Local infusion of ropivacaine for pain control after osseous free flaps: Randomized controlled trial.

Background: Donor site pain after osteocutaneous free flap surgery contributes to postoperative morbidity and impairs recovery. We evaluated the efficacy of local infusion of ropivacaine for treating donor-site pain after surgery.

Methods: We conducted a randomized, double-blind, placebo-controlled trial of patients undergoing osteocutaneous fibula or scapular tip free flaps for head and neck reconstruction at Mount Sinai Hospital.

Chronic Post-Surgical Pain in the Frail Older Adult.

Older adults are the fastest growing segment of the population and surgical procedures in this group increase each year. Chronic post-surgical pain is an important consideration in the older adult as it affects recovery, physical functioning, and overall quality of life. It is increasingly recognized as a public health issue but there is a need to improve our understanding of the disease process as well as the appropriate treatment and prevention.

Anesthesia and Chronic Pain Management.

The reasons for development of chronic pain are poorly understood. Chronic postoperative pain is linked to severe acute postoperative pain. Head and neck pain is often a complex phenomenon that requires meticulous diagnosis and treatment.

Preoperative frailty and its association with postsurgical pain in an older patient cohort.

Background And Objectives: Chronic postsurgical pain in patients over 65 negatively impacts recovery, quality of life and physical functioning. In the community setting, chronic pain has been shown to be related to frailty, a syndrome more commonly seen in older adults and characterized by limited physiologic reserve and ability to withstand stressors. While frailty is an important preoperative risk factor for poor surgical outcomes in older adults, the relationship between frailty and postsurgical pain in this population has not been investigated.

Exposure to Simulated Mortality Affects Resident Performance During Assessment Scenarios.

Background: The utility of simulated mortality remains controversial in the literature. We therefore sought primarily to determine whether there was a difference in performance for residents exposed to varying levels of simulated mortality during training scenarios. As a secondary objective, we also sought to determine whether their self-reported anxiety levels, attitudes toward, and engagement in the simulated encounters differed based on group assignment.

Perioperative Patient Beliefs Regarding Potential Effectiveness of Marijuana (Cannabinoids) for Treatment of Pain: A Prospective Population Survey.

Background And Objectives: Cannabinoids have an expanding presence in medicine. Perioperative patients' perceptions of the effectiveness of these compounds, and acceptance if prescribed for pain, have not been previously described. Our primary objective was to describe patients' beliefs regarding the potential effectiveness of cannabinoids for the treatment of acute and chronic pain, as well as gauge patient acceptance of these compounds if prescribed by a physician.

Presence of an arterial line improves response to simulated hypotension and pulseless electrical activity.

With pulseless electrical activity (PEA) emerging as one of the leading cardiac arrest arrhythmias, the rapid response and accurate diagnosis of PEA is essential to improve survival rates. Although the use of invasive blood pressure monitoring to more quickly detect changes in blood pressure is widespread, evidence for its use is largely anecdotal and placement is not without risk. This is a prospective, multi-center, randomized controlled trial involving 58 senior anesthesiology residents undergoing a simulation of intraoperative PEA using high-fidelity simulation.

A Multicenter Evaluation of Emergency Department Pain Care Across Different Types of Fractures.

Objectives: To identify differences in emergency department (ED) pain-care based on the type of fracture sustained and to examine whether fracture type may influence the more aggressive analgesic use previously demonstrated in older patients.

Design: Secondary analysis of retrospective cohort study.

Setting: Five EDs (four academic, one community) in the United States.

Incidence and Demographics of Post-Operative Naloxone Administration: A 13-Year Experience at a Major Tertiary Teaching Institution.

Background: Perioperative use of opioids is associated with the risk of opioid-induced respiratory depression. Naloxone is a competitive opioid antagonist typically administered to reverse opioid-induced respiratory depression. Postoperative administration of naloxone may be considered a proxy for significant postoperative opioid-induced respiratory depression and data regarding its use may be utilized as a quality measure.

Effect of buprenorphine on total intravenous anesthetic requirements during spine surgery.

Buprenorphine is a partial mu receptor agonist and kappa/delta antagonist commonly used for the treatment of opioid dependence or as an analgesic. It has a long plasma half-life and a high binding affinity for opioid receptors. This affinity is so high, that the effects are not easily antagonized by competitive antagonists, such as naloxone.

Occipital neuralgia after hair transplantation and its treatment.

While undergoing full thickness tissue harvest from the posterior scalp, a 72-year-old man experienced immediate severe pain in the right occiput and was unable to complete the procedure. The pain was constant "sharp" and "shocking" with numbness in the distribution of the lesser occipital nerve, exacerbated by physical activity, and local anesthetic blocks provided temporary complete relief. After numerous treatments over several years, including oral analgesics, botulinum toxin injections, and acupuncture, proved ineffective, pulsed radiofrequency neuromodulation provided greater than 80% relief for 5 months.

A patient who received clopidogrel with an indwelling epidural catheter.

A patient with a drug-eluting stent placed 18 months earlier received a thoracic epidural for perioperative analgesic control as part of her thoracotomy. Postoperatively, the patient was started on clopidogrel for secondary prevention. After consultation with the Hematology service and a platelet function assay, the patient was transfused two pools of platelets and the epidural catheter was removed on postoperative day 4.

Multimodal therapy in perioperative analgesia.

This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.

The influence of simulation-based physiology labs taught by anesthesiologists on the attitudes of first-year medical students towards anesthesiology.

Background: The development of medical students' perceptions of different medical specialties is based on many factors and influences their career choices and appreciation of other practitioners' knowledge and skills. The goal of this study was to determine if participation in a series of anesthesiologist-run, simulation-based physiology labs changed first year medical students' perceptions of anesthesiologists.

Methods: One hundred first-year medical students were surveyed at random three months before completion of a simulation-based physiology lab run by anesthesiologists.

Preventing post-thoracotomy pain syndrome.

This article provides a concise overview of post-thoracotomy pain syndrome, describes anesthetic and surgical factors that have been investigated to reduce the incidence of the syndrome, and explores the effectiveness of various treatments for this condition. Although some interventions (both procedural and pharmacologic) have been investigated in both preventing and treating post-thoracotomy pain syndrome, definitive studies are lacking and firm conclusions regarding the benefit of any intervention cannot be drawn. The problem is compounded further by our lack of understanding of the pathophysiologic mechanisms underlying the development of chronic pain after surgery.

The use of lumbar sympathetic blockade at L4 for management of malignancy-related bladder spasms.

Background: Cancer-related bladder spasms may be a rare but severe symptom of bladder or metastatic cancer or its related treatments. Various treatments described in the literature include systemic medications, intravesical or epidural medications, or even sacral neurolectomies.

Objective: We present 3 patients who have suffered from bladder spasm either from invasion of the bladder wall by tumor (2 patients) or from intravesical chemotherapeutic treatment.