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.

     

Sexual satisfaction of women partners of circumcised men in a randomized trial of male circumcision in Rakai,Uganda

OBJECTIVE

To investigate the effect of adult medical male circumcision on female sexual satisfaction.

SUBJECTS AND METHODS

We investigated self‐reported sexual satisfaction among 455 women partners of men circumcised in a randomized trial of male circumcision for the prevention of human immunodeficiency virus in Rakai, Uganda. Women aged 15–49 years were interviewed about their sexual satisfaction before and after their partners were circumcised. We analysed female‐reported changes in sexual satisfaction using chi‐square or Fisher’s exact tests.

RESULTS

Only 2.9% (13/455) of women reported less sexual satisfaction after their partners were circumcised; 57.3% (255/455) reported no change in sexual satisfaction and 39.8% (177/455) reported an improvement in sexual satisfaction after their partner’s circumcision. There were no statistically significant differences in sexual satisfaction before and after partner’s circumcision by age, religion and education status.

CONCLUSION

The overwhelming majority of women (97.1%) report either no change or improved sexual satisfaction after their male partner was circumcised. These findings suggest that male circumcision has no deleterious effect on female sexual satisfaction.     

How long should you wait for a chest radiograph after placing a chest tube on water seal? A prospective study

OBJECTIVE: The purpose of this study was to determine the optimal time interval for identifying a pneumothorax (PTX) on chest radiograph (CXR) after placing a chest tube on water seal. METHODS: One hundred nineteen chest tubes were placed on water seal according to a prospective, observational study protocol. After water seal, both an early (3.1 +/- 2.1 hours) and a late (17.6 +/- 8.0 hours) CXR was obtained. RESULTS: Thirty-one patients had a PTX on follow-up CXRs. There were 22 early and 9 late PTXs identified. Three patients in the early group had a clinically significant PTX or an increase in the size of PTX on follow-up CXR. None of the patients in the late group had a clinically significant PTX (any worsening of their PTX) or required further intervention. CONCLUSION: A normal chest radiograph obtained 3 hours after placing a chest tube on water seal effectively excludes development of a clinically significant pneumothorax.     

The Biomedical Research Hub: a federated platform for patient research data

ObjectiveThe objective was to develop and operate a cloud-based federated system for managing, analyzing, and sharing patient data for research purposes, while allowing each resource sharing patient data to operate their component based upon their own governance rules. The federated system is called the Biomedical Research Hub (BRH).Materials and MethodsThe BRH is a cloud-based federated system built over a core set of software services called framework services. BRH framework services include authentication and authorization, services for generating and assessing findable, accessible, interoperable, and reusable (FAIR) data, and services for importing and exporting bulk clinical data. The BRH includes data resources providing data operated by different entities and workspaces that can access and analyze data from one or more of the data resources in the BRH.ResultsThe BRH contains multiple data commons that in aggregate provide access to over 6 PB of research data from over 400 000 research participants.Discussion and conclusionWith the growing acceptance of using public cloud computing platforms for biomedical research, and the growing use of opaque persistent digital identifiers for datasets, data objects, and other entities, there is now a foundation for systems that federate data from multiple independently operated data resources that expose FAIR application programming interfaces, each using a separate data model. Applications can be built that access data from one or more of the data resources.     

The use of apraclonidine eyedrops to treat ptosis after the administration of botulinum toxin to the upper face

A side effect of the injection of botulinum toxin into the upper third of the face is ptosis or lid droop. A therapy recommended to treat ptosis resulting from administration of botulinum toxins A and B is Iopidine (apraclonidine 0.5 %) eye drops. Apraclonidine is an alpha2-adrenergic agonist, which causes Muller muscles to contract quickly elevating the upper eyelid 1-3 mm. Little published data discusses the use of apraclonidine to treat such ptosis. This communication discusses the extant literature on this usage. Research needs to be done to establish the utility and dosing of apraclonidine for botulinum toxin-induced ptosis.     

Changes in functional connectivity after theta-burst transcranial magnetic stimulation for post-traumatic stress disorder: a machine-learning study

European Archives of Psychiatry and Clinical Neuroscience - Intermittent theta burst stimulation (iTBS) is a novel treatment approach for post-traumatic stress disorder (PTSD), and recent...     

Horseshoe adrenal gland: a rare congenital anomaly

A solitary adrenal gland spanning the midline has been alternatively described as “Horseshoe” or “Butterfly” and is a rare congenital abnormality almost exclusively associated with neonates. There have been 65 reported cases in fetuses and infants, based on ultrasound and autopsy findings. Horseshoe adrenal gland is associated with several congenital anomalies, such as asplenia (52 %), neural tube defects (37 %), renal abnormalities (29 %), and diaphragmatic defects (1 %). Recently, Feldman and colleagues [2] reported the first case of an adult male with horseshoe adrenal gland and posterior midline diaphragmatic anomaly found incidentally with CT imaging. We present a second case of asymptomatic adult horseshoe adrenal gland with posterior midline diaphragmatic hernia in a 51-year-old woman discovered on CT imaging. In our patient these abnormalities were also associated with a 9th thoracic butterfly vertebrae and a unilateral region of underdevelopment of the paraspinal musculature at the level of the diaphragmatic defect. To our knowledge, this is the first time this abnormality has been documented with MRI.     

Structural integrity of extracted teeth restored using three different post-and-core systems: An in vitro comparative study

AimThe objective of the study was to assess the in vitro fracture resistance of endodontically treated teeth restored using different post-and-core materials.Materials and methodsExtracted human mandibular premolars (n = 36) were extracted teeth and equally distributed into four (4) treatment groups: cast metal post-and-core, milled zirconia post-and-core, pre-fabricated post with composite resin core and control group. These samples were then each subjected to the load to fracture test using a universal testing machine. Fracture resistance data were compared among groups by analysis of variance and Fisher’s exact test.ResultsThe highest mean fracture resistance value was observed in the zirconia post-and-core treatment group (1567.26 ± 317.66 N), followed by the cast metal (1355.92 ± 621.56 N) and lastly the pre-fabricated post with composite resin core (725.67 ± 251.05 N) treatment group. Differences among groups were not statistically significantly different (P = 3.77).ConclusionEndodontically treated mandibular premolars with a zirconia post-and-core system exhibited the highest robustness against structural failure based on its mean fracture resistance value. In addition, extracted teeth restored with cast post-and-core resisted a greater stress load than those restored with fiber-reinforced posts. Zirconia showed a more favorable fracture mode than the other restorations.