Advancement in the use of multimodal analgesia for acute postoperative pain

Size: px
Start display at page:

Download "Advancement in the use of multimodal analgesia for acute postoperative pain"

Transcription

1 Advancement in the use of multimodal analgesia for acute postoperative pain Ratan K. Banik, M.D., Ph.D. Assistant Professor Department of Anesthesiology University of Minnesota, Minneapolis, USA 4 October 2017

2 Role of an anesthesiologist - Acute pain service - Chronic pain clinic - Critical care service - Preop clinic - Ambulatory surgery service

3 The Scope of the Problem Post-Operative Pain Incidence 80% 25% of patients report sufficient post-op pain relief Moderate-Severe Pain 41% on DOS 15% on POD #4 Wu and Raja, Lancet 2011

4 Post-Op Pain Time Course Brennan TJ Pain (2011) 152:S33

5 The Mission Pain Minimize post-operative pain and suffering Early return of function Ambulation Feeding Activities of daily living Treatment Course Reduce inpatient length of stay Earliest possible return to normal daily activities Prevention of persistent post surgical pain

6 A System for the Mission Multimodal Therapy: A method of providing superior analgesia and reduced side-effects by combining interventional techniques and/or medications of different classes.

7 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques

8 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques

9 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques

10 Perioperative COX Inhibitors Inhibition of cyclooxygenase (COX) COX-1: constitutive COX-2: inducible Caveats to usage: Renal function GI bleeding Platelets function Klabunde cvphysiology.com

11 Perioperative COX Inhibitors Celecoxib Multiple Perioperative Doses Orthopedic surgery 200 mg BID-TID x 5 d Pain over 5 days Maximal pain intensity Rescue medication Medication adverse events Scott Reuben Controversy At least 12 Coxib related retractions Derry and Moore (2012) Cochrane 3 Gimbel (2001) Clin Ther (2001) 23(2):228.

12 Perioperative COX Inhibitors Multiple Perioperative Doses Limit to 15 mg IV Q 6 hrs Limit to 2-3 days Joint decision with surgeon Caution Renal dysfunction Single kidney > 65 years old Ketorolac De Oliveira et al. (2012) AA 114(2):424 Storm et al. JAMA (1997) 275(5):376

13 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques The perioperative Enhanced Recovery System

14 Perioperative Gabapentinoids GABA analog without significant direct GABAergic activity Bind a 2 d subunit of VG Ca 2+ channels Ca 2+ influx at presynaptic terminals release of Glutamate release sp/cgrp Clinically effective Post-surgical pain Neuropathic pain Melrose et al. Neurosci Lett (2007) 417(2):187

15 Perioperative Gabapentinoids Gabapentin Meta-analysis of single pre-operative dose static and dynamic pain for 24 hrs MEDD dose has larger in MEDD Sedation Unclear effect of subsequent dosing Hurley et al. RAPM (2006) 31(3) Seib and Paul. Can J Anesth (2006) 53(5): 461

16 Perioperative Gabapentinoids Pregabalin Meta-analysis of peri-operative dosing Hysterectomy, mastectomy, cholecystectomy, spine surgery, hip arthroplasty, dental extractions Static pain Unclear effect on dynamic pain MEDD Effects more robust for doses > 300 mg/d Dizziness, headache, and visual disturbance Zhang et al. BJA (2011) 106(4):454

17 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques The perioperative Enhanced Recovery System at MD Anderson

18 Perioperative Paracetamol Centrally acting analgesic Debated mechanism COX isoenzymes Cannabinoids Vanilloid (TRPA1) Route: IV, PO, PR IV route with double CSF concentration In cancer population Hepatic toxicity Temperature monitoring Andersson et al. Nature Comm (2011) 2: 551

19 Perioperative Paracetamol Single pre-operative oral dose 500-1,000 mg pain for 4-6 hours NNT 3.5 Poor dose-response curve 50% needed for additional analgesia Few adverse events Multiple IV Doses Q6 hr paracetamol vs placebo (RCT) 24 hrs after laparoscopic surgery pain time to first rescue opioid MEDD McNicol et al. BJA (2011) 106(6):764 Apfel et al. Pain (2013) 154:677 Wininger et al. Clin Ther (2010) 32: 2348 Toms et al. Cochrane (2012) 4

20 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques The perioperative Enhanced Recovery System at MD Anderson

21 Perioperative Tramadol Multiple mechanisms of action Weak MOR agonist (relatively selective) Augments release 5-HT NE reuptake inhibition Oral form only in US Caution Previous seizures Brain metastasis Patients taking SSRI and SNRI Neuroendocrine tumors

22 Perioperative Tramadol Single pre-operative oral dose Abdominal, ortho, gyn, OB, and dental pain with mg Excellent dose response curve Increased efficacy when combined with paracetamol Moore and McQuay. Pain (1997) 69:

23 Perioperative Tramadol Multiple perioperative oral doses Lumbar disc, groin, and laproscopic surgery mg/d pain over 24 hrs Similar efficacy to Codeine/APAP 30/500 mg Naproxen 500 mg No RCT with tramadol ER Grond and Sablotzki. Clin Pharma 92004) 43:879

24 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques The perioperative Enhanced Recovery System

