Improving Postoperative Pain Control After Cesarean Delivery with Enhanced Recovery in Patients on Buprenorphine Therapy

Abstract: Introduction: Prescription drug abuse presents a significant challenge to the management of post operative pain.Pain control amongst the opioid addicted patient can be especially challenging. We aimed to improve pain control after caesarian delivery with enhanced recovery in patients who are on buprenorphine medication-assisted therapy for the treatment of opioid addiction. Materials and Methods: We conducted a pilot study by implementing a protocol using liposomal bupivacaine injected at the time of cesarean delivery. Patients were then given 500mg acetaminophen every 4 hours, 800mg ibuprofen every 8 hours and 0.3mg IV buprenorphine every 6 hours as needed. The patients’ maintenance dosing of buprenorphine was divided into doses throughout the day. In addition, patients were ambulated 4 hours after surgery and had their catheter removed from their bladder as soon as they could safely ambulate. Eleven patients were prospectively recruited and then compared to a retrospective sample of seventeen patients. Results: Patients in the treatment group reported 27% lower pain scores (p Discussion: Our enhanced recovery protocol is an effective alternative to traditional pain control and is associated with a significant reduction in both pain scores and use of breakthrough IV buprenorphine as well as lower charges

Robotic Hysterectomy: Surgical Approach and Outcomes Among a Large Institutional Cohort

Introduction The purpose of this report is to describe a technique for performing a robotic total laparoscopic hysterectomy (rTLH) with clinical outcomes on safety and efficiency. The rationale for our approach is based on a critical evaluation of the literature. Methods Data from all rTLH procedures performed on our gynecologic oncology service between January 2017 and December 2019 were retrospectively reviewed. Using this database, perioperative data including surgical times, intra- and postoperative complications, and length of hospital stays were evaluated. The steps used to perform the procedure were outlined and illustrated. Results 826 cases of rTLH were performed during the study period. 688 of these cases were included for analysis. Malignant diagnoses were found in 218 cases. The median time from skin-to-skin for the entire cohort was 28.43 minutes for benign rTLH +/- BSO (bilateral salpingo oophorectomy) and 30.23 minutes for rTLH/BSO/cancer staging. Surgical complications included vaginal laceration, vaginal bleeding, urinary tract infection, serous fluid leakage from the incision, abdominal wall abscess, pelvic abscess, surgical site infection, serosal tear, enterotomy, rectal injury, acute kidney injury, perforated diverticulitis, and incarcerated bowel through the ventral hernia. The median length of stay was 1 day. The surgical technique is illustrated step by step. Conclusion This paper describes a safe and efficient technique to perform rTLH and shows that surgical times, complication rates, and length-of-stays compare favorably to the literature. A description of the technique clarifies many of the details of this procedure which can be made routine to minimize error and surgeon discrepancies. We encourage readers to use this paper as a guide to modify their techniques for robotically assisted laparoscopic hysterectomy

Velocity-independent thermal conductivity and volumetric heat capacity measurement of binary gas mixtures

In this paper, we present a single hot wire suspended over a V-groove cavity that is used to measure the thermal conductivity ($k$) and volumetric heat capacity ($\rho c_p$) for both pure gases and binary gas mixtures through DC and AC excitation, respectively. The working principle and measurement results are discussed

Reducing Postoperative Opioids After Minimally Invasive Hysterectomy with Enhanced Recovery

I Introduction: We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively. Materials and Methods: We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a 2-year period. We then compared six protocols, with 3 being ERAS protocols and 3 as traditional pain control methods. The control group was comprised of the traditional pain control group without intraoperative placement of local analgesia. Patient medical records were evaluated for demographics, surgical characteristics, opioid type and dose, pain scores, length of stay and complications. Opioids were converted to oral morphine dose equivalents. Results: 954 patients were included within the 6 protocols. Median opioid usage was the lowest in the ERAS group with premedication and highest in the control group (22.5mg versus 55.0mg, p Discussion: ERAS protocol with premedication was associated with significant reductions in postoperative opioid use and median pain scores when compared to traditional methods

