Implementation of a patient-specific tapering protocol at discharge decreases total opioid dose prescribed for 6 weeks after elective primary spine surgery.

Background And Objectives: At our institution, we developed an individualized discharge opioid prescribing and tapering protocol for joint replacement patients and implemented the same protocol for neurosurgical spine patients. We then tested the hypothesis that this protocol will decrease the oral morphine milligram equivalent (MME) dose of opioid prescribed postdischarge after elective primary spine surgery.

Methods: In this retrospective cohort study, we identified all consecutive elective primary spine surgery cases 1 year before and after introduction of the protocol.

A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total Opioid Dose Prescribed for Six Weeks After Total Hip Arthroplasty.

Objective: This retrospective cohort study tested the hypothesis that implementing a multidisciplinary patient-specific discharge protocol for prescribing and tapering opioids after total hip arthroplasty (THA) will decrease the morphine milligram equivalent (MME) dose of opioids prescribed.

Methods: With institutional review board approval, we analyzed a Perioperative Surgical Home database and prescription data for all primary THA patients three months before (PRE) and three months after (POST) implementation of this new discharge opioid protocol based on patients' prior 24-hour inpatient opioid consumption. The primary outcome was total opioid dosage in MME prescribed and opioid refills for six weeks after surgery.

Preoperative Ultrasound-Guided Botulinum Toxin A Injection Facilitates Closure of a Complex Abdominal Wall Hernia: A Case Report.

Complex abdominal wall hernia repairs can have high failure rates. Many surgical techniques have been proposed with variable success. We report our experience with a new collaborative protocol between general surgery and regional anesthesiology and acute pain medicine services to provide preoperative botulinum toxin A injections to a patient with a large complex ventral hernia to facilitate primary closure.

Implementation of the IPACK (Infiltration between the Popliteal Artery and Capsule of the Knee) block into a multimodal analgesic pathway for total knee replacement.

Background: The Infiltration between the Popliteal Artery and Capsule of the Knee (IPACK) block is a new anesthesiologist- administered analgesic technique for controlling posterior knee pain that has not yet been well studied in total knee arthroplasty (TKA) patients. We compared pain outcomes in TKA patients before and after implementation of the IPACK with the hypothesis that patients receiving IPACK blocks will report lower pain scores on postoperative day (POD) 0 than non-IPACK patients.

Methods: With Institutional Review Board approval, we retrospectively reviewed data for consecutive TKA patients by a single surgeon 4 months before (PRE) and after (POST) IPACK implementation.

The effects of mitochondria-associated long noncoding RNAs in cancer mitochondria: New players in an old arena.

LncRNAs, as new players in the old battle against cancer, are significant components of gene regulatory networks. Mitochondria-associated lncRNAs have newly been discovered to work in concert with transcription factors and epigenetic regulators to modulate mitochondrial gene expression and mitochondrial function. Many mitochondria-associated lncRNAs regulate mitochondrial biosynthesis, bioenergetics, apoptosis and possibly govern the cross-talk of mitochondria with nuclei.

Observational Study Using Ultrasound to Assess Midline Labor Epidural Analgesia Placement and Analgesic Efficacy.

Objectives: Labor epidural analgesia failure may relate to nonmidline placement of epidural catheters. We hypothesized that greater deviations of the epidural catheter insertion point from the ultrasound (US)-determined midline would be associated with less effective labor analgesia.

Methods: A prospective ethically approved cohort study was conducted.

Occupational Radiation Exposure of Anesthesia Providers: A Summary of Key Learning Points and Resident-Led Radiation Safety Projects.

Anesthesia providers are frequently exposed to radiation during routine patient care in the operating room and remote anesthetizing locations. Eighty-two percent of anesthesiology residents (n = 57 responders) at our institution had a "high" or "very high" concern about the level of ionizing radiation exposure, and 94% indicated interest in educational materials about radiation safety. This article highlights key learning points related to basic physical principles, effects of ionizing radiation, radiation exposure measurement, occupational dose limits, considerations during pregnancy, sources of exposure, factors affecting occupational exposure such as positioning and shielding, and monitoring.

Effects of prestorage vs poststorage leukoreduction on the rate of febrile nonhemolytic transfusion reactions to platelets.

The purpose of this study was to assess the incidence of febrile nonhemolytic transfusion reactions (FNHTRs) to concurrent transfusions of prestorage-leukoreduced (PreSLR) pooled platelets, poststorage-leukoreduced (PostSLR) pooled platelets, nonleukoreduced (NonLR) pooled platelets, and apheresis single-donor platelets (SDPs) to compare the rates of FNHTRs to PreSLR vs PostSLR pooled platelets. Reported transfusion reactions to platelets at 15 hospitals for a period of 45 months were retrospectively reviewed. Reaction rates to different types of platelet products were calculated and compared.