Gator Regional Anesthesia Program http://www.anest.ufl.edu/gator-rap Articles and Discussions on Acute Pain Medicine and Regional Anesthesia Sun, 22 Nov 2009 21:20:32 +0000 http://wordpress.org/?v=2.8.6 en hourly 1 Rivals Take Aim at the Software Company SAS – NYTimes.com http://www.anest.ufl.edu/gator-rap/2009/11/rivals-take-aim-at-the-software-company-sas-nytimes-com/?utm_source=rss&utm_medium=rss&utm_campaign=rivals-take-aim-at-the-software-company-sas-nytimes-com http://www.anest.ufl.edu/gator-rap/2009/11/rivals-take-aim-at-the-software-company-sas-nytimes-com/#comments Sun, 22 Nov 2009 21:20:32 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=952
  • Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com
    • ]]>     As healthcare attempts to bring electronic records into mainstream clinical care, users at all levels should keep this budding competition in mind.

    Rivals Take Aim at the Software Company SAS – NYTimes.com.

    Related posts:

    1. Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/11/rivals-take-aim-at-the-software-company-sas-nytimes-com/feed/ 0     TAP Blocks and C-Sections: Case Discussion for the Week of November 16, 2009 http://www.anest.ufl.edu/gator-rap/2009/11/tap-blocks-and-c-sections-case-discussion-for-the-week-of-november-16-2009/?utm_source=rss&utm_medium=rss&utm_campaign=tap-blocks-and-c-sections-case-discussion-for-the-week-of-november-16-2009 http://www.anest.ufl.edu/gator-rap/2009/11/tap-blocks-and-c-sections-case-discussion-for-the-week-of-november-16-2009/#comments Mon, 16 Nov 2009 19:08:28 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=950
  • Regional Anesthesia for Breast Surgery: Case Discussion for the Week of November 2, 2009
  • Whither the multimers? vWD and Regional Anesthesia: Case Discussion for the Week of September 14, 2009
  • End of the Block: Case Discussion for the Week of May 18, 2009
    • ]]>     A 25 year-old female presents for elective c-section at 39 weeks gestation. She had a c-section with her last pregnancy due to failure to progress. She did not have an epidural with her last labor, and received an intrathecal anesthetic with “that morphine stuff they put in your back” for her c-section. . She remembers itching. Lots, and lots, of itching.

    During your pre-operative discussion with the patient, her husband asks you about “those TAP blocks my friend’s wife had. Do those things really work?”

    Your patient looks up at you, very expectantly.

    Questions for discussion:

    1. What are TAP blocks?

    2. Have they ever been used in C-sections?

    3. Do TAP blocks work for C-sections?

    4. What is the evidence behind TAP blocks for C-sections?

    Related posts:

    1. Regional Anesthesia for Breast Surgery: Case Discussion for the Week of November 2, 2009
    2. Whither the multimers? vWD and Regional Anesthesia: Case Discussion for the Week of September 14, 2009
    3. End of the Block: Case Discussion for the Week of May 18, 2009

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/11/tap-blocks-and-c-sections-case-discussion-for-the-week-of-november-16-2009/feed/ 2     NEJM — Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use http://www.anest.ufl.edu/gator-rap/2009/11/nejm-outcome-reporting-in-industry-sponsored-trials-of-gabapentin-for-off-label-use/?utm_source=rss&utm_medium=rss&utm_campaign=nejm-outcome-reporting-in-industry-sponsored-trials-of-gabapentin-for-off-label-use http://www.anest.ufl.edu/gator-rap/2009/11/nejm-outcome-reporting-in-industry-sponsored-trials-of-gabapentin-for-off-label-use/#comments Thu, 12 Nov 2009 22:40:13 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=948 Pain Management: Acute Clinical'>Faculty of 1000 Medicine | Browse [...] Related posts:
    1. NEJM — A Bloody Mystery
    2. Gabapentin and Ketamine for TAH.
    3. Faculty of 1000 Medicine | Browse > Anesthesiology & Pain Management > Pain Management: Acute Clinical
    ]]>     Worth reading. With all of the relatively recent literature on gabapentin for acute pain, we should remember this bit of history. NEJM — Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use.

