Opioid Sparing in Cleft Palate Surgery Carr, Logan; Gray, Megan; Morrow, Brad ...
The Cleft palate-craniofacial journal,
10/2018, Letnik:
55, Številka:
9
Journal Article
Recenzirano
Objective:
This study aimed to determine whether intraoperative acetaminophen was able to decrease opioid consumption, pain scores, and length of stay while increasing oral intake in cleft palate ...surgery.
Design/Setting/Patients:
One hundred consecutive patients with cleft palate who underwent a von Langenbeck or 2-flap palatoplasty and intravelar veloplasty at a tertiary medical center by the 2 senior authors from 2010 to 2015 were reviewed.
Interventions:
Three intraoperative treatment groups were analyzed: intravenous (IV) acetaminophen, per rectal (PR) acetaminophen, and no acetaminophen. All patients received long-acting local anesthesia infiltration before incision. Additionally, all patients were admitted overnight and given weight-based per oral (PO) acetaminophen and oxycodone and IV morphine as needed based on pain scores.
Outcomes Measured:
The study outcomes included pain scores, opioid requirement, length of stay, and oral intake.
Results:
The treatment groups were comprised of 40 patients who received IV acetaminophen, 22 PR acetaminophen, and 35 none. Concerning demographic data, there was no statistical difference between treatment groups. There was no statistically significant difference for opioid intake, although both IV and PR acetaminophen groups had decreased pain scores (P = .029). There was no difference in oral intake (P = .13) or length of stay (P = .31) between treatment groups.
Conclusion:
In this study, intraoperative administration of acetaminophen was associated with decreased pain scores, but no opioid-sparing effect. As other studies have shown an opioid-sparing effect with postoperative acetaminophen, we recommend withholding the intraoperative dose and beginning therapy in the immediate postoperative period.
Background: Many techniques for injection of trigger fingers exist. The purpose of this study was to determine whether the type of steroid or technique used for trigger finger injection altered ...clinical outcomes. Methods: Six hand surgeons at a single institution were surveyed regarding their injection technique, preferred steroid used, and protocol for repeat injection or indication for surgery for symptomatic trigger finger. A retrospective chart review of patients who underwent trigger finger injections was performed by randomly selecting 35 patients for each surgeon between January 2013 and December 2015. Demographic data at the time of presentation were collected. Outcome data during follow-up appointments were also recorded. Results: A total of 210 patient charts were reviewed. Demographic data and initial presenting grade of triggering were similar among all groups. There was no significant difference in clinical course or eventual outcomes noted with injection technique. There were 70 patients in each steroid cohort. Patients receiving triamcinolone required additional injections compared with those receiving methylprednisolone and dexamethasone. Eventual surgical intervention was significantly higher in those patients receiving methylprednisolone. The methylprednisolone group also underwent operative release significantly earlier. Conclusions: Trigger finger injections with triamcinolone demonstrate a higher rate of additional injections when compared with dexamethasone and methylprednisolone. Patients who underwent methylprednisolone injection had surgical release performed earlier and more frequently than the other 2 groups. The choice of corticosteroid significantly affected clinical outcome in this study population. Clinicians performing steroid injections for trigger finger may wish to consider these results when selecting a specific agent.
The treatment of skin cancer has become an increasingly multispecialty practice. Ongoing surgical and postsurgical advances and emergent factors that predispose patients to these tumors have changed ...the treatment paradigm. Having a keen understanding of diagnostic, surgical, and nonsurgical treatment options is key to identifying, treating, or referring patients with potential cutaneous malignancies. While Brian R. Gastman's Cutaneous Malignancies: A Surgical Perspective is the first of its kind to emphasize surgical management of skin cancer, several sections are devoted to systemic nonsurgical therapies affecting patient care and surgical intervention. Topics encompassed include prevention, diagnosis, medication management, appropriate margin size, reconstruction methods, and the importance of stellar dermatopathology. Key Highlights * The role of Mohs micrographic surgery and radiation in skin cancer treatment * Treatment approaches for the two most common forms of skin cancer respectively, basal cell carcinoma and squamous cell carcinoma * Surgical treatment of cutaneous malignant melanoma and other high-risk malignancies * Clinical insights on completion lymphadenectomy and sentinel node biopsy for melanoma, two topics rarely addressed in context with skin cancer * Diagnosis and treatment of rare malignancies including Merkel cell carcinoma, dermatofibrosarcoma protuberans, cutaneous angiosarcoma, and cutaneous leiomyosarcoma * More than 400 high-quality illustrations further delineate surgical modalities Edited by an esteemed dual board certified plastic surgeon and otolaryngologist, this definitive book is the most complete guide to surgical management of skin cancer. It is essential reading for plastic surgeons, dermatologists, otolaryngologists, and all clinicians who treat or refer patients with suspected skin cancer.
