A Practical Analgesia Approach to Fragility Hip Fracture: A Single-Center, Retrospective, Cohort Study on Femoral Nerve Block.

Objective: To determine whether an effective opioid-sparing pain control modality is desirable for an aging population.

Design: Retrospective observational study SETTING:: Academic medical center PATIENTS:: 192 patients with various types of fragility hip fractures INTERVENTION:: A single-injection femoral nerve block (FNB) MAIN OUTCOME MEASUREMENTS:: Pain score, opioid consumption RESULTS:: We observed statistically significant effects of FNB on visual analogue scale pain score and the rate of opioid consumption diminution in all commonly encountered types of fragility hip fractures. The pain score reduction by FNB in subcapital femoral neck fracture, transcervical femoral neck facture, and intertrochanteric fracture are all statistically significant (P < 0.

Donor Hepatectomy Surgery using Ketamine to Compliment Analgesia and Reduce Morbidity - a Retrospective Chart Review Investigation.

Objective: Inferior and limited analgesic options/techniques during living donor hepatectomy surgery can result in pain and risks of morbidity, opioid-related adverse events (AEs), predisposition to the development of chronic pain and concerns of potential narcotic abuse. Traditional analgesia uses unimodal intravenous opioids that can cause significant side effects. Ketamine provides analgesia and may be opioid sparing, but use in living-donor hepatectomy has not been studied.

Complexities of Perioperative Pain Management in Orthopedic Trauma.

Purpose Of Review: This review discusses both obvious and hidden barriers in trauma patient access to pain management specialists and provides some suggestions focusing on outcome optimization in the perioperative period.

Recent Findings: Orthopedic trauma surgeons strive to provide patients the best possible perioperative pain management, while balancing against potential risks of opioid abuse and addiction. Surgeons often find they are ill-prepared to effectively manage postoperative pain in patients returning several months following trauma surgery, many times still dependent on opioids for pain control.

Influence of Medical Insurance Under the Affordable Care Act on Access to Pain Management of the Trauma Patient.

Background And Objectives: The Affordable Care Act intended to "extend affordable coverage" and "ensure access" for vulnerable patient populations. This investigation examined whether the type of insurance (Medicaid, Medicare, Blue Cross, cash pay) carried by trauma patients influences access to pain management specialty care.

Methods: Investigators phoned 443 board-certified pain specialists, securing office visits with 235 pain physicians from 8 different states.

Administration of Coagulation-Altering Therapy in the Patient Presenting for Oral Health and Maxillofacial Surgery.

Oral health care providers are concerned with how to manage patients prescribed coagulation-altering therapy during the perioperative/periprocedural period for dental and oral surgery interventions. Management and recommendation can be based on medication pharmacology and the clinical relevance of coagulation factor levels/deficiencies. Caution should be used with concurrent use of medications that affect other components of the clotting mechanisms; prompt diagnosis and any necessary intervention to optimize outcome is warranted.

Risk stratification, perioperative and periprocedural management of the patient receiving anticoagulant therapy.

As a result of the aging US population and the subsequent increase in the prevalence of coronary disease and atrial fibrillation, therapeutic use of anticoagulants has increased. Perioperative and periprocedural management of anticoagulated patients has become routine for anesthesiologists, who frequently mediate communication between the prescribing physician and the surgeon and assess the risks of both thromboembolic complications and hemorrhage. Data from randomized clinical trials on perioperative management of antithrombotic therapy are lacking.

Intraoral Infection and Oral Health in the Surgical Patient: Need for Concern During the Perioperative Period?

A patient's intraoral health condition is not typically a chief perioperative concern of surgical health care providers and preoperative dental evaluation/therapy is often left unattended prior to elective surgery. Consequently, patients for surgery may possess untreated dental caries, intraoral infection(s), and/or periodontal disease. Individuals who have not had a dental evaluation or examination for the previous several years may be harboring a quiescent and potent oral infection.

Perioperative pain management in hip and knee replacement surgery.

Many patients who undergo hip or knee replacement surgery today experience high levels of postoperative pain. Data from clinical studies and analyses of hospital records have demonstrated that severe postoperative pain is associated with an increased risk for complications, slowing of the rehabilitation process, delayed return to normal functioning, progression to persistent pain states, prolonged length of hospital stay, elevated rates of readmission, and higher overall costs. Orthopedic surgeons may now play a more active role in reducing the severity of pain following surgery, decreasing both opioid use and the incidence of opioid-related adverse events, and eliminating breakthrough pain and analgesic gaps.

Defining new directions for more effective management of surgical pain in the United States: highlights of the inaugural Surgical Pain Congress™.

Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes.

Perioperative multimodal anesthesia using regional techniques in the aging surgical patient.

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers.

Ultrasound brachial plexus anesthesia and analgesia for upper extremity surgery: essentials of our current understanding, 2011.

Purpose Of Review: Ultrasound-guidance is gaining tremendous popularity. There is growing evidence of value with emphasis on clinical relevance, but can ultrasound-guidance scientifically warrant changing the practice of upper extremity regional? The literature is searched to describe findings where ultrasound may reduce complication rates, reduce block performance times, and improve block efficacy and quality.

Recent Findings: Ultrasound examination identified variations in anatomical positioning of C5-C7 roots in approximately half of all patients despite no deleterious effects on block efficacy.

Regional anesthesia and co-existing chronic pain.

Purpose Of Review: Investigate the rational for incorporation of regional anesthesia techniques into a multimodal approach toward patients with co-existing chronic pain as increasing numbers of chronic pain patients are presenting for surgery.

Recent Findings: There is a growing body of evidence suggesting that regional anesthesia may be superior to opioids for improved pain control along with increased patient satisfaction and decreased perioperative morbidity and mortality comparing to general anesthesia in patients with significant medical disease(s) and may also carry several economic benefits. Despite the prevalence of chronic pain and data suggesting that patients with chronic pain are prone to exacerbation of their condition(s) following surgery, regional anesthesia techniques for these patients is only beginning to be developed.

Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia.

Purpose Of Review: To review the rational for use of the many regional anesthetic/analgesic techniques and acute pain management modalities in the elderly and cognitively impaired high-risk patients, as increasing numbers of older adults are presenting for surgery.

Recent Findings: There are numerous studies examining short and long-term consequences of regional anesthesia/analgesia along with identification of the many potential advantages, but those studying the influence and potential benefits in elderly and cognitively impaired patients are only beginning to be developed as issues related to cognitive dysfunction associated with surgery/anesthesia are beginning to be observed.

Summary: Pain management therapy, including regional anesthesia, along with multimodal analgesia may help reduce the risk of negative influences in the elderly patient along with reducing postoperative delirium and cognitive dysfunction.

Optimizing postoperative outcomes with efficient preoperative assessment and management.

Objective: To review the essential features of preoperative assessment, management, and planning, with special emphasis on high-risk patients who are likely to have manifestations related to their co-existing disease and disease treatment(s) in the postoperative setting.

Data Source: Review of recent studies and reviews as reprinted in Index Medicus.

Conclusions: The major shift in preoperative assessment and management from within the hospital to outside the hospital has prompted new efforts to coordinate preoperative care.