Summary This randomised, double‐blind, placebo‐controlled study compared the effect of perineural with intravenous dexamethasone, both administered concomitantly interscalene brachial plexus block for shoulder surgery. Patients received 8 mg dexamethasone mixed ropivacaine in injection (n = 42), intravenously at time 37), or saline 41) block. Perineural and resulted prolonged mean ( SD ) duration to 16.9 (5.2) h 18.2 (6.4) h, respectively, 13.8 (3.8) (p 0.001). Mean (SD) opioid consumption...

The conversion of high-dose intravenous (IV) opioids to an equianalgesic epidural (EP) or intrathecal (IT) dose is a common clinical dilemma for which there little evidence guide practice. Expert opinion varies, though 100 IV:10:EP:1 IT ratio commonly cited in the literature, especially morphine. In this study, authors surveyed 724 pain specialists elucidate ratios that respondents apply convert IV morphine, hydromorphone, and fentanyl both EP routes. Eighty-three completed survey....

To document the per patient rate of vasovagal reactions and other complications cervical vs. lumbar translaminar epidural steroid injections.Anecdotal observations at our institution suggested that are much more common during injections than injections, frequent previously reported.Records 249 patients undergoing their first injection were reviewed for adverse events. For comparison, a performed by same staff physician was matched to each procedure complications.The incidence reaction 7...

Abstract Introduction Analyzing hospital naloxone use may assist in identification of areas for quality and safety improvement. Our primary objective is to quantitate the incidence assess certain patient populations at risk. Methods During years 2008 2011, each clinical scenario where was administered on an in‐patient care ward reviewed. The events were assessed separate situations rescue effective reversing opioid‐induced intoxication vs. others. Further analysis conducted stratify greatest...

Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting elevated sternum. The optimal management regimen not determined. We designed this prospective, randomized trial compare postoperative outcomes between thoracic epidural analgesia (TEA) bilateral subcutaneous infusion pump catheters (On-Q).Patients undergoing MIRPE...

Patient perception of healthcare quality is growing interest. It has been shown that patient satisfaction associated with compliance medical advice and clinical outcome. The 3-fold purpose this study was to identify which attributes the patient-physician interaction most strongly correlated patients' perceptions provider care, key drivers move overall from "very good" "excellent," features pain clinic experience were important patients but simultaneously perceived as lacking.Randomized...

Sub-anesthetic ketamine is frequently used as an analgesic to reduce perioperative opioid consumption and has also been shown have antidepressant effects. Side effects of include dizziness, diplopia, nystagmus, psychomimetic It unclear what clinical factors may be associated with ketamine-related adverse drug events (ADEs).We performed a retrospective review 95 patients who received sub-anesthetic infusions at our institution. Data examined associations between ADEs various characteristics...

Obesity is a common comorbidity seen in the perioperative setting and associated with many diseases including cardiovascular disease obstructive sleep apnea. Laparoscopic Roux-en-Y gastric bypass gold standard surgical treatment for patients whose weight refractory to diet exercise. Caring these perioperatively presents unique challenges anesthesiologists an increased risk of adverse respiratory events. In our study, we hypothesize that low-dose ketamine infusion will reduce opioid...

Abstract Effective pathology services require timely communication of patient-related information between the laboratory and clinicians. The aim this study was to measure effect a compute...

Sexual dysfunction is a well-known side effect of antidepressants. Painful ejaculation rare that has been reported with the use some psychiatric drugs such as triclyclic Cyclobenzaprine muscle relaxant structurally similar to tricyclic It most commonly prescribed in United States and accounts for 18% all prescriptions written chronic back pain.A 55-year-old man was referred our pain medicine clinic evaluation treatment ejaculation.The main outcome measure review current published literature...

Abstract Effective pathology services require timely communication of patient-related information between the laboratory and clinicians. The aim this study was to measure effect a computerized provider order entry (CPOE) system on frequency with which clinicians notify Hematology Laboratory details heparin or warfarin treatments when ordering activated partial thromboplastin time (aPTT) prothrombin (PT) international normalized ratio (INR). Although about total number patients unavailable,...

During orthotopic liver transplantation, allograft reperfusion is a dynamic point in the operation and often requires vasoactive medications blood transfusions. Normothermic machine perfusion (NMP) of allografts has emerged to increase number transplantable organs may have utility during donation after circulatory death (DCD) transplantation reducing transfusion burden medication requirements. This single-center retrospective study involving 226 DCD transplant recipients who received an...

In most cases of post-dural puncture headache, the positional symptoms will resolve spontaneously within 2 weeks. Conservative therapies include oral analgesics and hydration, bed rest, abdominal binders. For refractory cases, an autologous epidural blood patch remains treatment choice. However, in certain use for may place patient at risk infectious or malignant contamination central nervous system. Coccidioidomycosis results from inhalation arthroconidia (spore) stage fungal lifecycle. The...

Abstract Objectives Patient satisfaction is tied to outcome, but there scant literature on the relationship of patient perceived outcome and attributes pain clinic visit, including interaction with management specialist. The primary purpose this study identify patient–provider most strongly associated their visit. secondary aim correlate self‐rated overall health. Methods A survey conducted via phone approximately 3 weeks after patient's Results response rate was 60.2%; 987 surveys collected...

This report describes a pontine hemorrhage in patient following implantation of an intrathecal drug delivery system.A 70-year-old old female with metastatic breast carcinoma underwent placement implantable system. Before implant she was neurologically intact only mild memory deficiencies attributed to narcotics and malignancy. No recent brain magnetic resonance imaging (MRI) on record. On post-implant day 2 after the initiation hydromorphone 0.45 mg/day bupivacaine 2.7 mg/day, developed...

Organ shortage is a major cause of delayed liver transplantation and increased waitlist time. The level donor steatosis significant determinant in organ selection. Scarcity organs has led some programs to expand their acceptable criteria for the percentage steatosis. We report two cases steatotic that resulted mortality within hours from transplantation. Postmortem analysis showed evidence diffuse pulmonary fat microemboli likely originating organ, with marked preservation reperfusion...

Intraoperative Transesophageal Echocardiography (TEE) during orthotopic liver transplant (OLT) is used to gather real-time information on cardiovascular function and intravascular volume status. We report a case where nonstandard TEE views were inspect the hepatic vasculature after allograft implantation. A 29-year-old male with secondary biliary cirrhosis MELD score of 20 underwent OLT using from 21-year-old brain-dead donor. Postreperfusion TEE, modified vein views, confirmed presence an...