25 Patient Controlled Analgesia (IV-PCA) Self-administered small doses of IV opioid Lock-out interval for safety Basal infusion for opioid tolerant patients only (if at all) Loading dose necessary Morphine M6G (MOR active) accumulation in renal failure M3G (MOR inactive) accumulation in renal failure neuroexcitatory Hydromorphone and Fentanyl No meaningful active metabolites Renal dysfunction in cancer patients Grass A&A 2005 Viscusi et al. NYSORA.com 2008

26 Patient Controlled Analgesia (IV-PCA) Traditional Teaching analgesic gaps opioid needed for same level of analgesia opioid related side effects nursing and pharmacy staff time $400 / d in U.S. patient satisfaction sense of control

27 Patient Controlled Analgesia (IV-PCA) Recent meta-analysis of 55 RCT s Mixed surgical types pain vs control patient satisfaction nursing and pharmacist staff costs other adverse SE hospital LOS total opioid itching Hudcova et al. Cochrane (2012) 6

28 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol Intra-Operative Medications Ketamine Lidocaine IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques The perioperative Enhanced Recovery System at MD Anderson

29 Epidural Recipients Thoracotomies Upper Abdominal Surgery Lower Abdominal Surgery Urological/Gynecological Othropaedic

30 Epidural Location Target: dermatomal midpoint of surgical site Thoracotomy: T4-7 Upper abdomen: T6-8 Mid abdomen: T8-10 Lower abdomen: T10-L1

31 Epidural Catheters 2500 Epidurals per Year 9 Average Epidural Days per Year

32 Anticoagulation: ASRA Guidelines PLUS Placing Epidural INR < 1.4 and Platelets > 100K No VEGF inhibitors in last 3-4 weeks Removing Epidural INR < 1.7 and Platelets > 70K Check thrombo-elastogram (TEG) 2% patients require transfusion

33 Epidurals and Health Outcomes Analgesia Lower pain score vs systemic opioids Improved static and dynamic pain scores Gastrointestinal Decreased duration of postoperative ileus Pulmonary Decreased duration of mechanical ventilation Less atalectasis and hypoxemia Decreased overall post-op pulmonary complications Metabolic Attenuates post-op nitrogen excretion sparing muscle mass Cardiovascular May lower risk MI or dysrhythmias Mortality Small reduction at 30-days Popping DM et al. Arch Surg (2008) 143: Nishimori M et al. Cochrane Database Syst Rev (2006) 3: CD Joshi GP et al. Anesth Analg (2008) 107: Wijeysundera DN et al. Lancet (2008) 372: Latterman et al. Pain Med (2007) 32: 227 Wu CL et al. RAPM (2004) 29: Liu SS and Wu CL. Anesth Analg (2007) Marret E et al. Br J Surg (2007) 94: Fischer HB et al. Anaesthesia (2008) 63:

34 Splitting Difficult clinical scenario Pain + Hypotension Patchy epidural Unilateral epidural Pain at non-surgical site Solution is splitting Local anesthetics alone in the epidural Provide systemic opioids through IV PCA or PO route Clinical rule: Do not mix neuraxial and systemic opioids Too difficult for patient Provider may forget about other source

35 Surgery Specific Duration of Catheter Thoracic Surgery After chest tube removed Pneumonectomy POD #5 Esophagectomy POD #7 Abdominal Surgery After tolerating full liquid diet OR tube feeds at 40 ml/hr Ortho When PT goals achieved

36 Epidural Misadventures No block Not in epidural space Migration Missing segments Unilateral block (catheter depth) Patchy block Wrong level Pain somewhere else Hypotension Fluid sparing anesthesia Motor block Sedation Dural puncture ~1% Post-Operative radicular pain 0.3%

37 Overview Components of Multimodal Analgesia Pre/Post-Operative Medications COX inhibitors Gabapentinoids Paracetamol Tramadol Intra-Operative Medications Ketamine Lidocaine IV PCA Epidurals Regional anesthesia with emphasis on ultrasound guided techniques The perioperative Enhanced Recovery System

38 Peripheral Nerve Blocks Rapidly expanding and changing Ultrasound guidance Catheters Mostly orthopedic surgeries in studies pain compared to systemic opioids MEDD Earlier mobilization Possible length of stay Viscusi et al. NYSORA.com 2008

39 Supraclavicular Plexus Block Neuraxiom.com NYSORA.com

40 Femoral n. Block Neuraxiom.com NYSORA.com

41 Transversus Abdominis Plane Block Nerves blocked: Anterior rami of T7-L1 Best block generally T10-L1

42 Transversus Abdominis Plane Block NYSORA.com

43 Further Learning USRA.ca NYSORA.com

44 Innovative Medications Extended release local anesthetics Liposomal bupivacaine Long acting single shot technique Unknown safety

45 Epidural/Peripheral Bupivacaine Na + Channel Block Gabapentinoids N-type Ca 2+ channel inhib Dexmedetomidine a 2 agonist NSAIDs Cyclooxygenase inhib Tramadol SNRI + weak MOR agonist POST-OP ANALGESIA Ketamine NMDA-R antagonism Paracetamol TRPA1 agonist (?) Lidocaine (infusion) Systemic Na + channel inhib Opioids Strong MOR agonists

