Pilot study of a novel pain management strategy: evaluating the impact on patient outcomes

Background

Our objective was to evaluate the impact of a novel multimodal pain management strategy on intraoperative opioid requirements, postoperative pain, narcotic use, and length of stay.

Methods

Consecutive patients undergoing elective laparoscopic colorectal resection were managed with an experimental protocol. The protocol uses a post-induction, pre-incision bilateral TAP block and local peritoneal infiltration at port sites with long-acting liposomal bupivacaine (20 mL long-acting liposomal bupivacaine, 30 mL 0.25 % bupivacaine, 30 mL saline). Experimental patients were matched on age, body mass index, gender, comorbidity, diagnosis, and procedure to a control group that received no block or local wound infiltration. Both groups followed a standardized enhanced recovery pathway. Demographics, perioperative, and postoperative outcomes were evaluated. The main outcome measures were intraoperative opioids, postoperative pain, opioid use, and length of stay.

Results

Fifty patients were analyzed—25 experimental and 25 controls. Patients were well matched on all demographics. In both cohorts, the main diagnosis was colorectal cancer and primary procedure performed a segmental resection. Operative times were similar (p = 0.41). Experimental patients received significantly less intraoperative fentanyl (mean 158 mcg experimental vs. 299 mcg control; p < 0.01). The experimental group had significantly lower initial (p < 0.01) and final PACU pain scores (p = 0.04) and shorter LOS (3.0 vs. 4.1 days, p = 0.04) compared to controls. Experimental patients trended toward shorter PACU times and lower opioid use and daily pain scores throughout the hospital stay. Postoperative complication and readmission rates were similar across groups. There were no reoperations or mortality.

Conclusions

Our multimodal pain management strategy reduced intraoperative opioid administration. Postoperatively, improvements in PACU time, postoperative pain and narcotic use, and lengths of stay were seen in the experimental cohort. With the favorable finding from the pilot study, further investigation is warranted to fully evaluate the impact of this pain management protocol on patient satisfaction, clinical and financial outcomes.

     

IPS Empress 2全瓷修复的临床特点

全瓷材料可以提高前牙修复体的自然、逼真效果,它克服了金瓷修复体不透光、颈缘效果差的缺点。但全瓷材料的挠曲性能低,且不能承受过大的抬力,因此仅限于一个单位的修复。最近一种新的全瓷材料(IPS Empress2)由于强度高,可用于前牙多个单位桥的修复,它具有极好的美观性能,高度半透明,边缘完整,它的可蚀刻性增加了与牙齿的粘接,     

Binaural cochlear implantation: comparison of 3M/House and Nucleus 22 devices with evidence of sensory integration

Direct comparison of the efficacy of cochlear implant designs has been difficult for several reasons. There have been wide variations in patients implanted and many differences in testing protocols for each device. In most instances, even a single patient may have unequal degrees of pathology and duration of deafness in the two ears. Implantation of a 3M/House device in the left ear and a Nucleus 22 device in the right ear of a 55-year-old woman, deafened to a similar degree and simultaneously in both ears by streptomycin, allows an opportunity to compare function under presumably similar circumstances. The Nucleus 22 cochlear implant was superior in this case in providing speech discrimination. Perhaps of greater interest, however, is evidence of a binaural effect. Presumably, central integration of sensory stimuli presented through two dissimilar processing strategies resulted in enhanced function on certain measures.     

Intraoperative spinal somatosensory evoked potential monitoring

The relationship of intraoperative monitoring of spinal cord somatosensory evoked potentials and postoperative deficit in 220 cases (121 with scoliosis, 41 with neoplasms, and 58 others) is reported. Bilateral posterior tibial nerve stimulation was used in 181 cases and unilateral median nerve stimulation in 39. Spinal cord (interspinous ligament needles), subcortical (neck surface), and cortical (scalp surface) SEP's were monitored. Seven patients had worsening of neurological function after surgery, three of whom demonstrated significant changes in SEP's monitored. In an additional four cases, there was more than a 50% decrease in amplitude of subcortical/cortical SEP's during monitoring, but no change in neurological status postoperatively. Combined monitoring of spinal cord, subcortical, and cortical SEP's enhanced the certainty of detecting spinal cord dysfunction even though there was a significant number of false-negative and false-positive results. A marked change in the SEP's indicated a high chance of developing a neurological deficit (three or 43% of seven cases), and if there was no change the chance of any neurological postoperative deficit was extremely low (four or 1.87% of 213 cases). These data justify the use of intraoperative SEP monitoring.     

The lateralizing significance of versive head and eye movements during epileptic seizures

We studied 37 patients who had head and eye turning during 74 spontaneous epileptic seizures. Videotapes and EEGs were analyzed independently. Turning movements were classified without knowledge of EEG or clinical data as either versive (unquestionably forced and involuntary, resulting in sustained unnatural positioning) or nonversive (mild, unsustained, wandering, or seemingly voluntary). Videotape observations were then correlated with the EEG location of seizure onset. Contralateral versive head and eye movements occurred during 61 seizures in 27 patients, but ipsilateral versive movements did not occur. Nonversive lateral head and eye movements occurred ipsilaterally and contralaterally with equal frequency and were nonlocalizing, but versive movement was a reliable lateralizing sign.     

WB852-β环糊精包合物的研究

环糊精(cyclodextrin,CD)的发现已近百年,其基础和应用方面的研究至今仍相当活跃,由于环糊精优良的理化性质和生物学特性,可使不稳定的药物包含于环糊精分子内,因此在某种程度上切断药物分子与周围化学环境的联系,而提高药物的稳定性。本文就抗癌抗炎新药WB_(852)~((2,3))的环糊精包合物进行研究,以期提高其化学稳定性。