    Related posts:

    1. NEJM — A Bloody Mystery
    2. Gabapentin and Ketamine for TAH.
    3. Faculty of 1000 Medicine | Browse > Anesthesiology & Pain Management > Pain Management: Acute Clinical

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/11/nejm-outcome-reporting-in-industry-sponsored-trials-of-gabapentin-for-off-label-use/feed/ 0     Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com http://www.anest.ufl.edu/gator-rap/2009/11/vital-signs-pain-often-lasts-long-after-breast-cancer-surgery-study-finds-nytimes-com/?utm_source=rss&utm_medium=rss&utm_campaign=vital-signs-pain-often-lasts-long-after-breast-cancer-surgery-study-finds-nytimes-com http://www.anest.ufl.edu/gator-rap/2009/11/vital-signs-pain-often-lasts-long-after-breast-cancer-surgery-study-finds-nytimes-com/#comments Tue, 10 Nov 2009 20:33:18 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=946
  • Pain Medicine: Acute and Persistent Postoperative Pain after Breast Surgery
  • Rivals Take Aim at the Software Company SAS – NYTimes.com
  • Continuous thoracic paravertebral block for major breast surgery.
    • ]]>     From the home page of the New York Times. A quick read on a topic of great importance for breast cancer survivors.   Vital Signs – Pain Often Lasts Long After Breast Cancer Surgery, Study Finds – NYTimes.com.

    Related posts:

    1. Pain Medicine: Acute and Persistent Postoperative Pain after Breast Surgery
    2. Rivals Take Aim at the Software Company SAS – NYTimes.com
    3. Continuous thoracic paravertebral block for major breast surgery.

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/11/vital-signs-pain-often-lasts-long-after-breast-cancer-surgery-study-finds-nytimes-com/feed/ 0     Regional Anesthesia for Breast Surgery: Case Discussion for the Week of November 2, 2009 http://www.anest.ufl.edu/gator-rap/2009/11/regional-anesthesia-for-breast-surgery-case-discussion-for-the-week-of-november-2-2009/?utm_source=rss&utm_medium=rss&utm_campaign=regional-anesthesia-for-breast-surgery-case-discussion-for-the-week-of-november-2-2009 http://www.anest.ufl.edu/gator-rap/2009/11/regional-anesthesia-for-breast-surgery-case-discussion-for-the-week-of-november-2-2009/#comments Mon, 02 Nov 2009 23:25:15 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=944
  • Blocking for Breast Surgery: Case for Discussion, Week of April 13 2009
  • TAP Blocks and C-Sections: Case Discussion for the Week of November 16, 2009
  • Whither the multimers? vWD and Regional Anesthesia: Case Discussion for the Week of September 14, 2009
    • ]]>     A 45 year-old female presents for unilateral, radical mastectomy. The patient has a history of malignant hyperthermia, is allergic to egg yolks, refuses etomidate due to nausea with prior uses, fears bad dreams from ketamine, worries about drug interactions with thiopental, dislikes the forgetfulness of benzodiazepines, and fears addiction from opioids. The patient is also intensely claustrophobic. She requests a regional anesthetic for her surgery, and complete avoidance of sedation or general anesthesia.

