The Journal of surgical research
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Comparative Study
Paravertebral Nerve Block With Liposomal Bupivacaine for Pain Control Following Video-Assisted Thoracoscopic Surgery and Thoracotomy.
Some surgeons have adopted the use of video-assisted thoracoscopic surgery (VATS) or robotic surgery to perform resections for lung cancer. VATS is associated with less pain and a decrease in pulmonary complications compared with open thoracotomies. Long-acting liposomal bupivacaine (LB) intercostal nerve blocks are reported to provide superior pain relief compared with epidural catheters in the first 3 d after a thoracotomy. This study examined whether LB improves pain after VATS and if it provides effective analgesia after a thoracotomy. ⋯ LB paravertebral blocks significantly improve postoperative pain in comparison with 0.25% BE blocks in VATS patients. LB paravertebral blocks also provide effective analgesia in patients undergoing thoracotomies.
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Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). ⋯ Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.
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Trauma patients with pelvic fractures have a high rate of venous thromboembolism (VTEs). The reason for this high rate is unknown. We hypothesize that fibrinolysis shutdown (SD) predicts VTE in patients with severe pelvic fracture. ⋯ In severely injured patients with pelvic fractures, there was a high rate of VTE and the majority presented in SD. However, we were unable to correlate initial SD with VTE. Ultimately, the high rate of VTE in this patient population supports the concept of implementing VTE chemoprophylaxis measures as soon as hemostasis is achieved.
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Surgical coaching is an emerging concept of education and collaboration to improve surgical performance. Surgical education in low-resource settings remains a challenge because of confounding barriers of access, resources, and sustainability. No formal assessments of coaching as a means to improve surgical quality in low- or middle-income countries (LMICs) exist. The purpose of this review is to explore if surgical coaching could serve as an effective method of fostering continued education and advancement of surgical skills in low-resource settings. ⋯ Coaching is a method of teaching surgeons at multiple stages of a career. The explored advantages of surgical coaching may be applied to continuous performance improvement and collaboration with surgeons in LMICs. Furthermore, coaching may aid in advancement of the well-established Lancet Global Surgery Indicators, improving surgical capacity and quality in LMICs.