Thermal Flow Meter with Integrated Thermal Conductivity Sensor

This paper presents a novel gas-independent thermal flow sensor chip featuring three calorimetric flow sensors for measuring flow profile and direction within a tube, along with a single-wire flow independent thermal conductivity sensor capable of identifying the gas type through a simple DC voltage measurement. All wires have the same dimensions of 2000 (Formula presented.) m in length, 5 (Formula presented.) m in width, and 1.2 (Formula presented.) m in thickness. The design theory and COMSOL simulation are discussed and compared with the measurement results. The sensor’s efficacy is demonstrated with different gases, He, N2, Ar, and CO2, for thermal conductivity and thermal flow measurements. The sensor can accurately measure the thermal conductivity of various gases, including air, enabling correction of flow rate measurements based on the fluid type. The measured voltage from the thermal conductivity sensor for air corresponds to a calculated thermal conductivity of 0.02522 [W/m·K], with an error within 2.9%.</p

The Effect of Aqueous Extract of Cinnamon on the Metabolome of Plasmodium falciparum

Malaria is responsible for estimated 584,000 deaths in 2013. Researchers are working on new drugs and medicinal herbs due to drug resistance that is a major problem facing them; the search is on for new medicinal herbs. Cinnamon is the bark of a tree with reported antiparasitic effects. Metabonomics is the simultaneous study of all the metabolites in biological fluids, cells, and tissues detected by high throughput technology. It was decided to determine the mechanism of the effect of aqueous extract of cinnamon on the metabolome of Plasmodium falciparum in vitro using 1HNMR spectroscopy. Prepared aqueous extract of cinnamon was added to a culture of Plasmodium falciparum 3D7 and its 50% inhibitory concentration determined, and, after collection, their metabolites were extracted and 1HNMR spectroscopy by NOESY method was done. The spectra were analyzed by chemometric methods. The differentiating metabolites were identified using Human Metabolome Database and the metabolic cycles identified by Metaboanalyst. 50% inhibitory concentration of cinnamon on Plasmodium falciparum was 1.25 mg/mL with p<0.001. The metabolites were identified as succinic acid, glutathione, L-aspartic acid, beta-alanine, and 2-methylbutyryl glycine. The main metabolic cycles detected were alanine and aspartame and glutamate pathway and pantothenate and coenzyme A biosynthesis and lysine biosynthesis and glutathione metabolism, which are all important as drug targets

Improving Postoperative Pain Control After Cesarean Delivery with Enhanced Recovery in Patients on Buprenorphine Therapy

Introduction: Prescription drug abuse presents a significant challenge to the management of post operative pain.Pain control amongst the opioid addicted patient can be especially challenging. We aimed to improve pain control after caesarian delivery with enhanced recovery in patients who are on buprenorphine medication-assisted therapy for the treatment of opioid addiction. Materials and Methods: We conducted a pilot study by implementing a protocol using liposomal bupivacaine injected at the time of cesarean delivery. Patients were then given 500mg acetaminophen every 4 hours, 800mg ibuprofen every 8 hours and 0.3mg IV buprenorphine every 6 hours as needed. The patients’ maintenance dosing of buprenorphine was divided into doses throughout the day. In addition, patients were ambulated 4 hours after surgery and had their catheter removed from their bladder as soon as they could safely ambulate. Eleven patients were prospectively recruited and then compared to a retrospective sample of seventeen patients. Results: Patients in the treatment group reported 27% lower pain scores (p Discussion: Our enhanced recovery protocol is an effective alternative to traditional pain control and is associated with a significant reduction in both pain scores and use of breakthrough IV buprenorphine as well as lower charges

Bi-Directional MEMS Thermal Flow Sensor for Respiratory Applications

This paper presents a MEMS bi-directional thermal flow sensor which consists of a pair of suspended thin wires. Wires are fabricated on both sides of the silicon wafer to form the upstream and downstream wires to measure the flow rate, and two more wires on the Si wafer to realize a Wheatstone bridge readout. Both wires are used as heater and sensor elements at the same time. In this paper we present a finite element analysis using COMSOL Multiphysics as well as measurement results on a fabricated device using air flow up to 2 m/s