Articles: pain-management.
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The opioid epidemic has stimulated initiatives to reduce the number of unnecessary narcotic prescriptions. We adopted an opt-in prescription system for patients undergoing ambulatory cervical endocrine surgery (CES). We hypothesized that empowering patients to decide whether or not to receive narcotics for pain control would result in fewer unnecessary opioid prescriptions. ⋯ By empowering patients undergoing ambulatory CES to accept or decline a prescription, we reduced the number of prescribed narcotic tablets by 96.6%. Although longer incisions and prior substance abuse predict higher likelihood of requesting pain medication on discharge, 207 of 216 patients were treated with acetaminophen alone.
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Paediatric anaesthesia · Aug 2021
To relieve pain or avoid opioid-related risk? A comparison of parents' analgesic trade-off preferences and decision-making in 2019 versus 2013 in a single U.S. pediatric hospital.
Analgesic trade-off preferences, or the relative preference for pain relief vs. risk aversion, shape parents' decisions to give prescription opioids to their children. These preferences may be influenced by personal experiences and societal factors. ⋯ Findings suggest that parents of children scheduled for painful surgery at our pediatric hospital have become more analgesic risk-averse during the past decade. Parents' analgesic trade-off preferences may influence their decisions to administer prescribed opioids after surgery, which may contribute to children's pain outcomes.
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Reg Anesth Pain Med · Aug 2021
Anatomy of the thoracic paravertebral space: 3D micro-CT findings and their clinical implications for nerve blockade.
A precise anatomical understanding of the thoracic paravertebral space (TPVS) is essential to understanding how an injection outside this space can result in paravertebral spread. Therefore, we aimed to clarify the three-dimensional (3D) structures of the TPVS and adjacent tissues using micro-CT, and investigate the potential routes for nerve blockade in this area. ⋯ A non-destructive, multi-sectional approach using 3D micro-CT more comprehensively demonstrated the real topography of the intricate TPVS than previous cadaver studies. The posterior boundary and connectivity of the TPVS provides an anatomical rationale for the notion that paravertebral spread can be achieved with an injection outside this space.
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The opioid epidemic has altered normative clinical perceptions on addressing both acute and chronic pain, particularly within the Emergency Department (ED) setting, where providers are now confronted with balancing pain management and potential abuse. This study aims to examine patient sociodemographic and ED clinical characteristics to comprehensively determine predictors of opioid administration during an ED visit (ED-RX) and prescribing upon discharge (DC-RX). ⋯ These findings demonstrate the utility of machine learning for understanding clinical predictors of opioid administration and prescribing in the ED, and its potential in informing standardized prescribing recommendations and guidelines.