Cost of sterility: probe covers should not be mandated for single-shot peripheral nerve blocks.

Ultrasound guidance has become ubiquitous with regional anesthesia, but little consistency exists on necessary ultrasound probe hygiene and sterility barriers. Fear of possible infection has led to calls for universal use of sterile ultrasound probe covers. Available data seems to suggest that single-shot peripheral nerve blocks have a low infectious risk.

Anesthesia start time documentation accuracy where peripheral nerve block is the primary anesthetic.

Introduction: When used as the primary anesthetic, nerve blocks are not billed as separate procedures. In this scenario, the anesthesia start (A) time should include the block procedural time. We measured how often A time was documented before the nerve block was placed in the preoperative area, and compared cases where a block team performed the nerve block and cases where the intraoperative anesthesia attending supervised the nerve block.

Chronic post amputation pain: pathophysiology and prevention options for a heterogenous phenomenon.

Purpose Of Review: Chronic postamputation pain (cPAP) remains a clinical challenge, and current understanding places a high emphasis on prevention strategies. Unfortunately, there is still no evidence-based regimen to reliably prevent chronic pain after amputation.

Recent Findings: Risk factors for the development of phantom limb pain have been proposed.

There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era.

Two recent, large-scale, randomized controlled trials comparing neuraxial anesthesia with general anesthesia for patients undergoing surgical fixation of a hip fracture have sparked interest in the comparison of general and neuraxial anesthesia. These studies both reported non-superiority between general and neuraxial anesthesia in this patient cohort, yet they have limitations, like their sample size and use of composite outcomes. We worry that that if there is a perception among surgeons, nurses, patients and anesthesiologists that general and spinal anesthesia are equivalent (which is not what the authors of the studies conclude), it may become difficult to argue for the resources and training to provide neuraxial anesthesia to this patient population.

Ultrasound-Guided Nerve Blocks: Suggested Procedural Guidelines for Emergency Physicians.

Acute pain is one of the most frequent, and yet one of the most challenging, complaints physicians encounter in the emergency department (ED). Currently, opioids are one of several pain medications given for acute pain, but given the long-term side effects and potential for abuse, alternative pain regimens are sought. Ultrasound-guided nerve blocks (UGNB) can provide quick and sufficient pain control and therefore can be considered a component of a physician's multimodal pain plan in the ED.

Opioid sparing effects of intravenous and oral acetaminophen in hip fracture patients: A population-based study.

Study Objective: Acetaminophen (APAP) and intravenous acetaminophen (IVAPAP) has been proposed as a part of many opioid-sparing multimodal analgesic pathways. The aim of this analysis was to compare the effectiveness of IVAPAP with oral APAP on opioid utilization and opioid-related adverse effects.

Design: Retrospective study of population-based database.

Intraoperative Methadone and Short Stay Spine Surgery: Possible Barriers to Implementation and Future Opportunities.

The frequency of shorter stay spine surgery is increasing. Acute pain is a common barrier to discharge following spine surgery. Long-acting opioid medications like methadone have the potential to provide sustained analgesia when given intraoperatively.

Understanding the Economic Impact of an Essential Service: Applying Time-Driven Activity-Based Costing to the Hospital Airway Response Team.

Background: As the United States moves toward value-based care metrics, it will become essential for anesthesia groups nationwide to understand the costs of their services. Time-driven activity-based costing (TDABC) estimates the amount of time it takes to perform a clinical activity by dividing complex tasks into process steps and mapping each step and has historically been used to estimate the costs of various health care services. TDABC is a tool that can be adapted for variable staffing models and the volume of service provided.

Institutional factors associated with adherence to enhanced recovery protocols for colorectal surgery: Secondary analysis of a multicenter study.

Introduction: Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.

The monthly operating cost of an institutional COVID-19 airway response team: A financial model and sensitivity analysis based on experience at an academic medical center.

Background: Coronavirus disease 2019 (COVID-19) airway response teams concentrate equipment and expertise while minimizing the number of providers exposed to aerosol generating procedures. These airway teams were implemented in various hospitals around the world to respond to the acute increase of critical ill patients requiring ventilatory support. We created a financial model to estimate the costs for staffing and maintaining a dedicated COVID-19 airway response team based on the experience at an urban academic hospital in the Northeastern United States between March and June of 2020.

Costs of Inaccurate Anesthesia Start Time Documentation Within a Health System.

Inaccurate anesthesia start time (AST) documentation can result in lost revenue. Using a retrospective analysis, we estimated lost revenue from inaccurate documentation of the AST within a single health care system, including academic and community-based facilities. We used differences in nursing documentation of "in-room" time and AST to calculate lost billable revenue.

Smartphone Photographs to Document Preoperative Dental Examination.

Dental injury is a common cause of malpractice claims involving anesthesiologists. Inadequate preoperative dental evaluations and incomplete documentation are often cited as contributing factors during reviews of closed claims. Point-of-care smartphone photographs are widely used in other medical fields such as dermatology and plastic surgery.