Comparison of Clinical Outcome Variables in Patients With and Without Etomidate Facilitated Anesthesia Induction
Despite some concerns about its correlation to adrenal insufficiency during surgery, new research suggests that etomidate continues to be a valid option for single-dose anesthesia induction. Investigators conducted a retrospective analysis of 3,054 anesthesia and ICU records for patients who had major cardiac surgery between 2008 and 2012. Some 58 percent of the patients were given a single dose of etomidate for anesthesia induction, and 42 percent were not; but postoperative data revealed no significant difference between the two cohorts in terms of mortality, mechanical ventilation hours, renal failure, length of time in the ICU, total hospital stay, or parameters tied to sepsis.
From "Comparison of Clinical Outcome Variables in Patients With and Without Etomidate Facilitated Anesthesia Induction"
New Data of Peripheral Nerve Blocks for Headache
Peripheral nerve blocks (PNBs) have been found to safely and effectively relieve headache pain; however, it is not known which patients benefit most from the treatment. To augment the body of knowledge on PNBs, researchers led by Georgetown Headache Center director Jessica Ailani, MD, collected data from 164 adults suffering from headache disorders. Patients from 11 different sites provided feedback on the location, severity, and duration of their headaches; their preventative medication regimens; pain levels immediately after nerve block and two weeks later; adverse events; and satisfaction levels. Their healthcare providers, meanwhile, confirmed data block characteristics as well as type and dose of medication used for the procedure. The findings indicated that a wide range of blocks are being used to treat headache and that most patients are satisfied with the procedure. Although PNB site soreness, nausea and/or vomiting, and head and neck pain were identified as adverse effects for a small subset of patients, pain levels declined for many post-nerve block. "This is a very well-tolerated procedure ...," Ailani concluded. "We are going to take these data and try to find out anything that we can associate with improvement ... Does it matter the age and gender of the patient? They type of headache they have? Where we do a nerve block? Whether the site is tender? And whether these factors predict the success of the nerve block."
From "New Data of Peripheral Nerve Blocks for Headache"
Medscape (07/04/14) Anderson, Pauline
Efficacy of Methylprednisolone on Pain, Fatigue, and Appetite Loss in Patients With Advanced Cancer Using Opioids
Despite little proof that this approach works, cancer patients often take corticosteroids to manage their pain. To test the efficacy, researchers compared outcomes in a small group of patients who received 16 mg of methylprednisolone twice per day against outcomes for patients in a control group, who received placebos. At the end of the week-long study period, the two groups had similar pain intensity and analgesic consumption. While the results suggest that 32 mg of methylprednisolone does not offer additional pain relief to cancer patients taking opioids, the corticosteroid therapy did, in fact, significantly improve fatigue, loss of appetite, and satisfaction in this patient population. Additional research is needed to determine if there is a clinical benefit beyond the short term.
From "Efficacy of Methylprednisolone on Pain, Fatigue, and Appetite Loss in Patients With Advanced Cancer Using Opioids"
Journal of Clinical Oncology (07/14) Paulsen, Ornulf; Klepstad, Pal; Fayers, Peter; et al.
Certain States Dole Out Many More Pain Pills
The Centers for Disease Control and Prevention (CDC) counts 259 million prescriptions written last year for opioid painkillers, with some parts of the country doling out the drugs at a far greater clip than others. Healthcare providers in Alabama—located in the Southeast, the region with the highest rates—wrote 143 opioid prescriptions for every 100 residents, compared to just 52 per 100 people in Hawaii. The disparity cannot be attributed to differences in rates of painful conditions or injuries and most likely indicates inappropriate use of the drugs in certain areas. "Overdoses from opioid narcotics are a serious problem across the country, and we know opioid overdoses tend to be highest where opioids get the highest use," said CDC director Tom Frieden, adding that narcotics are useful but are not a panacea for every patient experiencing pain. An accompanying report focusing on the response to Florida's overdose epidemic suggests that policy changes and enforcement can help combat the problem.
