Rejected

Many selective cyclooxygenase (COX-2) inhibitors are currently used in clinical practice. COX-2 inhibitors have good anti-inflammatory, analgesic, antipyretic effects, and gastrointestinal safety. However, the analgesic effects and adverse reactions of COX-2 after total knee/hip arthroplasty (TKA/THA) are not fully known.

Persistent post-concussive symptoms (PPCS) affect up to 30% of individuals following mild traumatic brain injury. PPCS frequently includes exercise intolerance. Sub-symptom threshold aerobic exercise has been proposed as a treatment option for symptom burden and exercise intolerance in this population. The primary aim of this study is to evaluate whether a progressive, sub-symptom threshold aerobic exercise program can alleviate symptom burden in adults with PPCS.

The opioid crisis has influenced practice changes to mitigate risks to patients receiving opioids. It is essential that nurses understand contemporary guidelines to provide safe patient care for patients receiving opioids.

Opioids are often prescribed in excess, or unnecessarily, after ambulatory surgery. Perioperative opioid stewardships should be a priority with an emphasis on multimodal pain control.

Pain control for patients in the Emergency Department (ED) with acute pancreatitis (AP) can be difficult and is often limited to intravenous opioids. The acute side effects from opioids are well known and their use in the treatment of AP is associated with prolonged length of hospitalization. Additionally, up to 10% of patients hospitalized for acute pancreatitis are still receiving opioids 6 months after discharge. Ultrasound-guided regional anesthesia by emergency physicians has increasingly proven to be an integral part of a multi-modal opioid sparing pain control strategy for patients in the ED. The ultrasound guided erector spinae plane block may be an ideal adjunct or alternative to opioids for analgesia from AP in the ED. The erector spinae plane block has already been successfully utilized by emergency physicians for pain control from rib fractures, herpes zoster, and more recently, acute appendicitis A lower thoracic erector spinae plane block targets sympathetic nerve fibers in addition to the dorsal and ventral rami via local anesthetic spread to the paravertebral space to provide both visceral and somatic analgesia. Herein, we present the first reported case of acute pancreatitis pain successfully managed by emergency physicians with the ESPB.

Labor is a complex process and labor pain presents challenges for analgesia. Epidural analgesia (EA) has a well-known analgesic effect and is commonly used during labor. This review summarized frequently encountered and controversial problems surrounding EA during labor, including the labor process and maternal intrapartum fever, to build knowledge in this area.

Enhanced recovery after cesarean (ERAC) delivery is an evidence-based, multi-disciplinary approach throughout pre-, intra-, post-operative period. The ultimate goal of ERAC is to enhance recovery and improve the maternal and neonatal outcomes. This review highlights the role of anesthesiologist in ERAC protocols. This review provided a general introduction of ERAC including the purposes and the essential elements of ERAC protocols. The tool used for evaluating the quality of ERAC (ObsQoR-11) was discussed. The role of anesthesiologist in ERAC should cover the areas including management of peri-operative hypotension, prevention and treatment of intra- and post-operative nausea and vomiting, prevention of hypothermia and multi-modal peri-operative pain management, and active pre-operative management of unplanned conversion of labor analgesia to cesarean delivery anesthesia. Although some concerns still remain, ERAC implementation should not be delayed. Regular assessment and process improvement should be imbedded into the protocol. Further high-quality studies are warranted to demonstrate the effectiveness and efficacy of the ERAC protocol.

Although peer coaching can help patients manage chronic conditions, few studies have evaluated the effects of peer coaching on coaches, and no studies have systematically examined these effects in the context of chronic pain coaching.

Physical therapy (PT) exercise is an evidence-based intervention for non-specific chronic low back pain, spinal deformities and poor posture. Home based PT programs are aimed at strengthening core muscle groups, improving mobility and flexibility, and promoting proper posture. However, assessing unsupervised home-based PT outcomes is a generally difficult problem due to lack of reliable methods to monitor execution correctness and compliance. We propose a monitoring method consisting of a wearable sensor array to monitor three geodesic distances between two points on the surface of the shoulders and one point on the lower back. The sensor array may be built into a custom garment or a light weight harness wirelessly linked to a pattern recognition algorithm implemented in a mobile app. We use a new type of triangular stretch sensor array design which can generate a unique signature for a correct spine therapy exercise when performed by a specific subject. We conducted a pilot test consisting of three experiments: (i) two exercise patterns simulated by a mechanical device, (ii) one PT case of a scoliosis therapy exercise including spinal flexion, extension, and rotation performed by one volunteer patient, and (iii) a set of three lower back flexibility exercises performed by six subjects. Overall, the results of correctness recognition show 70-100% sensitivity and 100% specificity. The pilot test provides key data for further development including clinical trials. The significance of the method includes simplicity of design and training method, ability to test with simulated signals, and potential to provide real time biofeedback.