Perioperative Analgesia in Spine Surgery: A Review of Current Data Supporting Future Direction.

This Clinical Research discusses the diverse nature of spine surgery procedures and the use of multimodal analgesia within enhanced recovery after surgery (ERAS) protocols to improve patient outcomes. Spine surgeries range from minor decompressions to extensive tumor resections, performed by neurosurgeons or orthopedic spine surgeons on adults and children. To manage perioperative pain effectively, various methods have been employed, including multimodal analgesia within ERAS protocols.

Lower Extremity Peripheral Nerve Blocks for Patients at Risk for Acute Compartment Syndrome.

A delayed acute compartment syndrome (ACS) diagnosis often results in devastating complications; however, the sensitivity of the classic signs and symptoms is very low. All analgesic modalities have been implicated in delaying the diagnosis, but there is very little evidence linking peripheral nerve blocks (PNBs) with delays in diagnosis. In fact, there is evidence that PNBs may facilitate an early diagnosis; this may be in part due to differences in how ischemic and inflammatory pain is transmitted through unique nociceptive pathways.

Efficacy of a Novel LAM Femoral Cutaneous Block Technique for Acute Donor Site Pain.

Patients with severe burn injuries often require split-thickness skin grafting to expedite wound healing with the thigh being a common donor site. Uncontrolled pain is associated with increased opioid consumption, longer lengths of stay, and delay in functional recovery. Peripheral nerve blocks are increasing in popularity although supportive literature is limited, and techniques vary.

Peripheral Nerve Block Complications in Children.

Regional anesthesia, and in particular peripheral nerve block (PNB) techniques, complement existing anesthetic and pain management strategies and facilitate a comprehensively safer experience for the pediatric patient. Ultimately, the use of regional anesthesia cultivates a more satisfactory experience for all involved. Complication rates are very low, making PNBs a very safe option as proliferative incorporation of ultrasound technology has led to further enhancement of regional anesthesia safety and efficacy in the pediatric population.

Approaching trauma analgesia using prolonged and novel continuous peripheral nerve blocks - A case report.

Background: A supraclavicular brachial plexus nerve block provides analgesia for the shoulder, arm, and hand; however, the maximum safe duration for a continuous infusion remains controversial. A novel continuous peripheral nerve block (CPNB) technique combining the Lateral, Intermediate, and Medial femoral cutaneous nerves (termed the 'LIM' block) to provide analgesia to the lateral, anterior, and medial cutaneous areas of the thigh while preserving quadriceps strength will also be described in detail here.

Case: We present a complex case in which simultaneous utilization of an unilateral supraclavicular CPNB (5 weeks) and bilateral LIM CPNB (5 days) are successfully performed to provide analgesia for a traumatic degloving injury resulting in multiple surgeries.

The Importance of Optimizing Acute Pain in the Orthopedic Trauma Patient.

Postoperative pain control is a highly studied topic because of its significant effect on costs, hospital course, and, most importantly, patient satisfaction. Opioid use has been the "status quo" of postoperative pain management but prolongs hospital stays and increases complications. Optimizing acute pain management in patients with orthopedic trauma is important and can translate into significant positive physiologic and financial outcomes.

[Axillary local anesthetic spread after the thoracic interfacial ultrasound block - a cadaveric and radiological evaluation].

Background: Oral opioid analgesics have been used for management of peri- and postoperative analgesia in patients undergoing axillary dissection. The axillary region is a difficult zone to block and does not have a specific regional anesthesia technique published that offers its adequate blockade.

Methods: After institutional review board approval, anatomic and radiological studies were conducted to determine the deposition and spread of methylene blue and local anesthetic injected respectively into the axilla via the thoracic inter-fascial plane.

Accidental scratch--or a sign of self-cutting?

Having a high index of suspicion is key to identifying adolescents who cut themselves. The approach described here can help you properly evaluate these patients and get them the help they need.

Participatory evaluation of a community mobilization effort to enroll Wyandotte County, Kansas, residents through the Affordable Care Act.

Successful implementation of the Affordable Care Act (ACA) depends on the capacity of local communities to mobilize for action. Yet the literature offers few systematic investigations of what communities are doing to ensure support for enrollment. In this empirical case study, we report implementation and outcomes of Enroll Wyandotte, a community mobilization effort to facilitate enrollment through the ACA in Wyandotte County, Kansas.

Are the benefits of a high-intensity progressive resistance training program sustained in rheumatoid arthritis patients? A 3-year followup study.

Objective: Rheumatoid arthritis (RA) patients were reassessed for body composition and physical function mean ± SD 39 ± 6 months after commencing a randomized controlled trial involving 24 weeks of either high-intensity progressive resistance training (PRT) or low-intensity range of movement exercise (control) to determine whether the benefits of PRT (i.e., reduced fat mass [FM], increased lean mass [LM], and improved function) were retained.

Genital and anal injuries requiring surgical repair in females less than 21 years of age.

Study Objective: The injuries of sexually abused and assaulted girls seldom require surgical repair, and genital and anal injuries due to other causes appear to require repair uncommonly. We sought to determine the causes of genital and anorectal injuries requiring surgical repair in relation to such variables as injury sites and severity.

Design: Retrospective study

Setting: A large tertiary care children's hospital

Participants: Forty-four girls less than 21 years of age who required surgical repair of genital injuries between June 1986 and April 2007 were identified.

Forensic laboratory evidence in sexually abused children and adolescents.

Objectives: To determine if forensic laboratory evidence could be recovered from alleged sexual abuse victims more than 24 hours after the event and to determine if age or historical factors could be used to determine the need for forensic evidence collections.

Design: Retrospective study of hospital records matched with forensic evidence reports from the Arkansas State Crime Laboratory, Little Rock.

Setting: The emergency department at Arkansas Children's Hospital, Little Rock.

Management of sexually abused children by non-forensic sexual abuse examiners.

Physicians who do not intend to examine children suspected of having been sexually abused still need information about the disorder and its management. A history from the caretaker and child is vital to determine the safety of the child from further abuse and the urgency of a physical evaluation for health and forensic purposes. The disclosure interview of a young child in Arkansas generally should be by an agency investigator to avoid multiple interviews, after a legally mandated report to the Child Abuse Hotline.

A videotape series for teaching physicians to evaluate sexually abused children.

A free videotape subscription series was utilized to increase the knowledge of general physicians in clinical practice about the medical evaluation of sexually abused children. Of the 65 physicians who requested the first tape, 39 (60%) completed it. Fourteen of the 39 physicians who completed the first tape (36%) completed the 5-tape series.

Evaluation and treatment of vertical microgenia.

Objective: To evaluate treatment of vertical microgenia in patients with chin deformities.

Methods: Twenty-one patients were included in this retrospective review. The 3 authors performed a lengthening genioplasty with or without interpositional grafting on each patient in either an academic or a private practice setting.