Rejected

Lidocaine, as the only local anesthetic approved for intravenous administration in the clinic, can relieve neuropathic pain, hyperalgesia, and complex regional pain syndrome. Intravenous injection of lidocaine during surgery is considered as an effective strategy to control postoperative pain, but the mechanism of its analgesic effect has not been fully elucidated. This paper intends to review recent studies on the mechanism of the analgesic effect of lidocaine. To the end, we conducted an electronic search of the PubMed database. The search period was from 5 years before June 2019. Lidocaine was used as the search term. A total of 659 documents were obtained, we included 17 articles. These articles combined with the 34 articles found by hand searching made up the 51 articles that were ultimately included. We reviewed the analgesic mechanism of lidocaine in the central nervous system.

This poster builds on the CDC pain management guidelines and the current ASAM recommendations for substance use assessment to build an integrated primary care model for holistic chronic pain management in an urban, underserved primary care clinic. Using a case from our Federally Qualified Health Care Center, which operates in a southwest Denver clinic, a program of integrated care assessment, diagnosis, and holistic treatment planning is outlined for this client with chronic pain, physical, and behavioral health issues. Using a comprehensive care approach for complex clients, which are typical presentations for urban, underserved clients, we discuss the utilization of best practices in medication management for chronic pain (Alternatives to Opioids (ALTOS), prescribed and complementary and alternative practices (e.g., PT, acupuncture, etc), and behavioral health services (psychiatric assessment and treatment, psychotherapy, support groups, etc) to improve outcomes for our clients.

Sleep disturbance is common in patients with primary headache disorders. We were interest in whether poor sleep quality affects patients directly or via increases in the frequency and severity of headaches. To that end, we investigated the direct and indirect effects of sleep quality on the headache-related impact among patients with primary headache disorders.

Pregabalin and gabapentin are similar compounds with analgesic, anticonvulsant, and anxiolytic characteristics. Due to these pharmacological features, they are commonly used throughout the world in neuropathic pain treatment and anxiety disorders. Mild to moderate side effects of the central nervous system, such as dizziness and somnolence, are important factors in deciding to terminate the use of pregabalin. Studies have also reported that the use of dose-dependent pregabalin resulted in peripheral edema and weight gain. Described in this case report is hearing loss occurring after an increase in the drug dose of a patient using pregabalin.In this case, we wanted to present the occuring hearing-loss after an increase in the drug dose of the patient already using pregabalin.

People with acute-on-chronic breathlessness due to cardiorespiratory conditions frequently present to the emergency department (ED) causing burden for the person concerned, their carers and emergency services.

A best evidence topic was constructed according to a structured protocol. The question addressed was whether the application of an enhanced recovery protocol or pathway improves patient outcomes after cardiac surgery. A total of 3091 papers were found using the reported search. Finally, 12 papers represented the best available evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Six studies referred to enhanced recovery protocol as fast track (FT) and another 6 studies referred to it as enhanced recovery after surgery (ERAS). Significant differences from conventional care were reported for time to extubation or intubation time in 4 studies (3 FT, 1 ERAS), duration of intensive care unit stay in 6 studies (4 FT, 2 ERAS), length of hospital stay (LOS) in 8 studies (5 FT, 3 ERAS), cost in 5 studies (4 FT, 1 ERAS), pain scores in 2 studies (2 ERAS) and opioid use in 3 studies (3 ERAS). We conclude that FT or ERAS improve postoperative outcomes including length of stay and pain control, without increasing morbidity, mortality or readmission. However, there is a need for prospective studies and standardized protocols.

The management of pain, particularly chronic pain, is still an area of medical need. In this context, opioids remain a gold standard for the treatment of pain. However, significant side effects, mainly of central origin, limit their clinical use. Here, we review recent progress to improve the therapeutic and safety profiles of opioids for pain management. Characterization of peripheral opioid-mediated pain mechanisms have been a key component of this process. Several studies identified peripheral µ, δ, and κ opioid receptors (MOR, DOR, and KOR, respectively) and nociceptin/orphanin FQ (NOP) receptors as significant players of opioid-mediated antinociception, able to achieve clinically significant effects independently of any central action. Following this, particularly from a medicinal chemistry point of view, main efforts have been directed towards the peripheralization of opioid receptor agonists with the objective of optimizing receptor activity and minimizing central exposure and the associated undesired effects. These activities have allowed the characterization of a great variety of compounds and investigational drugs that show low central nervous system (CNS) penetration (and therefore a reduced side effect profile) yet maintaining the desired opioid-related peripheral antinociceptive activity. These include highly hydrophilic/amphiphilic and massive molecules unable to easily cross lipid membranes, substrates of glycoprotein P (a extrusion pump that avoids CNS penetration), nanocarriers that release the analgesic agent at the site of inflammation and pain, and pH-sensitive opioid agonists that selectively activate at those sites (and represent a new pharmacodynamic paradigm). Hopefully, patients with pain will benefit soon from the incorporation of these new entities.

The purpose of this study was to assess if clinical indications, patient location, and imaging sites predict the viewing pattern of referring physicians for CT and MR of the head, chest, and abdomen. Our study included 166,953 CT/MR images of head/chest/abdomen in 2016-2017 in the outpatient (OP, n = 83,981 CT/MR), inpatient (IP, n = 51,052), and emergency (ED, n = 31,920) settings. There were 125,329 CT/MR performed in the hospital setting and 41,624 in one of the nine off-campus locations. We extracted information regarding body region (head/chest/abdomen), patient location, and imaging site from the electronic medical records (EPIC). We recorded clinical indications and the number of times referring physicians viewed CT/MR (defined as the number of separate views of imaging in the EPIC). Data were analyzed with the Microsoft SQL and SPSS statistical software. About 33% of IP CT and MR studies are viewed > 6 times compared to 7% for OP and 19% of ED studies (p < 0.001). Conversely, most OP studies (55%) were viewed 1-2 times only, compared to 21% for IP and 38% for ED studies (p < 0.001). In-hospital exams are viewed (≥ 6 views; 39% studies) more frequently than off-campus imaging (≥ 6 views; 17% studies) (p < 0.001). For head CT/MR, certain clinical indications (i.e., stroke) had higher viewing rates compared to other clinical indications such as malignancy, headache, and dizziness. Conversely, for chest CT, dyspnea-hypoxia had much higher viewing rates (> 6 times) in IP (55%) and ED (46%) than in OP settings (22%). Patient location and imaging site regardless of clinical indications have a profound effect on viewing patterns of referring physicians. Understanding viewing patterns of the referring physicians can help guide interpretation priorities and finding communication for imaging exams based on patient location, imaging site, and clinical indications. The information can help in the efficient delivery of patient care.

Postoperative pain is a negative factor that seriously affects a surgical patient's rehabilitation. We investigated whether nalbuphine provides superior postoperative analgesia in orthognathic surgery compared with sufentanil and whether the superior analgesia is achieved by the regulation of inflammatory and oxidative stress.