46

47 Difficult Clinical Scenario #1 Obstructive Sleep Apnea Higher risk of respiratory complications post-op Strongly push for neuraxial or regional technique if applicable Utilize home CPAP/BiPAP immediately after extubation Maximize non-opioid medications Minimum effective opioid dose Vigilant post-op monitoring

48 Difficult Clinical Scenario #2 Opioid tolerant patient Often misunderstood by physicians Continue pre-operative opioid MORE opioid needed in the perioperative period Strongly push for neuraxial or regional technique if applicable Patient must have access to opioids to prevent perioperative withdrawal IV PCA to determine new opioid requirement Pain score will be higher than the average patient Remember careful titration

49 Difficult Clinical Scenario #3 The Unhappy Triad Maximize non-opioid medications Consider regional techniques Eliminate other sedating medications Benzodiazepines, antiemetics, anti-histamines Ensure adequate fluid status Safety first

50 Questions

ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT

ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT ENHANCED RECOVERY PROTOCOLS FOR KNEE REPLACEMENT Jeff Gadsden, MD, FRCPC, FANZCA Associate Professor Duke University Department of Anesthesiology Regional Anesthesia and Acute Pain Medicine DISCLOSURES

More information

Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital

Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine

More information

Nerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS

Nerve Blocks & Long Acting Analgesia for Plastic Surgeons. Karol A Gutowski, MD, FACS Nerve Blocks & Long Acting Analgesia for Plastic Surgeons Karol A Gutowski, MD, FACS Disclosures None related to this topic Why is Non-Opioid Analgesia Important Opioid epidemic Less opioid use Less PONV

More information

Balanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D

Balanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor

More information

Learning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16

Learning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16 Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center

More information

Current evidence in acute pain management. Jeremy Cashman

Current evidence in acute pain management. Jeremy Cashman Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side

More information

Objectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE

Objectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation

More information

ERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland

ERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published

More information

Intravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC

Intravenous lidocaine infusions. Dr Ian McConachie FRCA FRCPC Intravenous lidocaine infusions Dr Ian McConachie FRCA FRCPC Thank the organisers for inviting me. No conflicts or disclosures Lidocaine 1 st amide local anesthetic Synthesized in 1943 by Lofgren in Sweden.

More information

Perioperative Pain Management

Perioperative Pain Management Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists

More information

Gabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement. Manyat Nantha-Aree, MD

Gabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement. Manyat Nantha-Aree, MD Gabapentin Does Not Improve Analgesia Outcomes For Total Joint Replacement Manyat Nantha-Aree, MD Objective n Preliminary results of MOBILE study in total hip and knee arthroplasty Background n Gabapentin=

More information

Postoperative Pain Management. Nimmaanrat S, MD, FRCAT, MMed (Pain Mgt)

Postoperative Pain Management. Nimmaanrat S, MD, FRCAT, MMed (Pain Mgt) Postoperative Pain Management Nimmaanrat S, MD, FRCAT, MMed (Pain Mgt) Topics to be Covered Definition Neurobiology Classification Multimodal analgesia Preventive analgesia Step down approach Measurement

More information

Lumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes.

Lumbar Fusion. Reference Guide for PACU CLINICAL PATHWAY. All patient variances to the pathway are to be circled and addressed in the progress notes. Reference Guide for PACU Lumbar Fusion CLINICAL PATHWAY All patient variances to the pathway are to be circled and addressed in the progress notes. This Clinical Pathway is intended to assist in clinical

More information

Role and safety of epidural analgesia

Role and safety of epidural analgesia Anaesthesia for Liver Resection Surgery The Association of Anaesthetists Seminars 21 Portland Place, London Thursday 15 th December 2005 Role and safety of epidural analgesia Lennart Christiansson MD,

More information

Analgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital

Analgesia for ERAS programs. Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Analgesia for ERAS programs Dr Igor Lemech VMO Anaesthetist Wagga Wagga Base Hospital Disclosure I have received honoraria from Mundipharma and MSD The new Wagga Wagga Rural Referral Centre Scope Analgesic

More information

Objectives. Conflict of Interest Disclosure. Neuraxial and Regional Anesthesia in the Pediatric Population

Objectives. Conflict of Interest Disclosure. Neuraxial and Regional Anesthesia in the Pediatric Population Neuraxial and Regional Anesthesia in the Pediatric Population Lauren Renner, MS, RN-BC, PNP Sharon Wrona, DNP, RN-BC, PNP, PMHS, AP- PMN.... Conflict of Interest Disclosure Conflicts of Interest for ALL

More information

STARTER PACK: Webinar #1 ADE4 - OPIOIDS

STARTER PACK: Webinar #1 ADE4 - OPIOIDS STARTER PACK: Webinar #1 ADE4 - OPIOIDS Welcome to the Starter Pack Webinar #1 Why this is important Establishing a Team Best practices Understanding the Measures Completing a gap analysis First Steps

More information

Anesthesia for OutPatient Spine Surgery. Michael A. Kellams, D.O.

