Clinics in podiatric medicine and surgery
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Clin Podiatr Med Surg · Apr 2003
ReviewCurrent trends in preoperative patient evaluation and management for podiatric surgeons.
In preparation for elective foot and ankle surgery, the podiatric surgeon often will refer the patient for a preoperative evaluation. Surgeons rely on the input of that consultant to provide a determination as to the operative risk for the patient. This article reviews the fundamental parts of the preoperative evaluation, perioperative patient management, and recent changes and trends within this arena.
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This review covers the perioperative management of trauma to the foot and ankle. The goal when treating these injuries is to return the patient to a sensate, plantigrade, painless, and functioning foot and ankle. Depending on the nature of the trauma, realistic outcomes should be established for the patient, family, and surgeon. The importance of early recognition and treatment of foot and ankle injuries has been established and is paramount for the overall recovery of traumatized patient.
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Clin Podiatr Med Surg · Apr 2003
ReviewPsychosocial management of the foot and ankle surgery patient.
Currently, many patients undergo surgery when they and their families are not prepared or resilient enough to recover fully, predisposing them to poor outcomes. These poor outcomes lead to missed work, patient depression, chronic pain, litigation, and surgeon frustration. Sometimes these individuals require the surgeon's oversight and are more likely to improve with rapid vocational therapy, physical therapy, and aggressive, continuous chronic-pain management. ⋯ The ABLE Presurgical Assessment Tool and related treatment strategies provide foot and ankle surgeons with an easy-to-use, research-based application to better screen and manage their surgical patients. The goal of this review and assessment tool is not to determine a quantitative level of risk. Instead, the authors hope to facilitate a surgeon's awareness of critical preoperative risk factors and provide a tool to efficiently identify these factors and arrange appropriate treatment as needed.
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Central neuroplasticity, or changes in CNS processing due to surgical nociception. can amplify postoperative pain. As a result, a hyperalgesic state called wind-up can occur, having debilitating effects on postoperative patients. Preemptive analgesia works to prevent this process and results in a more positive surgical experience. ⋯ The Agency for Health Care Policy and Research now recommends a multifaceted approach to postoperative pain. The goal in pain management is to inhibit destructive pain pathways, maintain intraoperative analgesia, and prevent central sensitization. Preliminary results of multimodal preemptive analgesia trials continue to be promising.
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There are many options for perioperative pain control available to surgeons. Given these options, adequate levels of analgesia should be achieved and maintained in all surgical patients. Data suggest that analgesia may be improved by combining different analgesic approaches. ⋯ A multimodal recovery program consists of three major components: (1) early mobilization, (2) complete perioperative analgesia, and (3) early oral nutrition. The goal of multimodal programs is to accelerate patient rehabilitation and reduce hospital stays. Balanced multimodal programs are the present and future of perioperative pain control and will enhance patient care.