Background: Indication for intervention in Dupuytren disease is influenced by many factors, including location and extent of disease, surgeon preference, and comfort level with different treatment ...techniques. The aim of this study was to determine current Dupuytren disease management trends. Methods: A questionnaire was sent through the American Society for Surgery of the Hand to all members. In addition to demographic data, questions focused on indications for different procedural interventions based on location of disease, age, and activity level of the patient. Results: Approximately 24% of respondents completed the survey. Respondents were mostly orthopedic surgeons in private practice who do not work with residents or fellows. Respondents preferred collagenase over needle aponeurotomy and limited fasciectomy for primary Dupuytren disease involving only the metacarpophalangeal (MCP) joint. Limited fasciectomy was the preferred treatment for primary Dupuytren disease involving the MCP and proximal interphalangeal joints. For a patient amenable to any treatment option, the majority would use collagenase, although 87.1% felt that fasciectomy offered the longest disease-free interval. Furthermore, given the option of a young, working patient, 42.7% would use collagenase, while plastic and general surgeons were more likely to treat this patient with limited fasciectomy. More plastic surgeons (vs orthopedic) believe that limited fasciectomy yields the longest disease-free interval. For a patient amenable to any surgical option, orthopedic surgeons prefer collagenase, whereas plastic hand surgeons prefer a limited fasciectomy. Conclusion: There are several procedural options for the treatment of Dupuytren disease. This study details current practice patterns among hand surgeons and reveals the increasingly prevalent use of collagenase.
A reader-friendly, how-to guide on reconstructive plastic surgery from international experts Reconstructive Plastic Surgery: An Atlas of Essential Procedures edited by esteemed authors, educators, ...and surgeons Robert X. Murphy Jr. and Charles K. Herman is a comprehensive resource detailing head-to-toe surgical procedures for a broad range of conditions. The senior editors have more than 50 years of collective surgical experience and expertise training hundreds of medical students and plastic surgery residents. A distinguished and diverse group of contributors from more than 15 countries and five continents share clinical pearls throughout the book. Sixty-seven chapters organized in five sections start with head and neck chapters detailing cleft palate defects and repair, followed by functional rhinoplasty, neoplasms, and trauma. Section two encompasses breast reduction/reconstruction techniques and other breast deformities; and management of trunk ulcers, deep wounds, and defects. The hand and upper extremity section details reconstructive techniques for infections, trauma, and Dupuytren's contracture. The final two sections cover a wide spectrum of nerve-related conditions and syndromes, followed by burns, melanoma, and vascular anomalies. Key Features * High-quality illustrations and intraoperative photographs enhance understanding of step-by-step operative procedures * More than 30 procedural videos provide hands-on guidance on how to perform specific steps in reconstructive plastic surgery * A broad range of reconstructive techniques cover trauma, tumor resection, burns, congenital deformities, and degenerative conditions * Consistent chapter formatting includes a clear and concise introduction, discussion of pertinent anatomy, surgical indications, operative techniques, complications, and long-term results This highly accessible yet comprehensive procedural guide is must-have reading for medical students, plastic surgery residents, and early-career plastic surgeons. It will also benefit veteran reconstructive plastic surgeons looking for a robust refresher with an international perspective.
PDF