Anesthesia for OutPatient Spine Surgery. Michael A. Kellams, D.O. Anesthesia for OutPatient Spine Surgery Michael A. Kellams, D.O. DISCLOSURE None! Hot Topics 2017 -Multimodal Analgesia/ERAS -TAP block -Inpatient procedures outpatient (Fusions) Multimodal Analgesia -Using

More information

Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus

More information

Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation

Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee

More information

Reversing the Opioid Epidemic: Pain & Symptom Management Inpatient Considerations and Peri operative Multi Modal Analgesia

Reversing the Opioid Epidemic: Pain & Symptom Management Inpatient Considerations and Peri operative Multi Modal Analgesia Reversing the Opioid Epidemic: Pain & Symptom Management Inpatient Considerations and Peri operative Multi Modal Analgesia Aaron Wood 25 July 2018 Disclosures No Financial Interests Gratitude Feedback

More information

Management of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017

Management of Acute Pain in the Chronic Pain Patient. Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Management of Acute Pain in the Chronic Pain Patient Eric Cannon, MD Mountain West Anesthesia December 1, 2017 Objectives 1. Describe the unique challenges of managing acute pain episodes in patients being

More information

What s New in Post-Cesarean Analgesia?

What s New in Post-Cesarean Analgesia? Anesthesia & Obstetrics What s New in Post-Cesarean Analgesia? October 23rd, 2013 2013 UCSF What Does The Evidence Tell Us? Mark Rollins, MD, PhD UC SF Post-Delivery Pain (Mean pain scores for first 24

More information

Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government

Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Mr David A McDonald Service Improvement Manager Whole System patient Flow Improvement Programme Scottish Government Introduction Brief update Two main topics Use of Gabapentin Local Infiltration Analgesia

More information

Presentation objectives. Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient

Presentation objectives. Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient Overcoming Acute Pain Management Hurdles in the Tertiary Setting The High Risk Patient Ewan McNicol PharmD, MS Presentation objectives Outline principles for management of acute pain, with focus on perioperative

More information

Opioids and Respiratory Depression

Opioids and Respiratory Depression Opioids and Respiratory Depression Clinical Committee Society of Anesthesia and Sleep Medicine https://commons.wikimedia.org/wiki/file:mu_opioid_receptor.svg Introduction Opioid-induced respiratory depression

More information

Labor Epidural: Local Anesthetics and Beyond

Labor Epidural: Local Anesthetics and Beyond Goals: Labor Epidural: Local Anesthetics and Beyond Pedram Aleshi MD The Changing Practice of Anesthesia September 2012 Review Concept of MLAC Local anesthetic efficacy Local anesthetic sparing effects:

More information

Inpatient Management of Trauma Related Pain

Inpatient Management of Trauma Related Pain Inpatient Management of Trauma Related Pain STOMP Summit September 9, 2016 Ann O Rourke, MD, MPH University of Wisconsin Department of Surgery 1 Our patient Small SDH Intubated Hemopneumothorax with multiple

More information

Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view

Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal

More information

To staple or to sew. Zeng Xuan Hu

To staple or to sew. Zeng Xuan Hu To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress

More information

Anesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty

Anesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty Anesthetic Techniques for Rapid Recovery in Total Knee Arthroplasty Scott T. Ball, MD Chief, Adult Joint Reconstruction Department of Orthopaedic Surgery University of California, San Diego Disclosures

More information

Satisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone

Satisfactory Analgesia Minimal Emesis in Day Surgeries. (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone Satisfactory Analgesia Minimal Emesis in Day Surgeries (SAME-Day study) A Randomized Control Trial Comparing Morphine and Hydromorphone HARSHA SHANTHANNA ASSISTANT PROFESSOR ANESTHESIOLOGY MCMASTER UNIVERSITY

More information

Continuous Wound Infusion and Postoperative Pain Current status?

Continuous Wound Infusion and Postoperative Pain Current status? Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe

More information

PERIOPERATIVE PAIN MANAGEMENT: WHAT S UP WITH METHADONE?

PERIOPERATIVE PAIN MANAGEMENT: WHAT S UP WITH METHADONE? PERIOPERATIVE PAIN MANAGEMENT: WHAT S UP WITH METHADONE? Sandra Z Perkowski, VMD, PhD, DACVAA University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA Pre-emptive and multimodal use

More information

RECENT ADVANCES IN ANALGESIA

RECENT ADVANCES IN ANALGESIA 4th ERAS UK Conference RECENT ADVANCES IN ANALGESIA Dr William J Fawcett Royal Surrey County Hospital, Guildford University of Surrey, Guildford November 14th 2014 Conflict of interests Paid honoraria

More information

Innovative Approaches and New Technology to Gain Access

Innovative Approaches and New Technology to Gain Access Innovative Approaches and New Technology to Gain Access The following is intended only for presentation to the Reimbursement and Access 2017 audience, August 17, 2017. This information is not for promotional

More information

Evidenzbasiertes, perioperatives Analgesie- Konzept in der Fast Track Chirurgie. Christoph Konrad Luzern

Evidenzbasiertes, perioperatives Analgesie- Konzept in der Fast Track Chirurgie. Christoph Konrad Luzern Evidenzbasiertes, perioperatives Analgesie- Konzept in der Fast Track Chirurgie Christoph Konrad Luzern Prävalenz Prävalenz 40.0 Hüft TEP Leistenhernie Knie TEP Thorakotomie 30.0 20.0 Br J Anaesth. 2010

