Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Oct 2014
Enhanced recovery after surgery pathway for abdominal wall reconstruction: pilot study and preliminary outcomes.
Enhanced recovery after surgery (ERAS) pathways represent a multimodal approach to improve the quality of postoperative care by diminishing the stress response to the trauma of an operation, thereby minimizing hospital length of stay and potentially complications. At a time when healthcare costs are being intensely scrutinized, efforts to reduce patient morbidity and hospital stay are imperative and timely. ⋯ Although hastened patient recovery is clearly multifactorial, our pathway, incorporating alvimopan, early feeding strategies, and multimodal pain therapy with an emphasis on the reduction of opiate usage as well as precise intraoperative nerve block with novel longer-acting local anesthetic Exparel, appears to provide significant improvement in postoperative pain, bowel function recovery, and shorter hospital stay. Although a prospective evaluation of the entire ERAS pathway as well as contribution of its various components is currently ongoing at our Hernia Center, we believe ours or similar ERAS pathways will soon become standard for the vast majority of patients undergoing abdominal wall surgery.
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Plast. Reconstr. Surg. · Oct 2014
Putting it all together: recommendations for pain management in nonsurgical facial rejuvenation.
Nonsurgical procedures for facial rejuvenation vastly outnumber surgical procedures among board-certified plastic surgeons; interest in nonsurgical cosmetic procedures is rapidly growing for patients and physicians, with less down time, less scars, and potentially less cost. Nonsurgical procedures are often a gateway for patients into more invasive surgical procedures. Providing patients with a comfortable, pleasant experience increases the chance of referrals and return for future procedures, surgical and nonsurgical. ⋯ A wide range of nonsurgical options exist for rejuvenation, and there is nearly as much variety in pain associated with these procedures. As with any procedure that potentially may lead to pain or anxiety for a patient, it is important to assess patient's pain tolerance preprocedurally to determine the level of intervention needed. Providing a relaxed, calm environment and satisfactory pain control helps to reduce anxiety and improve the overall perception of the procedure and provider.
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Plast. Reconstr. Surg. · Oct 2014
Putting it all together: recommendations for improving pain management in plastic surgical procedures: hand surgery.
Approaches to upper extremity anesthesia in hand surgery include regional blocks, wide-awake hand surgery with local anesthesia, and stellate ganglion blocks. ⋯ Pain management in hand surgery can be achieved through regional blocks and wide-awake techniques that do not necessitate general anesthesia in an effort to improve safety, convenience, cost savings, and efficiency.