    Questions for consideration:

    1. Is propofol contraindicated based upon her allergy?

    2. How would you counsel this patient on the risks, benefits and alternatives of her request?

    3. For a complete regional anesthetic, which nerves would need to be blocked? Which nerve blocks would you employ?

    Related posts:

    1. Blocking for Breast Surgery: Case for Discussion, Week of April 13 2009
    2. TAP Blocks and C-Sections: Case Discussion for the Week of November 16, 2009
    3. Whither the multimers? vWD and Regional Anesthesia: Case Discussion for the Week of September 14, 2009

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/11/regional-anesthesia-for-breast-surgery-case-discussion-for-the-week-of-november-2-2009/feed/ 2     ROARing about Complications http://www.anest.ufl.edu/gator-rap/2009/10/roaring-about-complications/?utm_source=rss&utm_medium=rss&utm_campaign=roaring-about-complications http://www.anest.ufl.edu/gator-rap/2009/10/roaring-about-complications/#comments Fri, 30 Oct 2009 12:00:58 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=942
  • Identifying the sciatic nerve at the sub-gluteal level with u/s
  • A rose by any other name…
  • Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine: Maternal Mortality and Anesthesia
    • ]]>     How do we report complications stemming from the administration and management of regional anesthetics?  Once reported, how should we categorize them? What about advanced decision-support to guide local practices?

    Recently, Buckenmaier et al have recently published a superb system for cataloguing complications from regional anesthesia. In this series, they reported an overall morbidity rate of 9.5% and mortality rate of 0.08%.

    The story doesn’t end there. Head on over to http://www3.interscience.wiley.com/cgi-bin/fulltext/122593797/HTMLSTART for a nice review.

    Related posts:

    1. Identifying the sciatic nerve at the sub-gluteal level with u/s
    2. A rose by any other name…
    3. Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine: Maternal Mortality and Anesthesia

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/10/roaring-about-complications/feed/ 0     Test http://www.anest.ufl.edu/gator-rap/2009/10/test/?utm_source=rss&utm_medium=rss&utm_campaign=test http://www.anest.ufl.edu/gator-rap/2009/10/test/#comments Thu, 29 Oct 2009 18:14:55 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=935 Test

    No related posts.

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/10/test/feed/ 0     Gabapentin and Ketamine for TAH. http://www.anest.ufl.edu/gator-rap/2009/10/gabapentin-and-ketamine-for-tah/?utm_source=rss&utm_medium=rss&utm_campaign=gabapentin-and-ketamine-for-tah http://www.anest.ufl.edu/gator-rap/2009/10/gabapentin-and-ketamine-for-tah/#comments Thu, 29 Oct 2009 12:12:00 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=933
  • NEJM — Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use
  • The Effect of Perioperative IV Lidocaine on Post-Op Pain and Immune Function
  • Tapping into the Alternatives: Case for Discussion, Week of April 6 2009
    • ]]>     Ok, that’s a lot of gabapentin, at least compared to our use. Ketamine dosing a bit on the low end as the authors point out.  However, no difference in sedation post-operatively!. Also, minimal differences in opioid side-effect profile despite decreased opioid consumption. Wished they would have had a fourth group combining ketamine and gabapentin.

    via A&A via Ovid.

    Related posts:

    1. NEJM — Outcome Reporting in Industry-Sponsored Trials of Gabapentin for Off-Label Use
    2. The Effect of Perioperative IV Lidocaine on Post-Op Pain and Immune Function
    3. Tapping into the Alternatives: Case for Discussion, Week of April 6 2009

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/10/gabapentin-and-ketamine-for-tah/feed/ 0     The Effect of Perioperative IV Lidocaine on Post-Op Pain and Immune Function http://www.anest.ufl.edu/gator-rap/2009/10/the-effect-of-perioperative-iv-lidocaine-on-post-op-pain-and-immune-function/?utm_source=rss&utm_medium=rss&utm_campaign=the-effect-of-perioperative-iv-lidocaine-on-post-op-pain-and-immune-function http://www.anest.ufl.edu/gator-rap/2009/10/the-effect-of-perioperative-iv-lidocaine-on-post-op-pain-and-immune-function/#comments Thu, 29 Oct 2009 12:00:15 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=931
  • Pain Medicine: Acute and Persistent Postoperative Pain after Breast Surgery
  • Needles for Neurosurgery: Do preoperative skull blocks improve post-operative pain scores?
  • Gabapentin and Ketamine for TAH.
    • ]]>     What’s nice about this study is the control group: PCEA! The differences in pain scores were statistically different but of questionable clinical difference. Another study with incremental pain improvements, but importantly reflecting non-incremental changes in perioperative stress response. Also note the higher pain scores despite increased PCEA volume and intra-op opioid use (although, this could increase OR decrease post-op pain depending on your literature purview). A&A via Ovid.