More information

Turlough O Hare, MD, FRCPC, MSc Assistant Clinical Professor, Department of Anesthesia, St. Joseph s Healthcare Hamilton McMaster University

Turlough O Hare, MD, FRCPC, MSc Assistant Clinical Professor, Department of Anesthesia, St. Joseph s Healthcare Hamilton McMaster University Turlough O Hare, MD, FRCPC, MSc Assistant Clinical Professor, Department of Anesthesia, St. Joseph s Healthcare Hamilton McMaster University To understand the current options available to best manage pain

More information

Non-Narcotic Pain Management Strategies in Post-Operative Patients

Non-Narcotic Pain Management Strategies in Post-Operative Patients Non-Narcotic Pain Management Strategies in Post-Operative Patients Danielle Tompkins, PharmD University of Illinois at Chicago, College of Pharmacy PGY2 Critical Care Pharmacy Resident 1 Conflicts of Interest

More information

Acute Postoperative Pain. David Radvinsky, MD March 24, 2016

Acute Postoperative Pain. David Radvinsky, MD March 24, 2016 Acute Postoperative Pain David Radvinsky, MD March 24, 2016 Objectives 1. Discuss the multimodal approach to pain management and discuss the various classes of drugs based on receptor mechanism. 2. Give

More information

Treatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am

Treatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am Treatment of Neuropathic Pain: What Does the Evidence Say? or Just the Facts Ma am Tim R Brown, PharmD, BCACP, FASHP Director of Clinical Pharmacotherapy Cleveland Clinic Akron General Center for Family

More information

Professor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden

Professor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden Professor Narinder Rawal, MD, PhD, FRCA (Hon), EDRA Department of Anaesthesiology and Intensive Care University Hospital Örebro, Sweden Infiltrative techniques in perioperative pain lecture outline Why

More information

Improving acute pain care with multimodal analgesia. Sponsored by Mallinckrodt Pharmaceuticals.

Improving acute pain care with multimodal analgesia. Sponsored by Mallinckrodt Pharmaceuticals. Improving acute pain care with multimodal analgesia Discussion topics Section 1 Opioid monotherapy and the state of acute pain management Section 2 Multimodal analgesia for balanced acute pain management

More information

Post Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark

Post Caesarean Analgesia An Update. Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post Caesarean Analgesia An Update Kim Ekelund MD, PhD, associate professor Rigshospitalet Copenhagen, Denmark Post caesarean analgesia No Conflicts of Interests Neuraxial opioids Multimodal therapy Plan

More information

Innovative Pain Management Practices in Spine Surgery Patients

Innovative Pain Management Practices in Spine Surgery Patients Disclosures Innovative Pain Management Practices in Spine Surgery Patients There are no conflicts of interest or relevant financial interests in making this presentation. Matt Kresl PharmD, BCPS Pharmacist

More information

Post-caesarean analgesia. Genevieve Goulding Royal Brisbane & Women's Hospital 1

Post-caesarean analgesia. Genevieve Goulding Royal Brisbane & Women's Hospital 1 Post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's Hospital 1 Contemporary challenges & barriers to providing optimal post-caesarean analgesia Genevieve Goulding Royal Brisbane & Women's

More information

Effective Postoperative Pain Management for Children. Nancy L. Glass, MD, MBA,

Effective Postoperative Pain Management for Children. Nancy L. Glass, MD, MBA, Effective Postoperative Pain Management for Children Nancy L. Glass, MD, MBA, FAAP nglass@bcm.edu @DrNancyGlass1 None Disclosures Learning Objectives At the end of this presentation, participants will

More information

Opioid reduction strategies in an academic tertiary medical center

Opioid reduction strategies in an academic tertiary medical center Opioid reduction strategies in an academic tertiary medical center Terry Bosen, PharmD Medication Safety Program Director Vanderbilt University Medical Center Tennessee MME data per capita MME = Morphine

More information

NYSPFP Kickoff. Reducing Adverse Drug Events from Opioids. April 6, 2017

NYSPFP Kickoff. Reducing Adverse Drug Events from Opioids. April 6, 2017 NYSPFP Kickoff Reducing Adverse Drug Events from Opioids April 6, 2017 I have no financial relationships with drug companies, durable medical equipment companies or other for profit entities related to

More information

How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium

How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium No conflict of interest to declare. Does severe acute postoperative pain still

More information

Digital RIC. Rhode Island College. Linda M. Green Rhode Island College

Digital RIC. Rhode Island College. Linda M. Green Rhode Island College Rhode Island College Digital Commons @ RIC Master's Theses, Dissertations, Graduate Research and Major Papers Overview Master's Theses, Dissertations, Graduate Research and Major Papers 1-1-2013 The Relationship

More information

Effective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1

Effective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1 Effective pain management begins with OFIRMEV (acetaminophen) injection FIRST Proven efficacy with rapid reduction in pain 1 Fast onset of pain relief with 7% reduction in visual analog scale (VAS) scores

More information

PAIN MANAGEMENT IN HIP SURGERY. Khoa D. Nguyen, MD, PhD Dept. of Rheumatology, Cho Ray Hosital