From "Certain States Dole Out Many More Pain Pills"
USA Today (07/02/14) P. 3A Painter, Kim
Finally, A Diet That Doesn't Hurt
Some foods may trigger inflammation, which can affect pain; but researchers in France say that consuming a diet low in polyamines actually may alleviate pain following spinal surgery. Based on positive findings with rats, they conducted a study of 64 patients with high chronic pain levels and similar demographic traits. Some participants were randomly assigned to follow a special diet with intake of less than 10 micromoles of polyamines per day, while others were directed to a modified diet averaging more than 400 micromoles per day. All were instructed to adhere to the diets for seven days before spine surgery and for five days after. Patients in the polyamine-deprived group experienced significantly less postoperative pain at rest, as well as significantly improved quality-of-life scores both before and after the operation. The investigators documented mild gastrointestinal intolerance as the only side effect. "So a low-polyamine diet could be useful for surgery because pain is decreased, compliance [in following the diet] is high and adverse effects show no difference between the two groups," noted lead researcher Jean-Pierre Estebe, MD, PhD. He and his team suspect that polyamines modulate a particular kind of receptor that has been shown to influence chronic pain.
From "Finally, A Diet That Doesn't Hurt"
Anesthesiology News (07/01/14) Vol. 40, No. 7 Vlessides, Michael
Video Observation to Map Hand Contact and Bacterial Transmission in Operating Rooms
Researchers used intraoperative video observation to track patterns of anesthesia provider hand contact with anesthesia work environment (AWE) surfaces and to determine hand hygiene (HH) compliance. Serial bacterial cultures of high contact objects were used to characterize bacterial transmission over time. The researchers found a large number of HH opportunities and a low rate of HH compliance by anesthesia providers, with no correlation between frequency of hand contact with the AWE and bacterial contamination. According to the authors, while adherence to existing HH recommendations by anesthesia providers may not be feasible, "there does appear to be a correlation between HH compliance rates and bacterial contamination of the AWE, an observation that should stimulate further work to design new methods for control of bacterial transmission in operating rooms."
From "Video Observation to Map Hand Contact and Bacterial Transmission in Operating Rooms"
American Journal of Infection Control (07/01/2014) Vol. 42, No. 7, P. 698 Rowlands, John; Yeager, Mark P.; Beach, Michael; et al.
Gene Variants Found That Increase Pain Sensation After Common Childhood Surgery
Children with certain genetic variants may experience greater pain and require higher-than-average levels of morphine after surgery. The first genome-wide analysis of postsurgical pain in children found that two single-base gene variants at the TAOK3 locus, a site not previously linked to morphine sensitivity, was associated with a higher morphine requirement. The study, published online in the journal Pain, looked at 617 children between ages four and 18 who had their tonsils and adenoids removed in day-surgery procedures. The two TAOK3 variants were associated with about 8 percent of a 10-fold variance in morphine requirement among the children, which was comparable to the influence associated with age, body-mass index, and overall health status combined. The variants in TAOK3 and the amount of morphine necessary for pain relief held up for children of European ancestry but not for African-American children. Both groups, however, showed that the gene variants correlated with increased postoperative pain. Genes in the TAOK3 locus carry the code for a protein involved in signal transduction for many cell types, including neurons that transmit the sensation of pain.