    Related posts:

    1. Pain Medicine: Acute and Persistent Postoperative Pain after Breast Surgery
    2. Needles for Neurosurgery: Do preoperative skull blocks improve post-operative pain scores?
    3. Gabapentin and Ketamine for TAH.

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/10/the-effect-of-perioperative-iv-lidocaine-on-post-op-pain-and-immune-function/feed/ 0     Legal Case of the Month: October 2009 http://www.anest.ufl.edu/gator-rap/2009/10/legal-case-of-the-month-october-2009/?utm_source=rss&utm_medium=rss&utm_campaign=legal-case-of-the-month-october-2009 http://www.anest.ufl.edu/gator-rap/2009/10/legal-case-of-the-month-october-2009/#comments Fri, 23 Oct 2009 20:54:04 +0000 Patrick Tighe http://www.anest.ufl.edu/gator-rap/?p=926
  • Legal Case of the Month – May 2009
  • Legal Case of the Month: August 2009
  • Delayed onset quadriparesis and bilateral ptosis following an interscalene block- Case discussion week of 0ct 5th 2009
    • ]]>     A 42 year-old high earning medical professional that mostly works with his hand (he was a surgeon), and is also a very keen fly fisherman, developed a small rotator cuff tear that bothered him with fly-fishing. He sought the help of a famous orthopaedic surgeon in another state who could fix this tear arthroscopically.
    The anesthesia selected for this procedure was a continuous interscalene nerve block combined with light general anesthesia, although the patient expressed the doubt if he needed the continuous nerve block. In spite ofLegal Case of the Month: August 2009

    Disclaimer: The legal cases presented in this section are actual cases dealt with by Dr A P Boezaart as expert witness.  They are not dramatized and are factually presented to serve as learning experiences and teaching tool through cases that have no chance of ever getting published in the regular literature or otherwise reaching our attention.  Defense lawyers will never allow their clients to publish their mistakes.  The cases are presented in good faith, taking great care to avoid any references that can possibly identify the patient, the anesthesiologist, the surgeon, and the hospital the state or any other factor that may identify the case or put its outcome in jeopardy.  Most of these cases are settled out of court and are not sub judicae anymore.  If they are still sub judicae that is without the knowledge of the author.  If anybody recognizes the case, they are most likely mistaken.

    What follows is intended for Residents and Fellows to serve ONLY as a teaching tool. Other practitioners are welcome to read it and perhaps learn from it.

    André P Boezaart, MD, PhD that,

    A 42 year-old high earning medical professional that mostly works with his hand (he was a surgeon), and is also a very keen fly fisherman, developed a small rotator cuff tear that bothered him with fly-fishing. He sought the help of a famous orthopaedic surgeon in another state who could fix this tear arthroscopically.

    The anesthesia selected for this procedure was a continuous interscalene nerve block combined with light general anesthesia, although the patient expressed the doubt if he needed the continuous nerve block. In spite of that…

    Read more…

    Related posts:

    1. Legal Case of the Month – May 2009
    2. Legal Case of the Month: August 2009
    3. Delayed onset quadriparesis and bilateral ptosis following an interscalene block- Case discussion week of 0ct 5th 2009

    ]]>     http://www.anest.ufl.edu/gator-rap/2009/10/legal-case-of-the-month-october-2009/feed/ 1