PAIN MANAGEMENT IN HIP SURGERY. Khoa D. Nguyen, MD, PhD Dept. of Rheumatology, Cho Ray Hosital PAIN MANAGEMENT IN HIP SURGERY Khoa D. Nguyen, MD, PhD Dept. of Rheumatology, Cho Ray Hosital MUSCULOSKELETAL PAIN IS COMMON Hip replacement increasing POSTOPERATIVE PAIN: INTRODUCTION Very common Causes

More information

Outpatient Total Knee Arthroplasty: Anesthetic Implications

Outpatient Total Knee Arthroplasty: Anesthetic Implications Outpatient Total Knee Arthroplasty: Anesthetic Implications Anthony Edelman, MD, MBA Clinical Assistant Professor Director, Division of Orthopedic Anesthesia Disclosures None Objectives Examine current

More information

Multimodal perioperative pain management protocols

Multimodal perioperative pain management protocols Multimodal perioperative pain management protocols Nader M. Hebela, MD كليفالند كلينك أبوظبي Dhabi Cleveland Clinic Abu معهد األعصاب Institute Neurological slide count: 30 January 2016 title slide explained

More information

Disclosures. Total knee and Total Hip Replacement, a Fast Track. Outline of my talk. What is Fast Track Arthroplasty? I have nothing to disclose

Disclosures. Total knee and Total Hip Replacement, a Fast Track. Outline of my talk. What is Fast Track Arthroplasty? I have nothing to disclose Total knee and Total Hip Replacement, a Fast Track Muhammad I Shaikh M.D.,Ph.D. Associate Professor of Anesthesiology, UCSF Outline of my talk Definition of Fast Track Principles of FT as applied to Orthopedics

More information

Enhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Enhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid

More information

Fiegel, Matthew, MD Regional Anesthesia and Pain Medicine Update 2013

Fiegel, Matthew, MD Regional Anesthesia and Pain Medicine Update 2013 Regional Anesthesia and Pain Medicine Update: 2013 CRASH I have no disclosures Disclosures Matthew J. Fiegel, M.D. Associate Professor of Anesthesiology University of Colorado Director, Acute Pain Service

More information

disease or in clients who consume alcohol on a regular basis. bilirubin

disease or in clients who consume alcohol on a regular basis. bilirubin NON-OPIOID Acetaminophen(Tylenol) Therapeutic class: Analgesic, antipyretic Aspirin (ASA, Acetylsalicylic Acid) Analgesic, NSAID, antipyretic Non-Opioid Analgesics COMMON USES WHAT I NEED TO KNOW AS A

More information

Screening - inclusion criteria

Screening - inclusion criteria PAIN OUT Community research EU ROP EAN COMMISSION A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Room number: Screening

More information

Peri operative pain control. Disclosure. Objectives 9/1/2011. No current conflicts of interest

Peri operative pain control. Disclosure. Objectives 9/1/2011. No current conflicts of interest Peri operative pain control Chris Herndon, PharmD, FASHP Southern Illinois University Edwardsville Disclosure No current conflicts of interest Objectives Discuss studies evaluating the transformation of

More information

EXPAREL. An Innovative Non-Opioid Option for the Management of Postsurgical Pain. Presenter s Name Affiliation Date

EXPAREL. An Innovative Non-Opioid Option for the Management of Postsurgical Pain. Presenter s Name Affiliation Date EXPAREL An Innovative Non-Opioid Option for the Management of Postsurgical Pain Presenter s Name Affiliation Date Disclosures The speaker has a consulting relationship with Pacira Pharmaceuticals, Inc.

More information

Anesthesia for Total Hip and Knee Arthroplasty

Anesthesia for Total Hip and Knee Arthroplasty Anesthesia for Total Hip and Knee Arthroplasty Typical approach Describe anesthesia technique Rather Describe issues with THA and TKA How anesthesia can modify Issues Total Hip Total Knee Blood Loss ++

More information

Acute pain management in opioid tolerant patients. Muhammad Laklouk

Acute pain management in opioid tolerant patients. Muhammad Laklouk Acute pain management in opioid tolerant patients Muhammad Laklouk General principles An adequate review and assessment Provision of effective analgesia (including attenuation of tolerance and hyperalgesia)

More information

What a Pain! A Review of Post-operative Pain Management. Ashley W. Sturm, PharmD, BCPS. Pharmacy Grand Rounds March 21 st, MFMER slide-1

What a Pain! A Review of Post-operative Pain Management. Ashley W. Sturm, PharmD, BCPS. Pharmacy Grand Rounds March 21 st, MFMER slide-1 What a Pain! A Review of Post-operative Pain Management Ashley W. Sturm, PharmD, BCPS Pharmacy Grand Rounds March 21 st, 2017 2016 MFMER slide-1 Objectives Review multi-modal approach for pain control

More information

ASA Closed Claims Project: Regional Anesthesia Claims 1990 or later Lorri A. Lee MD Department of Anesthesiology University of Washington, Seattle, WA

ASA Closed Claims Project: Regional Anesthesia Claims 1990 or later Lorri A. Lee MD Department of Anesthesiology University of Washington, Seattle, WA ASA Closed Claims Project: Regional Anesthesia Claims 1990 or later Lorri A. Lee MD Department of Anesthesiology, Seattle, WA OVERVIEW 1. Closed Claims Project 2. Peripheral Nerve Blocks 3. Neuraxial Claims

