constipation delay patient recovery. These data show that patients who received ketorolac have a decreased length of hospital stay and lower narcotic use, suggesting ketorolac may be a safe and cost-effective adjustment to a multi-modal pain control regimen postoperatively. Level of Evidence: 4

Fifty Percent Reduction in Narcotic Use After Minimally Invasive Cardiac Surgery Using Liposomal Bupivacaine

2019 ◽  
Vol 14 (6) ◽  
pp. 512-518
Author(s):  
Mario Castillo-Sang ◽  
Cheryl Bartone ◽  
Cassady Palmer ◽  
Vien T. Truong ◽  
Brian Kelly ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Mitral Valve ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Hospital Length ◽  
Minimally Invasive Cardiac Surgery ◽  
Hospital Length Of Stay ◽  
Liposomal Bupivacaine ◽  
Asd Closure

Objective Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations. Methods Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( n = 12). An early cohort was treated with standard postoperative analgesia while another underwent intraoperative field block with LB immediately after incision. We compared postoperative pain level, narcotic utilization (morphine milligram equivalent), and intensive care unit (ICU) and hospital length of stay. Results The procedures included 48 isolated mitral valve replacements (MVR); 2 MVR with other procedures; 93 mitral valve repairs (MVRr); 9 MVRr with other procedures; 4 isolated tricuspid valve repairs; 2 myxoma resections; 1 ASD closure. There were 13 patients in the non-LB group and 146 patients in the LB group. Use of LB decreased mean postoperative narcotic utilization by 50% ( P = 0.003). The LB group had lower pain levels on postoperative day 1 ( P = 0.039), which continued through postoperative day 5 ( P = 0.030). We found no difference in ICU or hospital length of stay between groups. There were no complications from LB field block. Conclusions LB field block decreases postoperative pain and narcotic utilization after cardiac surgery via a RMT, but it does not reduce length of stay. The technique is safe and should be considered in all patients undergoing RMT cardiac surgery.

Intraoperative Methadone Reduces Postoperative Opioid Requirements in Nuss Procedure for Pectus Excavatum

2021 ◽  
pp. 000313482110540
Author(s):  
Nadia M. Froehling ◽  
James A. Martin ◽  
M. Victoria P. Miles ◽  
Andrew W. Wilson ◽  
Brynn Byers ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Retrospective Cohort ◽  
Pectus Excavatum ◽  
Chart Review ◽  
Hospital Length ◽  
Solid Food ◽  
Hospital Length Of Stay ◽  
Nuss Procedure ◽  
Pain Scores ◽  
Significant Difference

Introduction Surgical correction of pectus excavatum by Nuss procedure, commonly referred to as minimally invasive repair of pectus excavatum (MIRPE), often results in significant postoperative pain. This study investigated whether adding intraoperative methadone would reduce the postoperative opioid requirement during admission for patients undergoing MIRPE. Methods A retrospective cohort chart review was conducted for 40 MIRPE patients between 2018 and 2020. Patients were stratified into 2 groups: those who received multimodal anesthesia (MM, n = 20) and those who received multimodal anesthesia with the addition of intraoperative methadone (MM + M, n = 20). Data collected included total opioid consumption during hospital stay (morphine milligram equivalents [MMEs]), hospital length of stay (LOS), pain scores, time to ambulation, and time to tolerating solid food. Results Addition of intraoperative methadone for patients undergoing MIRPE significantly reduced postoperative opioid requirements (MME/kg) during admission ( P = .007). On average, patients in the MM group received 1.61 ± .55 MME/kg while patients in the MM + M group received 1.16 ± .44 MME/kg. Hospital opioid (non-methadone) total was also significantly reduced between the MM (1.87 ± .54) and MM + M group (1.37 ± .46), P = .003. There was no significant difference in hospital opioid total MME/kg administered between the groups. There were no significant differences observed in hospital LOS, pain scores, time to ambulation, or time to toleration of solid food. Discussion Incorporating intraoperative methadone for patients undergoing MIRPE reduced postoperative opioid requirements and hospital opioid (non-methadone) totals without a significant change in pain scores. Patients undergoing the Nuss procedure may benefit from the administration of intraoperative methadone.

scholarly journals A self-extubation case series in an ICU after the introduction of an early mobilization project

2014 ◽  
Vol 2 (8) ◽  
pp. 17
Author(s):  
Jim Tseng ◽  
Mark Sigler ◽  
Hawa Edriss ◽  
Alisha Turner ◽  
Kristi Valdez ◽  
...  
Keyword(s):  
Peep Level ◽  
Night Shift ◽  
Case Series ◽  
Early Mobilization ◽  
Hospital Length ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Unplanned Extubation ◽  
Improvement Project ◽  
The Mean

Background: Recent studies demonstrate that early mobilization of patients with acute respiratory failure reduces ICU and hospital length of stay.  This patient care activity necessarily requires coordinated efforts by ICU personnel and alert patients and has the potential for adverse outcomes, including unplanned extubation. Methods: Our intensive care unit introduced an early mobilization quality improvement project in April 2014.  This project involved an eight step program which was started as soon as the patient was medically stable. The nurse managers kept a log of patients who participated in this project and a log of all patients who self-extubated during this period. Results: Twenty-five patients self-extubated during this time period; the event rate was 1.1 episodes per week in a 31 bed ICU.  The mean age was 46.8 ± 13.6 years; 64% were men. The initial indications for mechanical ventilation in these patients included respiratory disease (40%), sepsis (4%), encephalopathy (8%), and miscellaneous diagnoses (48%). Initial chest x-ray readings included clear lung fields, infiltrates, effusions, and other abnormalities. Twelve episodes occurred on the day shift, and 13 episodes occurred on the night shift.  The most recent Glasgow Coma Scale score in these patients was 11.8 (mean) with a range of 8-15. Eighty percent of the patients were restrained, 40% were on analgesics, and 56% were on sedatives.  The mean FiO2 at the time of self-extubation was 57.3 ± 29%, and the mean PEEP level was 5.4 ± 1.5 cm H2O.  Seven patients (28%) required reintubation. None of these patients in the early mobilization project had an episode of self-extubation. Conclusions: The patients who self-extubated in our ICU had no unique characteristics which might help us identify them before these events occurred. This did not occur in the patients in the early mobilization project. Self-extubation events provide a good monitor for ICU care.  In our ICU the frequency of reintubation was low, and this might suggest that we need to manage our weaning protocols better with earlier extubation in some patients.

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