The Ochsner journal
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The Ochsner journal · Jan 2015
Benefits of a Multimodal Regimen for Postsurgical Pain Management in Colorectal Surgery.
Postoperative pain management is a major concern and a significant component of postoperative care pathways for surgery patients. ⋯ The use of multimodal pain management including liposomal bupivacaine during major colorectal surgeries improved postoperative outcomes, decreased lengths of stay, and increased bed availability.
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The Ochsner journal · Jan 2014
Analgesic efficacy and technique of ultrasound-guided suprascapular nerve catheters after shoulder arthroscopy.
Conventional approaches to brachial plexus blocks may not cover the suprascapular nerve. Accordingly, after shoulder arthroscopy, sensation from the posterior part of the shoulder is commonly spared. Most previous research involving suprascapular nerve blocks described single-injection techniques. However, with the widespread availability and fairly reasonable cost of disposable infusion pumps, continuous catheter techniques provide a more appealing method of prolonging postoperative analgesia. ⋯ Continuous suprascapular catheter techniques provide good pain relief and improve postoperative analgesia after shoulder arthroscopy.
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The Ochsner journal · Jan 2014
ReviewEffect of opiates, anesthetic techniques, and other perioperative factors on surgical cancer patients.
Opioid pharmacotherapy is often used to treat cancer pain. However, morphine and other opioid-like substance use in patients with cancer may have significant adverse consequences, including the suppression of both innate and acquired immune responses. Although studies have examined the possibility that regional anesthesia attenuates the immunosuppressive response of surgery, the effects of morphine and other opioid-related substances on tumor progression remain unknown. ⋯ Immune responses from all components of the immune system, including both the humoral and cell-mediated components, appear to be suppressed by anesthetics and analgesics. The clinical anesthesiologist should consider these factors in the application of technique, especially in cancer surgery.
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The Ochsner journal · Jan 2014
ReviewAcute hypertension: a systematic review and appraisal of guidelines.
Few clinical practice guidelines provide management recommendations for acute hypertensive episodes except in the context of specific conditions such as pregnancy and stroke. ⋯ NHLBI and ESH/ESC guidelines are high quality and provide similar recommendations for management of asymptomatic acute hypertensive episodes and hypertensive emergencies. Additional research is needed to inform clinical practice guidelines for this common condition.
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The most common cause of recurring lost time from work, low back pain is a huge burden on society. Medical training dictates that we must establish a cause for pain before we can treat it and then base our treatment on a recognized and agreed-upon pathology. But in the overwhelming majority of low back pain cases, the issue is nothing more than a minor mechanical malfunction, the inevitable consequence of normal wear and tear. The severity of the pain does not reflect the benign nature of the underlying problem and its limited extent makes a definitive diagnosis impossible. One important component of the solution is improved spinal triage. Using patterns or syndromes in the initial assessment of low back pain is gaining renewed interest and clinical acceptance. ⋯ A clinical perspective capable of recognizing a defined syndrome at first contact will lead to a better outcome. Most patients with low back pain can be treated successfully with simple, pattern-specific, noninvasive primary management. Patients without a pattern and those who do not respond as anticipated require further investigation and specialized care.