More information

Professor Richard Langford Barts and The London NHS Trust. South Thames Acute Pain 10 th Nov 2011

Professor Richard Langford Barts and The London NHS Trust. South Thames Acute Pain 10 th Nov 2011 Current Issues in Postoperative Pain Management Professor Richard Langford Barts and The London NHS Trust South Thames Acute Pain 10 th Nov 2011 Types of acute pain Outline issues and unmet clinical needs

More information

NEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS

NEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS 2017 CSA Fall Anesthesia Conference NEW KIDS ON THE BLOCK: THE NEW ERA OF REGIONAL ANESTHESIA PLANE BLOCKS Michael Barrington, MB BS, FANZCA, PhD Senior Staff Anaesthetist, St Vincent s Hospital, Melbourne.

More information

5 th ERAS UK Conference. Advances in Pain Management. Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh

5 th ERAS UK Conference. Advances in Pain Management. Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh 5 th ERAS UK Conference Advances in Pain Management Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh Pre-op information Optimised organ function No nutritional

More information

Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland

Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Update Update on Anaesthesia for c-section Dr Kerry Litchfield Consultant Anaesthetist Princess Royal Maternity Glasgow, Scotland Caesarean section is the most common surgical procedure in the world 1

More information

Antiplatelet and Anticoagulant management for Regional Anesthesia

Antiplatelet and Anticoagulant management for Regional Anesthesia Antiplatelet and Anticoagulant management for Regional Anesthesia Deborah Richman MBCHB, FFA(SA) Director of Pre-Operative Services Department of Anesthesia Stony Brook MedicineStony Brook, NY SPAQI Immediate

More information

Screening - inclusion criteria

Screening - inclusion criteria A Date of data collection: B Time of data collection: C Ward where data is collected: 2 0 1 Y M M D D H H M M D Research assistant Code: Patient code (local): Room number: Screening - inclusion criteria

More information

1

1 Disclosures I do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with

More information

Acute Peri-Operative Pain Management Strategies

Acute Peri-Operative Pain Management Strategies Slide 1 Acute Peri-Operative Pain Management Strategies Phillip Gallegos, MD USAP Pinnacle Anesthesiologist Director of Anesthesia and Peri-Operative Medicine BOSHA Slide 2 ERAS Enhanced Recovery After

More information

2018 Learning Outcomes

2018 Learning Outcomes I. Pain Physiology and Anatomy (20%) A. Describe the basic anatomy of the nervous system. B. Describe the physiological mechanisms of neuronal function (eg- action potentials). C. Review the nociceptive

More information

Goals for sedation during mechanical ventilation

Goals for sedation during mechanical ventilation New Uses of Old Medications Gina Riggi, PharmD, BCCCP, BCPS Clinical Pharmacist Trauma ICU Jackson Memorial Hospital Disclosure I do not have anything to disclose Objectives Describe the use of ketamine

More information

The Pain of Pain: or Patience for Patients

The Pain of Pain: or Patience for Patients The pain of pain or: Patience for Patients Alan Bielsky Objectives Discuss mechanisms of acute on chronic pain Explain the practical use of multimodal analgesia Detail different regimens that may benefit

More information

Non-opioid-based adjuvant analgesia in perioperative care

Non-opioid-based adjuvant analgesia in perioperative care Non-opioid-based adjuvant analgesia in perioperative care Shankar Ramaswamy MBBS MD FRCA John A. Wilson MBChB MD MRCP FRCA FFPMRCA Lesley Colvin MBChB FRCA PhD FFPMRCA 1A02, 1D02, 2E01, 3E00 Key points

More information

Acute Post-Surgical Pain Management: A Critical Appraisal of Current Practice

Acute Post-Surgical Pain Management: A Critical Appraisal of Current Practice Acute Post-Surgical Pain Management: A Critical Appraisal of Current Practice James P. Rathmell, M.D., Christopher L. Wu, M.D., Raymond S. Sinatra, M.D., Ph.D., Jane C. Ballantyne, M.D., F.R.C.P., Brian

More information

META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY

META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY META-ANALYSIS OF INTRATHECAL MORPHINE FOR LUMBAR SPINE SURGERY RESIDENT RESEARCH EXCHANGE DAY MAY 30 TH, 2014 SUPERVISOR: DR. JAMES PAUL SUSAN JO PGY4 SUZANNE LAMBERT PGY4 ADA HINDLE PGY4 INTRODUCTION

More information

ICU Management of Minimally Invasive Cardiac Surgery

ICU Management of Minimally Invasive Cardiac Surgery ICU Management of Minimally Invasive Cardiac Surgery Benjamin A. Kohl, MD, FCCM Chief of Critical Care, Aria-Jefferson Health Professor of Anesthesiology Thomas Jefferson University Sidney Kimmel Medical

More information

PAIN PODCAST SHOW NOTES:

PAIN PODCAST SHOW NOTES: PAIN PODCAST SHOW NOTES: Dallas Holladay, DO Ultrasound Fellow Cook County Hospital Rush University Medical Center Jonathan D. Alterie, DO PGY-2, Emergency Medicine Midwestern University An overview of

