- |||||||||| ketamine / Generic mfg.
[VIRTUAL] Ketamine Use For Pediatric Medical Pain (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2594;
This study provides evidence that ketamine may be a useful treatment for pain control in children with medical diseases. It is associated with a significant decrease in opioid use.
- |||||||||| morphine sulphate / Generic mfg.
Beyond DNR: Perioperative Management of Limits on Life Sustaining Medical Therapies (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2476;
Pertinent history •Prostate cancer with metastasis to liver and multiple bones •Difficult cancer pain control; 240 mg morphine equivalents daily prior to fracture •Code status listed in chart is "DNR/DNI" (Do not resuscitate / Do not intubate) •Electronic Provider Orders for Life-Sustaining Treatment (ePOLST) available: Section A "Do Not Attempt Resuscitation/DNR," and Section B "Limited Additional Interventions" Physical Exam •Thin, somnolent, elderly-appearing man grimacing occasionally•Benign cardiopulmonary and airway exams •Vital signs - HR 105, BP 137/85, RR 16, SpO2 95% on room air Studies •INR 1.5 •Hematocrit 27 Section 1: Preoperative discussion 1.How does a patient's pre-operative code status apply in the operating room?...2.Would you place invasive monitors and/or begin vasoactive infusions? 3.Would you transfer the patient to the ICU?
- |||||||||| ketamine / Generic mfg.
[VIRTUAL] Ketamine As An Opioid Sparing Agent In Pre-hospital Trauma Casualty Care (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2336;
The opioid-sparing effect was mainly due to a reduction in the use of OTFC in patients receiving ketamine (41.4% vs. 60.2% of patients, p=0.001). Conclusion The use of ketamine in the prehospital setting as part of a pain management protocol has a significant opioid-sparing effect while maintaining a non-inferior analgesic effect.
- |||||||||| morphine sulphate / Generic mfg.
[VIRTUAL] Efficacy Of Liposomal Bupivacaine Tap Blocks In C-section Patients Receiving Intrathecal Morphine: An Observational Study (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2324;
All patients received spinal anesthesia (1.3-1.6 mL 0.75% bupivacaine) with preservative free morphine (100-200mcg.), post-op acetaminophen, and nonsteroidal anti-inflammatory...Opioid side effect was measured by tallying antiemetic and diphenhydramine use...Discussion In this population, LB TAP blocks were statistically effective but may not be clinically important in added pain reduction and do not substantially extend pain relief beyond intrathecal morphine. In other populations such as those at higher risk for uncontrolled postop pain such as opioid tolerance and chronic pain the effect may be more pronounced.
- |||||||||| morphine sulphate / Generic mfg., ropivacaine / Generic mfg.
[VIRTUAL] Postoperative Analgesia For Cystectomy - Comparison Between Epidural And Intravenous Pca Approaches (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2322;
Conclusion - These results show that the epidural analgesia protocol is more efficient at controlling both static and dynamic pain at 24h in a patient who underwent a partial or complete cystectomy. There were no other significant differences in respect to the outcomes studied, thus making it the most suitable analgesic protocol for this procedure.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., hydromorphone hydrochloride / Generic mfg.
[VIRTUAL] Pectoralis I And Serratus Anterior Plane Block Analgesia For Bilateral Mastectomy And Reconstruction: A Retrospective Analysis (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2315;
While our analysis did show a reduction in intraoperative opioid consumption, we did not see a significant postoperative benefit in either pain scores, opioid consumption, or LOS. This may be in part due to inadequate analgesia to the medial portion of the breast, as the PECS I/SAP combination might not anesthetize the anterior cutaneous branches of the intercostal nerves supplying the skin medial to the midclavicular line.3
- |||||||||| remifentanil / Generic mfg., morphine sulphate / Generic mfg., dantrolene / Generic mfg.
Uncle Rhabdo, My Cousin Vinnie, and Serena Williams Walk into a Bar - Rhabdomyolysis, Professional Ethics, and Legal Defense in the Setting of Medical Complications (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2295;
You proceed with an intravenous induction and maintain the patient under an unremarkable general anesthestic using a total intravenous anesthestic with propofol and remifentanil for the duration of the 4 hour procedure...Additional morphine does nothing to stop the patient's screaming, who is now febrile to 39.5 with a HR 200, BP 160/65...Dantrolene is started for rhabdomylosis...How is the role of an anesthesiologist different than other treating physicians? Things you should do vs. absolutely should not do?
- |||||||||| morphine sulphate / Generic mfg.
