A Review of the Analgesic Benefi ts and Potential Complications Related to Epidural Corticosteroid Injections.

The Institute of Medicine has reported that greater than 115 million adults in the United States are living with some form of chronic pain. Back pain is the most prevalent and is associated with high individual morbidity and increased healthcare costs. One approach for the management of chronic back pain involves the injection of corticosteroids in the epidural space.

Opioid Overdose and Naloxone Kit Distribution: A Quality Assurance Educational Program in the Primary Care Setting.

Problem: In 2014, there were approximately 200,000 incidents of an unintentional opioid overdose nationwide. The 2016 Centers for Disease Control and Prevention opioid prescription guidelines identified a knowledge deficit regarding opioid prescribing among primary care providers as a contributing factor to this epidemic.

Purpose: The purpose of this quality assurance project was to provide education on opioid overdose and distribution of naloxone kits through a presentation to primary care providers at Veterans Administration facilities in the southeast region of the United States.

The Last State to Grant Nurse Practitioners DEA Licensure: An Education Improvement Initiative on the Florida Prescription Drug Monitoring Program.

Nurse practitioners (NPs) now have prescriptive authority for controlled substances in all 50 states in the United States. Florida, the last state to grant NPs DEA licensure, has been wrought with prescription diversion practices for a number of years as pill mills, doctor shopping, and overprescribing proliferated. Prescription Drug Monitoring Programs (PDMPs) help curb drug diversion activity and play a key role in reducing the abuse of controlled substances.

Evaluation of postprocedure cognitive function using 3 distinct standard sedation regimens for endoscopic procedures.

The primary purpose of this investigation was to evaluate postprocedure cognitive function associated with 3 distinct standard sedation regimens used for endoscopic procedures. A secondary aim was to identify complications requiring provider interventions. Subjects scheduled for colonoscopies were approached for enrollment the day of their procedure.

Determining the relationship of acute stress, anxiety, and salivary alpha-amylase level with performance of student nurse anesthetists during human-based anesthesia simulator training.

Managing stress for student nurse anesthetists represents a multifaceted educational concern for anesthesia educators. Our purpose was to determine the relationship between physiologic measures of stress and performance of student nurse anesthetists during anesthesia simulator training. Following institutional review board approval, 78 students were enrolled from a nurse anesthesia program.

Effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures: a randomized, single-blind study.

The purpose of this investigation was to evaluate the effects of guided imagery on postoperative outcomes in patients undergoing same-day surgical procedures. Forty-four adults scheduled for head and neck procedures were randomly assigned into 2 groups for this single-blind investigation. Anxiety and baseline pain levels were documented preoperatively.

Therapeutic modalities for the prophylactic management of postoperative nausea and vomiting.

The occurrence of postoperative nausea and vomiting (PONV) remains one of the most common complications after general anesthesia. The causes of PONV are multimodal, involving several physiologic pathways that stimulate the vomiting center, including the chemoreceptor trigger zone, the gastrointestinal tract, the vestibular system, the cerebral cortex, and the midbrain. Significant research has been published focusing on the use of different pharmacologic agents and varying anesthetic techniques to prevent and manage PONV.

Headache disability in orofacial pain patients.

Objective: To retrospectively examine the reported history of and the disability caused by headaches in patients presenting for evaluation and treatment of orofacial pain.

Background: More than 81% of patients with the chief complaint of pain in the orofacial region concomitantly report pain in other body locations. Among the comorbidities frequently reported with orofacial pain are a variety of different headaches types, including migraines, tension type headaches, and chronic daily headaches.

The addition of clonidine to bupivacaine in combined femoral-sciatic nerve block for anterior cruciate ligament reconstruction.

Clonidine has been shown to prolong sensory analgesia when given as an adjunct to peripheral nerve blocks but has not been evaluated when given in conjunction with a femoral-sciatic nerve block. The purpose of this investigation was to determine whether the addition of clonidine to a femoral-sciatic nerve block would prolong the duration of sensory analgesia in groups of patients undergoing anterior cruciate ligament (ACL) reconstruction. This prospective, randomized, double-blind investigation was performed on 64 subjects undergoing ACL reconstruction.

Postoperative respiratory depression and unresponsiveness following epidural opiate administration: a case report.

The profound segmental antinociception that epidural opioids offer has increased their use over the last 2 decades. Though side effects may accompany the use of epidural opioids, clinicians have found that the advantages far outweigh the disadvantages. The following case report outlines a patient's postoperative course in which she experienced respiratory depression while receiving epidural opioids.

Effect of needle size on success of transarterial axillary block.

The transarterial approach to brachial plexus block is a well-established method of producing anesthesia of the upper extremity. However, it is associated with a failure rate of 20% to 30%. Failure may be secondary to the common use of a relatively long needle, which can penetrate the posterior wall of the sheath and result in inadvertent injection of the local anesthetic into the surrounding tissue.

Severe intraoperative hyponatremia in a patient scheduled for elective hysteroscopy: a case report.

Hysteroscopy is a minimally invasive procedure that may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for visualization of the endometrium. Potential risks include fluid volume overload, uterine perforation, hemorrhage, infection, and the need for immediate hysterectomy.

Hand ischemia associated with profound hypotension and radial artery catheterization in a pediatric patient: a case report.

Direct arterial blood pressure monitoring via the radial artery is a relatively common method employed during the perioperative period. Complications attributed to radial artery catheterization are extremely rare but can include thrombosis, ischemia, infection, and aneurysm formation at the site of catheter insertion. This report describes an episode of hand ischemia in a pediatric patient.

Acute fatty liver of pregnancy: a case report.

The third trimester of pregnancy has several unique disease entities that challenge the anesthetist. Acute fatty liver of pregnancy (AFLP) is an increasingly recognized metabolic disorder found late in pregnancy. Current research estimates the incidence of AFLP at 1 per 6,659 births.