From "Gene Variants Found That Increase Pain Sensation After Common Childhood Surgery"
Medical Xpress (06/30/14)
More Women Choosing Longer Labor With Less Pain, and Opting for Epidurals
Stanford University researchers say their research indicates a preference for the less painful childbirth that comes with an epidural, even if it prolongs labor. They administered a questionnaire to 40 women after they arrived at the hospital for induction of labor but before painful contractions set in. The survey—which asked if they would rather have higher pain for a shorter duration or lower pain for a longer period of time—was completed again within 24 hours after the women had their babies, to determine changes in attitude. Led by Brendan Carvalho, the researchers concluded that women are neither uninterested in natural children nor unduly afraid of pain; they simply want a lower level of manageable pain. "The one good thing that does happen in labor is we use patient-controlled analgesia," Carvalho noted. "Women control how much medication they get, which is better than getting prescribed a set dose from start to finish." Some experts, however, challenge the theory that epidurals drag out labor—which they say makes the research, published in the British Journal of Anaesthesia
From "More Women Choosing Longer Labor With Less Pain, and Opting for Epidurals"
Medical Daily (06/28/14) Mientka, Matthew
Do Teething Babies Need Medicine on Their Gums? No
Prescription drugs such as viscous lidocaine should not be used to treat teething in infants and young children, the Food and Drug Administration (FDA) is warning. A previous FDA recommendation said that parents and caregivers should not use benzocaine products for children under two years, except under the advice and supervision of a healthcare professional. In rare cases, the local anesthetic—which is used in various over-the-counter products—can lead to a condition called methomoglobinemia, in which the amount of oxygen carried in the bloodstream is significantly reduced. Children under two seem to be at higher risk for the condition. Viscous lidocaine is a prescription anesthetic that may be prescribed to chemotherapy patients who cannot eat because of mouth ulcers or to reduce the gag reflex during dental X-rays and impressions. But the Institute for Safe Medication practices has received reports of teething babies experiencing overdoses of viscous lidocaine, with symptoms including jitteriness, confusion, vision problems, vomiting, falling asleep too easily, shaking, and seizures. According to Michael R. Cohen, RPh, MS, ISMP president, the drug also "can make swallowing difficult and can increase the risk of choking or breathing in food. It can lead to drug toxicity and affect the heart and nervous system." Dr. Ethan Hausman, a pediatrician and pathologist at the FDA, noted that the agency "does not recommend any sort of drug, herbal or homeopathic medication or therapy for teething in children."
From "Do Teething Babies Need Medicine on Their Gums? No"
FDA Consumer Updates (06/26/2014)
While a pattern of perioperative hypotension and postoperative acute kidney injury (AKI) has been established in patients who receive angiotensin axis blockade (AAB) before vascular and other types of procedures, the implications of AAB before major orthopedic surgery are not well known. University of Michigan researchers undertook a single-site, retrospective study that included 922 patients having total knee or hip replacement or undergoing spinal fusion. The results revealed markedly higher post-induction hypotension and postoperative AKI in the 37 percent of patients who received AAB. As a result of the AKI, the AAB patients stayed in the hospital for 5.76 days compared to 3.28 days for the rest of the study population. There was no difference in the two groups, however, in terms of two-year mortality rates. The investigators conclude that a prospective, multi-center trial is necessary to verify that avoiding preoperative AAB would reduce AKI in patients having major orthopedic surgery under general anesthesia.
From "Pre-Operative Angiotensin Axis Blockade Increases Risk of Hypotension, Acute Kidney Injury With Major Orthopedic Surgery"
The Hospitalist (06/01/14) Grant, Julieann F.; Saul, D'Anna; Lopez, Alexis N.; et al.
New PNS Lead Relieves Pain in Amputees
The number of amputees in this country is growing as a result of war and diabetes, but healthcare providers still struggle to provide sufficient analgesia to these patients. Phantom or residual limb pain is often addressed with narcotics that offer limited relief, but there is promise in a new therapy being investigated at the Carolinas Pain Institute in Winston-Salem. Researchers there tested a lead developed specifically for peripheral nerve stimulation (PNS), as an alternative to using leads originally designed for spinal cord stimulation systems. The new device, which aims for less-invasive implantation and more flexibility and elasticity, effectively provided paresthesia coverage and significantly alleviated pain in 14 of 16 study participants who used it during a two-week home trial. The findings were well-received by experts, who welcomed the study as a solid first step in developing a clinically approved lead for PNS in treating pain.
From "New PNS Lead Relieves Pain in Amputees"
Pain Medicine News (06/01/2014) Ochoa, George