Predictive Factors of Postdischarge Narcotic Use After Female Pelvic Reconstructive Surgery

Objective The aim of the study was to evaluate the association of patient factors, amount of in-hospital postoperative narcotics, and pain scores on postdischarge narcotic use (PDNU). Methods This is a secondary analysis of a randomized controlled trial comparing a postoperative usual-care regimen with multimodal pain regimen after pelvic reconstructive surgery. This analysis evaluated patients in the multimodal arm. Postdischarge narcotic use (as mg oral morphine equivalents, MME, calculated from narcotic tablets remaining) was assessed postoperative days 7 to 10. Brief Pain Inventory (BPI) surveys were collected preoperatively and at postoperative day 1. Patient factors were evaluated using univariate and multivariate analysis. Correlations examined the relationships between PDNU and postoperative in-hospital narcotic use and BPI scores. Results Sixty-eight patients randomized to the multimodal pain regimen arm had median (interquartile range) PDNU of 22.5 (0–159.4) MME. After excluding postdischarge narcotic nonusers (34.8%), the median PDNU was 127.5 (22.5–180.0) MME. The median PDNU was 172.5 (150.0–180.0) MME after abdominal reconstructive surgery (n = 7), 82.5 (28.1–180.0) MME after laparoscopic reconstructive surgery (n = 22), and 37.5 (13.1–181.2) MME after vaginal reconstructive surgery (n = 14). A linear correlation was noted between the amount of postoperative narcotics used in-hospital and the amount needed postdischarge afte...
Source: Female Pelvic Medicine and Reconstructive Surgery - Category: OBGYN Tags: AUGS Special Issue Submissions Source Type: research

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Publication date: Available online 21 August 2019Source: Surgery (Oxford)Author(s): Gideon Blecher, Kara McDermott, Benjamin ChallacombeAbstractRenal carcinoma is a reasonably common cancer in the UK. Fortunately, its diagnosis is nowadays much earlier due to the increased utilization of radiological imaging. While surveillance is an option, particularly in older/comorbid patients, nephron-sparing surgery remains the gold standard treatment for small renal masses. Laparoscopic, robotic or open partial nephrectomy have excellent cure rates. For larger tumours, radical nephrectomy may be required. This again can be performed...
Source: Surgery (Oxford) - Category: Surgery Source Type: research
CONCLUSIONS: We were able to define predictors of admission for patients having LH/RAH managed with an ERAS pathway. Increased ASA physical status, being African American, and increased length of procedure were significantly associated with admission after LH/RAH performed under an ERAS pathway. In addition, the incidences of urgent clinic and ER visits, readmissions, and reoperations within 90 days of surgery were similar for patients who were discharged on the day of surgery compared to those admitted. PMID: 31425219 [PubMed - in process]
Source: Anesthesia and Analgesia - Category: Anesthesiology Authors: Tags: Anesth Analg Source Type: research
Condition:   Endometriosis Intervention:   Other: BSGE pelvic pain questionnaire and VAS scores Sponsor:   Acibadem Fulya Hastanesi Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
WORCESTER (CBS) – It’s the latest generation of robotic surgery, but don’t worry there’s a doctor controlling its every move. And that means increased precision and shorter recovery times. WBZ got a surgeon’s eye view of how it works. “What’s important about the robot for me is that this is the way technology is going to go for the next generation,” said Dr. John Kelly, the chief of general surgery at UMass Memorial Medical Center in Worcester. We were able to observe him performing gastric sleeve surgery for weight loss and he used four robotic arms to do it. “I can ...
Source: WBZ-TV - Breaking News, Weather and Sports for Boston, Worcester and New Hampshire - Category: Consumer Health News Authors: Tags: Boston News Health Syndicated CBSN Boston Syndicated Local Watch Listen Dr. Mallika Marshall Robotic Surgery UMass Memorial Medical Center Source Type: news
AbstractObjectiveIn this systematic review, we evaluated all literature reporting on the surgical treatment of primary epigastric hernias, primarily focusing on studies comparing laparoscopic and open repair, and mesh reinforcement and suture repair.MethodsA literature search was conducted in Embase.com, PubMed and the Cochrane Library up to 24 April 2019. This review explicitly excluded literature on incisional hernias, ventral hernias not otherwise specified, and isolated (para)umbilical hernias. Primary outcome measures of interest were early and late postoperative complications.ResultsWe  obtained a total of ...
Source: Hernia - Category: Sports Medicine Source Type: research
ConclusionLESS hysterectomy is a reliable and safe option in gynecologic surgery. Compared to conventional laparoscopic hysterectomy, LESS surgery demonstrated comparable surgical properties in regard to blood loss, duration of surgery, and intra-/postoperative complications. Notably, patients undergoing LESS hysterectomy experienced some less pain postoperatively.
Source: Gynecological Surgery - Category: OBGYN Source Type: research
ConclusionCEP is a variant of EP with low or absent trophoblast activity. A prolonged clinical course is typical and surgery is the mainstay of treatment.
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
ConclusionsContinuous rocuronium infusion did not improve surgical conditions when boluses of rocuronium were available on-demand. No major benefits in other outcomes were seen.Trial registrationEUDRACT (2014-002147-18); registered 19 May, 2014 and clinicaltrials.gov (NCT02320734); registered 18 December, 2014.
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
Just recently started doing these blocks and I am getting convinced that they are not worth it. It was a learning curve for me but I think I am getting good and the last few I have done looked good. However the patients are still in PACU complaining of pain. I ask the nurses and they say that yeah, the patients sometimes still complain of pain from the gas from laparoscopy but I am getting disappointed each and every time. I know they only help with somatic and not visceral pain, but... TAP blocks inferior blocks?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Anesthesiology Source Type: forums
The patient is a 46-year-old female with a history of morbid obesity, status post laparoscopic sleeve gastrectomy at an outside institution, complicated by a left diaphragmatic thermal injury. On review of the sleeve gastrectomy operative dictation, an approximately 3 cm defect was incidentally made in the left diaphragm by a harmonic scalpel, which was repaired primarily with interrupted permanent suture at that time. She presented three years later with emesis, obstipation, and left upper quadrant abdominal pain for several days.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
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