More information

Acute Pain Management in the Opioid Tolerant Patient. Objectives. Opioids. The participant will be able to define opioid tolerance

Acute Pain Management in the Opioid Tolerant Patient. Objectives. Opioids. The participant will be able to define opioid tolerance Acute Pain Management in the Opioid Tolerant Patient Kathleen M. Colfer, MSN, RN-BC Clinical Nurse Specialist Acute Pain Management Service Department of Anesthesiology Thomas Jefferson University Hospital

More information

ERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic

ERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acetaminophen, for geriatric surgical patients, 569 570 Acute kidney injury, critical care issues in geriatric patients with, 555 556

More information

Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years

Peripheral regional anaesthesia and outcome: lessons learned from the last 10 years British Journal of Anaesthesia 114 (5): 728 45 (2015) Advance Access publication 17 February 2015. doi:10.1093/bja/aeu559 REVIEW ARTICLES Peripheral regional anaesthesia and outcome: lessons learned from

More information

Palliative Prescribing - Pain

Palliative Prescribing - Pain Palliative Prescribing - Pain LAURA BARNFIELD 21/2/17 Aims To understand the classes of painkillers available in palliative care To gain confidence in counselling regarding opiates To gain confidence prescribing

More information

NMDA Receptor Antagonists. Tanyanun Ngam-ek-eu Samita Pirotesak Supervised by Assist.Prof. Nantthasorn Zinboonyahgoon

NMDA Receptor Antagonists. Tanyanun Ngam-ek-eu Samita Pirotesak Supervised by Assist.Prof. Nantthasorn Zinboonyahgoon NMDA Receptor Antagonists Tanyanun Ngam-ek-eu Samita Pirotesak Supervised by Assist.Prof. Nantthasorn Zinboonyahgoon NMDA Receptor N-metyl-D-aspartic-acid receptors Glutamate-gated cation channels with

More information

Pain Management in the NICU. Tamorah Lewis MD, PhD

Pain Management in the NICU. Tamorah Lewis MD, PhD Pain Management in the NICU & Iatrogenic Opiate Withdrawal Tamorah Lewis MD, PhD Assistant Professor Divisions of Neonatology & Clinical Pharmacology, Toxicology and Therapeutic Innovation The Children's

More information

Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain

Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain H A R S H A S H A N T H A N N A. M D, M S C A S S O C I A T E P R O F E S S O R D E P A R T M E N T O F A N E S T H E S I A C H R O N I C

More information

Subspecialty Rotation: Anesthesia

Subspecialty Rotation: Anesthesia Subspecialty Rotation: Anesthesia Faculty: John Heaton, M.D. GOAL: Maintenance of Airway Patency and Oxygenation. Recognize and manage upper airway obstruction and desaturation. Recognize and manage upper

More information

ABSTRACT TITLE: Near-OR Perioperative Interventions to Decrease Hospital Length

ABSTRACT TITLE: Near-OR Perioperative Interventions to Decrease Hospital Length ABSTRACT NUMBER: 020-0094 ABSTRACT TITLE: Near-OR Perioperative Interventions to Decrease Hospital Length of Stay AUTHORS: Mark J. Lenart, MD Vanderbilt University 1301 Medical Center Drive Nashville,

More information

in the treatment of post-thoracotomy pain

in the treatment of post-thoracotomy pain Role of thoracic epidural anesthesia/analgesia in the treatment of post-thoracotomy pain 26th International Winter Symposium Update in Cardiothoracic Anesthesia January 7th - 8th, 2011, Leuven, Belgium

More information

The TAP Block: Rapidly Evolving From Managing Acute Post-Op Pain to Treating Chronic Abdominal Pain

The TAP Block: Rapidly Evolving From Managing Acute Post-Op Pain to Treating Chronic Abdominal Pain Interventional APRIL 9, 2018 The TAP Block: Rapidly Evolving From Managing Acute Post-Op Pain to Treating Chronic Abdominal Pain By Anil P. Pisharoty, MD Purpose This review article describes the increasing

More information

Clinical Fellowship Regional Anesthesia

Clinical Fellowship Regional Anesthesia Anesthesia and Perioperative Medicine Western University Regional Anesthesia Fellowship Program Directors Dr. Kevin Armstrong & Dr. Shalini Dhir Clinical Fellowship Regional Anesthesia The regional anesthesia

More information

EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC1

EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC1 PREVENTING PAIN IN NEUROSURGICAL PATIENTS EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 07RC1 SABINE HIMMELSEHER, EBERHARD F. KOCHS Department of Anaesthesiology Technical University Munich

More information

The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia

The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia This study has been published: The intensity of preoperative pain is directly correlated

More information

SEEING KETAMINE IN A NEW LIGHT

SEEING KETAMINE IN A NEW LIGHT SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES

More information

The Role of Ketamine in the Management of Complex Acute Pain

The Role of Ketamine in the Management of Complex Acute Pain The Role of Ketamine in the Management of Complex Acute Pain Dr James Bennett Consultant Anaesthetist Consultant Lead for Inpatient Pain Service East Sussex Healthcare NHS Trust STAPG Committee Member

More information