Beyond DNR: Perioperative Management of Limits on Life Sustaining Medical Therapies (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_2126;
Pertinent history •Prostate cancer with metastasis to liver and multiple bones •Difficult cancer pain control; 240 mg morphine equivalents daily prior to fracture •Code status listed in chart is "DNR/DNI" (Do not resuscitate / Do not intubate) •Electronic Provider Orders for Life-Sustaining Treatment (ePOLST) available: Section A "Do Not Attempt Resuscitation/DNR," and Section B "Limited Additional Interventions" Physical Exam •Thin, somnolent, elderly-appearing man grimacing occasionally•Benign cardiopulmonary and airway exams •Vital signs - HR 105, BP 137/85, RR 16, SpO2 95% on room air Studies •INR 1.5 •Hematocrit 27 Section 1: Preoperative discussion 1.How does a patient's pre-operative code status apply in the operating room?...2.Would you place invasive monitors and/or begin vasoactive infusions? 3.Would you transfer the patient to the ICU?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., sevoflurane / Generic mfg.
[VIRTUAL] Reduced Postoperative Pain In Patients Receiving Nociception Monitor Guided Analgesia During Elective Surgery (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_2002;
We attribute this to more timely, objective and personalized fentanyl dosing based on improved tritation of opioids to individual patient's response to nociceptive stimuli during anesthesia resulting in beneficial effects on pain experience. This study confirms the results of a previous pilot study conducted by Meijer et al., and further demonstrates that the benefits of NOL-Guided analgesia titration may be achieved independently of depth of anesthesia monitoring which may increase its adoption in routine clinical practice.
- |||||||||| remifentanil / Generic mfg., morphine sulphate / Generic mfg., dantrolene / Generic mfg.
Uncle Rhabdo, My Cousin Vinnie, and Serena Williams Walk into a Bar - Rhabdomyolysis, Professional Ethics, and Legal Defense in the Setting of Medical Complications (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1884;
You proceed with an intravenous induction and maintain the patient under an unremarkable general anesthestic using a total intravenous anesthestic with propofol and remifentanil for the duration of the 4 hour procedure...Additional morphine does nothing to stop the patient's screaming, who is now febrile to 39.5 with a HR 200, BP 160/65...Dantrolene is started for rhabdomylosis...How is the role of an anesthesiologist different than other treating physicians? Things you should do vs. absolutely should not do?
- |||||||||| ropivacaine / Generic mfg.
[VIRTUAL] Posterior Quadratus Lumborum Block In Myomectomy: A Randomized, Controlled, Trial (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1662;
P1
Here, we evaluated the posterior QLB's use in reducing morphine milligram equivalent (MME) consumption and post-operative pain in laparoscopic myomectomies...After induction of anesthesia, patients in the QLB group received bilateral posterior QLBs with 30 mL of 0.25% ropivacaine per side...Conclusion While this study is limited by its small sample size, it provides evidence the QLB may be useful in laparoscopic myomectomies. Further studies with a larger sample size may determine the effectiveness of this block in laparoscopic myomectomy.
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., rocuronium / Generic mfg.
Labor Epidural Struggles Lead to Cesarean Delivery Troubles on a TOLAC Patient (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1657;
The patient expresses a preference to avoid another neuraxial technique and you decide to bolus the labor epidural catheter with fentanyl 100 mcg and then with lidocaine 2% in 5 ml increments as you transport her urgently to the operating room...Is there any advantage in using succinylcholine or rocuronium?...What if the patient received intrathecal morphine as part of a spinal anesthetic? Does an intraoperative transversus abdominus block performed under direct visualization by the obstetrician have any additional benefit?
- |||||||||| morphine sulphate / Generic mfg.
[VIRTUAL] Tnfri-mtros-caspase-11 Pathway Plays An Important Role In Hiv Gp120 With Morphine-induced Neuropathic Pain (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_1486;
Does an intraoperative transversus abdominus block performed under direct visualization by the obstetrician have any additional benefit? These results suggest that spinal TNFRI-mtROS-caspase-11 signal pathway plays an important role in the HIV gp120-related neuropathic pain state, and provide evidence for a novel approach to treating chronic pain for PLWH with opioids.
- |||||||||| ketamine / Generic mfg.
The Heartbreak of Severe Aortic Stenosis in Pregnancy (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_1190;
If she received ketamine supplementation for her previous C-section do you think that any of the responsibility for her post-partum mental health problems can be laid at the feet of ketamine?...After LOR was achieved at a different intervertebral level this time with CSF return, PF morphine 100 ug and fentanyl 10 ug are administered intrathecally and the epidural catheter is threaded...What should you do now? If you choose to use an intrathecal catheter how should it be dosed for c-section anesthesia?
- |||||||||| ketamine / Generic mfg.
