Articles: postoperative-pain.
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The purpose of this study was to determine if short-term, high-quantity opioid use following adult tonsillectomy in active duty military members results in opioid misuse, using a proxy measure of referrals to substance abuse rehabilitation programs. ⋯ Short-term, high-quantity opioid treatment of post-tonsillectomy pain in active duty adults does not result in long-term opioid misuse, as measured by substance abuse treatment program referrals within a year after surgery. This finding supports the appropriateness of adequate short-term narcotic medication treatment. The long-term readiness of these patients appears unaffected by long-term opioid misuse or abuse. Even with this finding, there is an institutional shift to multi-modality pain management and appropriate opioid reduction to further mitigate the risk of opioid misuse. Extrapolation of these findings to all adult tonsillectomy patients should be done with caution, as there are several protective factors in the active duty population such as stable full-time employment with mandatory random drug screening.
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Given the public health toll exacted by the Opioid Crisis, it is important for providers in all disciplines to examine their opioid prescribing patterns to see where opioid reduction strategies can be effectively employed. Limiting the impact of the Opioid Crisis on active duty service members is a critical component of maintaining a ready fighting force. One avenue for reducing the potential for opioid diversion and abuse is developing and implementing non-opioid postsurgical pain management strategies that both provide adequate pain relief and also ensure an expedient return to full duty. ⋯ This change was accompanied by a concerted education effort aimed at both providers and patients on the benefits of avoiding opioids as well as the importance of strict adherence to a standardized medication dosing regimen for efficacious non-opioid pain control consisting of maximum doses of ibuprofen and acetaminophen taken every six hours. No increase in convalescent time off and no increase in postoperative visits related to pain control were noted. In our experience, eliminating routine post-procedure opioids for dentoalveolar surgery was a viable strategy for reducing the potential for opioid diversion and abuse among our patients with no negative impact on the operational and training tempo of the associated command.
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Reg Anesth Pain Med · Aug 2022
Plasma bupivacaine levels (total and free/unbound) during epidural infusion in liver resection patients: a prospective, observational study.
Liver resection patients may be at an increased risk of local anesthetic (LA) toxicity because the liver is essential for metabolizing LA and producing proteins (mainly α1-acid glycoprotein (AAG)) that bind to it and reduce the free (and pharmacologically active/toxic) levels in circulation. The liver resection itself, manipulation during surgery, and pre-existing liver disease may all interfere with normal hepatic protein synthesis and result in an attenuation of the increased AAG (a positive acute-phase protein) that normally occurs postoperatively. The purpose of this study was to determine whether the AAG response is attenuated postoperatively following liver resection and whether patients approach toxicity thresholds with continuous postoperative epidural infusion of bupivacaine. ⋯ Our results are supported by the literature in suggesting that major liver resection patients may be at an increased vulnerability for LAST. Factors such as the extent of liver disease, resection and intraoperative blood loss should be considered when using continuous postoperative epidural infusion of bupivacaine and vigilance should be used in monitoring, for signs/symptoms of LAST, even for those subtle and non-specific. Future research will be required to verify these findings.
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Randomized Controlled Trial Multicenter Study
The efficacy and safety of oxycodone in treating the uterine contraction pain after negative pressure aspiration: A randomized, compared, multicenter clinical study.
Oxycodone hydrochloride injection could be safely and effectively applied to negative pressure aspiration, and a 0.08 mg/kg dose could significantly reduce postoperative uterine contraction pain of patients with dysmenorrhea.
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The aim of the present study was to observe the abrasion of implant drills and postoperative reactions for the preparation of the interradicular immediate implant bed during the COVID-19 pandemic and beyond. Thirty-two implant drills were included in four groups: blank, improved surgery, traditional surgery, and control. In the improved surgery group, a dental handpiece with a surgical bur was used to decoronate the first molar and create a hole in the middle of the retained root complex, followed by the pilot drilling protocol through the hole. ⋯ This study proved that a new pilot drill could only be used once in traditional surgery but could be used regularly in improved surgery. Improved surgery was more effective, efficient, and economical than the traditional surgery. The higher FCV-19S, the more severe swelling, pain, and trismus.