Safe transition to opioid-free pathway after robotic-assisted laparoscopic prostatectomy

AbstractTo determine whether local anesthetic infiltration and non-narcotic pain medications can safely reduce or eliminate opioid use following robotic-assisted laparoscopic prostatectomy while maintaining adequate pain control. After initiation of this quality-improvement project, patients undergoing robotic-assisted laparoscopic prostatectomy had surgeon-administered local anesthesia around all incisions into each successive layer from peritoneum to skin, with the majority infiltrated into the transversus abdominis muscle plane and posterior rectus sheath of the midline extraction incision. Post-operatively patients received scheduled acetaminophen plus ketorolac, renal function permitting. A retrospective review was performed for all cases over 19  months, spanning project implementation. 157 cases (76 in opioid-free pathway, 81 in standard pathway) were included. Five patients (6.6%) in the opioid-free pathway required post-operative opioids while inpatient, versus 61 (75.3%) in the standard pathway,p 
Source: Journal of Robotic Surgery - Category: Surgery Source Type: research

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CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients’ fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.
Source: Journal of Neuroscience Nursing - Category: Neuroscience Tags: Articles Source Type: research
People who experience debilitating back pain come to their doctors with one pressing question: Do I need back surgery? Often, they are surprised to hear me, a neurosurgeon, answer, “No.” In many cases, physical therapy, pain management, weight loss management, and physiatry can help people to delay – and in some cases avoid – backRead more …Expertise is the backbone of successful spine treatment originally appeared
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Neurosurgery Orthopedics Source Type: blogs
CONCLUSIONS: The free antegrade palmaris longus tendocutaneous venous flap enabled the repair of compound tissue defects of the dorsal digit, resulting in acceptable aesthetics, repaired tendon defects, and wound coverage. This surgical method is an option for the reconstruction of small compound defects of digits with extensor defects.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.PMID:35031123 | DOI:10.1016/j.jhsa.2021.11.023
Source: Hand Surgery - Category: Surgery Authors: Source Type: research
Pflugers Arch. 2022 Jan 15. doi: 10.1007/s00424-021-02656-6. Online ahead of print.ABSTRACTSensory neurons are responsible for the generation and transmission of nociceptive signals from the periphery to the central nervous system. They encompass a broadly heterogeneous population of highly specialized neurons. The understanding of the molecular choreography of individual subpopulations is essential to understand physiological and pathological pain states. Recently, it became evident that species differences limit transferability of research findings between human and rodents in pain research. Thus, it is necessary to syst...
Source: Pflugers Archiv : European Journal of Physiology - Category: Physiology Authors: Source Type: research
Queen Elizabeth II’s decision to strip Prince Andrew of his military titles and patronages was a brutal and humiliating exercise in damage-limitation, royal experts said. #elizabethii
Source: Reuters: Health - Category: Consumer Health News Source Type: news
Chronic musculoskeletal pain (CMP) – daily pain in the muscles, bones, ligaments, tendons and nerves that lasts for six months or longer – contributes to approximately 21% of worker disability issues in this country and costs $500 billion annually from lost wages, treatment and medications, according to a study published by Johns Hopkins University. In an effort to develop a more effective strategy against this debilitating condition, a team of doctors and researchers at Wake Forest School…
Source: Health Care:Physician Practices headlines - Category: American Health Authors: Source Type: news
However, most costs are paid out of pocket
Source: The Doctors Lounge - Psychiatry - Category: Psychiatry Tags: Family Medicine, Internal Medicine, Psychiatry, Anesthesiology & amp; Pain, Journal, Source Type: news
... persistent on multiple attempts Thanks!
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Pain Medicine Source Type: forums
AbstractA recent article entitled “Full‑endoscopic (bi‑portal or uni‑portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta‑analysis” written by Pairuchvej et al. (Eur J Orthop Surg Traumatol 30(4):595–611, 2019) published in “European Journal of Ortho paedic Surgery&Traumatology ” has aroused our great interest. The authors concluded that compared with minimally invasive decompression surgery, full endoscopic spinal surgery had better pain relief (back pain and leg pain) in the treatment of lumbar spinal stenosis an...
Source: European Journal of Orthopaedic Surgery and Traumatology - Category: Orthopaedics Source Type: research
We present a 43  year old female with a nuanced constellation of comorbidities and confirmed MCTLMP following a workup for abdominal pain and irritative lower urinary tract symptoms. Notably, this tumor did not change in size over a 3-year course of serial imaging prior to surgical excision. This urachal MCTLMP re presents roughly the 26th and one of the smallest of its subtype reported in the literature. This case illustrates the diagnosis and management of this rare urachal MCTLMP. Individual patient medical history, clinical considerations, and neoplasm characteristics are examined. Although rare, the pot enti...
Source: International Cancer Conference Journal - Category: Cancer & Oncology Source Type: research
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