Opioids and the Operating Room: Peri-operative Wean, Intra-operative Care, and Post-operative Pain Management (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_895;
Since she fell and fractured her ankle, she has been taking hydrocodone/acetaminophen 10/325 mg 6-8 times a day, prescribed by the emergency department...What if she were on chronic opioids such as morphine and hydrocodone, would a peri-operative wean be necessary?...You proceed with the surgery and take the patient to the operating room where you induce general anesthesia with propofol, fentanyl, and rocuronium uneventfully...The ketamine infusion is weaned and she is started on oral methadone 20mg three times daily with a fentanyl patient controlled analgesia (PCA) for break through pain...How will you discharge the patient from the hospital with treatment for the pain and addiction? Is it safe to prescribe a recovering opioid addict short-acting agents?
- |||||||||| morphine sulphate / Generic mfg.
[VIRTUAL] Neuraxial Infusion Of Chloroprocaine Is Associated With Lower Postoperative Opioid Exposure In Infants (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_769;
While there was no difference between groups with regards to mean minimum alveolar concentration of inhaled anesthetic (R: 0.34 vs. G: 0.35; p = 0.91), the intraoperative morphine equivalents (mg/kg) were significantly lower in Group R (0.8 vs. G: 1.9; p = 0.001)... Continuous neuraxial administration of 2-chloroprocaine supports lower opioid consumption and facilitates extubation of neonates and infants undergoing open abdominal surgery.
- |||||||||| ketamine / Generic mfg.
Lost in Conversion: Intrathecal Opioids to Equivalent Oral Opioids in a Chronic Pain Patient with an Intrathecal Drug Delivery System (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_749;
Currently, >300,000 IDDSs have been implanted for chronic cancer pain and non-cancer pain, such as discogenic pain, lumbar spinal stenosis, low back pain, chronic abdominal pain, complex regional pain syndrome, and neuropathic pain conditions.2 Only three drugs (morphine, baclofen, and ziconotide) are approved by the US Food and Drug Administration (FDA) for use in intrathecal pain pump, but several drugs are used off-label, such as hydromorphone, fentanyl, sufentanyl, ketamine, clonidine, and bupivacaine...CASE HISTORY The patient is a 66-year-old female with a past medical history significant for pulmonary embolism, deep venous thrombosis (on Xarelto), bipolar disorder, asthma, chronic obstructive pulmonary disease, and chronic low back pain...Her pain is well controlled with oxycontin 30 mg bid and oxycodone 15 mg tid...Does it relate to the content of drug or it can happen to anyone with intrathecal drug delivery? 10) Your new pain fellow asked if there is anything you can do to prevent formation of granuloma in other patients.
- |||||||||| ketamine / Generic mfg.
Lost in Conversion: Intrathecal Opioids to Equivalent Oral Opioids in a Chronic Pain Patient with an Intrathecal Drug Delivery System (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_622;
Currently, >300,000 IDDSs have been implanted for chronic cancer pain and non-cancer pain, such as discogenic pain, lumbar spinal stenosis, low back pain, chronic abdominal pain, complex regional pain syndrome, and neuropathic pain conditions.2 Only three drugs (morphine, baclofen, and ziconotide) are approved by the US Food and Drug Administration (FDA) for use in intrathecal pain pump, but several drugs are used off-label, such as hydromorphone, fentanyl, sufentanyl, ketamine, clonidine, and bupivacaine...CASE HISTORY The patient is a 66-year-old female with a past medical history significant for pulmonary embolism, deep venous thrombosis (on Xarelto), bipolar disorder, asthma, chronic obstructive pulmonary disease, and chronic low back pain...Her pain is well controlled with oxycontin 30 mg bid and oxycodone 15 mg tid...Does it relate to the content of drug or it can happen to anyone with intrathecal drug delivery? 10) Your new pain fellow asked if there is anything you can do to prevent formation of granuloma in other patients.
- |||||||||| ketamine / Generic mfg.
[VIRTUAL] Incorporating Intraoperative Acupuncture To Reduce Opioid Usage After Total Knee Arthroplasty: A Prospective Cohort Trial (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_509;
Primary outcome data included the incidence of patients who maintained a low-dose opioid regimen defined as 15 or fewer oxycodone 5mg pills, or 112.5 oral morphine equivalents (OME) from POD0 to 30...ConclusionIn the context of the opioid epidemic, achieving low-dose perioperative opioid consumption is critical to reducing the risk of long-term opioid use. In this prospective cohort study, we present a feasible approach to integrating intraoperative electro-auricular acupuncture into an existing multimodal analgesia regimen for patients undergoing TKA to minimize post operative opioid usage.
- |||||||||| ketamine / Generic mfg.
The Heartbreak of Severe Aortic Stenosis in Pregnancy (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_424;
If she received ketamine supplementation for her previous C-section do you think that any of the responsibility for her post-partum mental health problems can be laid at the feet of ketamine?...After LOR was achieved at a different intervertebral level this time with CSF return, PF morphine 100 ug and fentanyl 10 ug are administered intrathecally and the epidural catheter is threaded...What should you do now? If you choose to use an intrathecal catheter how should it be dosed for c-section anesthesia?
- |||||||||| fentanyl citrate / Generic mfg., morphine sulphate / Generic mfg., tranexamic acid oral / Generic mfg.
Obstetric Hemorrhage: Be Ready, Prepare and Recognize (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_412;
A CSE is placed (1.5cc, hyperbaric 0.75% bupivacaine + fentanyl 15 mcg + preservative free morphine 150 mcg) in the OR and the surgery started...The MTP is continued and you request cryoprecipitate and tranexamic acid...On postoperative day two the patient's trachea is extubated and she is transferred to the postpartum floor on postoperative day three. The patient and her neonate are discharged home on postoperative day five.
- |||||||||| morphine sulphate / Generic mfg., temozolomide / Generic mfg.
[VIRTUAL] Morphine Reduces Glioma Tumor Growth Through Modulation Of Idh1 And Metabolic Re-programming (Virtual) - Jun 20, 2021 - Abstract #ASA2021ASA_355;
Thus, we conclude that the interaction between morphine and IDH1 mimics the beneficial IDH1 mutant phenotype. Our research highlights the need for personalized medicine pathways, illustrating that that even the choice of opiate for pain management can potentially affect oncologic disease.
- |||||||||| ketamine / Generic mfg.
Opioids and the Operating Room: Peri-operative Wean, Intra-operative Care, and Post-operative Pain Management (Mezzanine 16AB) - Jun 20, 2021 - Abstract #ASA2021ASA_72;
Since she fell and fractured her ankle, she has been taking hydrocodone/acetaminophen 10/325 mg 6-8 times a day, prescribed by the emergency department...What if she were on chronic opioids such as morphine and hydrocodone, would a peri-operative wean be necessary?...You proceed with the surgery and take the patient to the operating room where you induce general anesthesia with propofol, fentanyl, and rocuronium uneventfully...The ketamine infusion is weaned and she is started on oral methadone 20mg three times daily with a fentanyl patient controlled analgesia (PCA) for break through pain...How will you discharge the patient from the hospital with treatment for the pain and addiction? Is it safe to prescribe a recovering opioid addict short-acting agents?
- |||||||||| morphine sulphate / Generic mfg.
Enrollment change, Trial completion date, Trial withdrawal, Trial primary completion date: Anti-suicidal Effects of Buprenorphine in Opioid Use Disorder (clinicaltrials.gov) - Jun 18, 2021
P4, N=0, Withdrawn,
Is it safe to prescribe a recovering opioid addict short-acting agents? N=20 --> 0 | Trial completion date: Jan 2022 --> Jun 2021 | Recruiting --> Withdrawn | Trial primary completion date: Oct 2021 --> Jun 2021
- |||||||||| Decadron (dexamethasone) / Merck (MSD), Maxidex (dexamethasone eye drops, suspension) / Novartis
Enrollment change, Trial completion date, Trial termination, Trial primary completion date: Dose Escalation of Dexamethasone to Increase Duration of Transversus Abdominal Plane Block Following Cesarean Section (clinicaltrials.gov) - Jun 18, 2021
P2/3, N=29, Terminated,
N=20 --> 0 | Trial completion date: Jan 2022 --> Jun 2021 | Recruiting --> Withdrawn | Trial primary completion date: Oct 2021 --> Jun 2021 N=60 --> 29 | Trial completion date: Dec 2021 --> May 2021 | Active, not recruiting --> Terminated | Trial primary completion date: Dec 2020 --> May 2021; Low enrollment; recruitment challenges due to competing studies in women and infant center
- |||||||||| VS-505 / Vidasym
[VIRTUAL] Peri-operative Pain, Opioid Use, and Opioid Prescriptions Following Inpatient Head and Neck Cancer Surgery () - Jun 18, 2021 - Abstract #AHNS2021AHNS_135;
Our data shows that a substantial number of patients achieve adequate pain control without opioids prior to discharge from the hospital, yet a significant proportion of these patients still receive prescriptions for opioid medications. Furthermore, the amount of opioids prescribed at discharge does not consistently correlate with opioid use or pain levels while inpatient, particularly for patients with shorter durations of admission.
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