scholarly journals Opioid analgesia on the battlefield: a retrospective review of data from Operation HERRICK

2018 ◽  
Vol 164 (5) ◽  
pp. 328-331 ◽  
Author(s):  
Pip Lewis ◽  
C Wright ◽  
C Hooper
Keyword(s):  
Local Population ◽  
Opioid Analgesics ◽  
Published Data ◽  
Opioid Analgesia ◽  
Complication Rates ◽  
Microsoft Excel ◽  
Fentanyl Citrate ◽  
Opium Abuse ◽  
Battlefield Environment ◽  
The 19Th Century

BackgroundAcute pain secondary to trauma is commonly encountered on the battlefield. The use of morphine to manage pain during combat has been well established since the 19th century. Despite this, there is relatively little research on analgesia use in this environment. This study aims to review the use and complications of morphine and other opioids during Operation HERRICK.MethodsA database search of the Joint Theatre Trauma Registry was completed looking for all incidences of morphine, fentanyl or naloxone use from February 2007 to September 2014. Microsoft Excel was used to analyse the results.ResultsOpioid analgesia was administered to 5801 casualties. Morphine was administered 6742 times to 3808 patients. Fentanyl was administered 9672 times to 4318 patients. Naloxone was used 18 times on 14 patients, giving a complication rate of 0.24%. Opioid doses prior to naloxone administration range from 0 to 72 mg of morphine and from 0 to 100 mcg of fentanyl. Four casualties (two local civilians and two coalition forces) received naloxone despite no recorded opioids being administered. Opium abuse was prevalent among the local population in Afghanistan, and this could explain the rationale behind two local national casualties receiving naloxone without any documented opioids being given.ConclusionThe use of opioids in a battlefield environment is extremely safe. Complication rates are similar to previously published data which is reassuring. The efficacy of different opioids was not covered by this study, and further analysis is required, particularly following the introduction of oral transmucosal fentanyl citrate and the availability of novel non-opioid analgesics.

2 Combat use of opioid analgesia and its complications: a retrospective review of data from OP herrick

2018 ◽  
Vol 164 (3) ◽  
pp. 224.2-224
Author(s):  
P Lewis ◽  
C Wright ◽  
C Hooper
Keyword(s):  
Local Population ◽  
Opioid Analgesia ◽  
Complication Rates ◽  
Microsoft Excel ◽  
Fentanyl Citrate ◽  
Opium Abuse ◽  
Battlefield Environment ◽  
The 19Th Century ◽  
Published Research ◽  
Combat Environment

BackgroundOn the battlefield, acute pain, particularly secondary to trauma, is a common condition which requires treatment in the pre-hospital, evacuation and hospital settings. The use of morphine to manage pain during combat has been well established since the 19th century. Despite this, there are relatively few papers reviewing analgesia use in a combat environment. This study aims to review the use and complications from morphine and other opioids during Op HERRICK.MethodsA database search of the Joint Theatre Trauma Registry (JTTR) was carried out looking for all incidences of administration of either morphine, fentanyl or naloxone from January 2007 to September 2014. Microsoft Excel was then used to analyse the dataset and perform descriptive statistics on the data retrieved.ResultsOpioid analgesia was administered to 5801 casualties. Morphine was administered 6742 times to 3808 patients. Fentanyl was administered 9672 times to 4318 patients. Naloxone was used 18 times on 14 patients, giving a complication rate of 0.24%. Opioid doses prior to naloxone administration range from 0–72 mg of morphine and 0–100 mcg of fentanyl. 4 casualties (2 local civilian and 2 coalition forces) received naloxone despite no recorded opioids being administered. Opium abuse was prevalent amongst the local population in Afghanistan, and this could explain the rationale behind 2 local national casualties receiving naloxone without any documented opioids being given.ConclusionThe use of opioids in a battlefield environment is extremely safe, with very few incidences of complications requiring the use of naloxone. Complication rates are comparable to previously published research. We are unable to comment on the effectiveness of opioids in relieving pain in this study, and further research is needed, particularly following the introduction of oral transmucosal fentanyl citrate (OTFC) and the availability of non-opioid analgesia.

scholarly journals Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 564
Author(s):  
Yen-Bo Liu ◽  
Lu-Ting Kuo ◽  
Chih-Hao Chen ◽  
Woon-Man Kung ◽  
Hsin-Hsi Tsai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Large Scale ◽  
Promising Result ◽  
Multivariable Logistic Regression Analysis ◽  
Published Data ◽  
Complication Rates ◽  
Minimally Invasive Neurosurgery ◽  
Reduction Of Mortality

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.

scholarly journals Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice

2002 ◽  
Vol 13 (6) ◽  
pp. 1-8 ◽  
Author(s):  
David G. Malone ◽  
Nevan G. Baldwin ◽  
Frank J. Tomecek ◽  
Christopher M. Boxell ◽  
Steven E. Gaede ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
Spinal Manipulation ◽  
Cervical Disc ◽  
Published Data ◽  
Complication Rates ◽  
Single Group ◽  
Expected Number ◽  
Manipulation Therapy ◽  
Number Of Patients

Object The authors report a series of 22 patients in whom major complications developed after cervical spinal manipulation therapy (CSMT). A second objective was to estimate the regional incidence of these complications and to compare it with the very low incidences reported in the literature. Methods During a 5-year period, practioners at a single group neurosurgical practice in Tulsa, Oklahoma, treated 22 patients, who were markedly worse during, or immediately after, CSMT. The details of these cases are reported. The 1995 US Government National Census was used to define the regional referral population for Tulsa. The published data regarding the incidence of serious CSMT-related complications and the rate of CSMTs undertaken nationally were used to estimate the expected number of CSMT-related complications in the authors' region. The number (22 cases) reported in this series was used to estimate the actual regional incidence. Complications in the series included radiculopathy (21 cases), myelopathy (11 cases), Brown–Séquard syndrome (two cases), and vertebral artery (VA) occlusion (one case). Twenty-one patients underwent surgery. Poor outcomes were observed in three, outcome was unchanged in one, and 17 improved. The number of patients in this series exceeded the expected number for the region. Conclusions Cervical spinal manipulation therapy may worsen preexisting cervical disc herniation or cause disc herniation resulting in radiculopathy, myelopathy, or VA compression. In cases of cervical spondylosis, CSMT may also worsen preexisting myelopathy or radiculopathy. Manipulation of the cervical spine may also be associated with higher complication rates than previously reported.

Endoscopic pituitary surgery: a systematic review and meta-analysis

2009 ◽  
Vol 111 (3) ◽  
pp. 545-554 ◽  
Author(s):  
Abtin Tabaee ◽  
Vijay K. Anand ◽  
Yolanda Barrón ◽  
David H. Hiltzik ◽  
Seth M. Brown ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Pituitary Surgery ◽  
Small Sample ◽  
Csf Leak ◽  
Tumor Control ◽  
Published Data ◽  
Complication Rates ◽  
Short Term ◽  
The Impact

Object Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes. Methods The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes. Results Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67–89%). Hormone resolution was achieved in 81% (95% CI 71–91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76–92%) of growth hormone secreting tumors, and 82% (95% CI 70–94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0–4%) for CSF leak and 1% (95% CI 0–2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%. Conclusions The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.

The opioid crisis: evaluating the safety and efficacy of opioid analgesia in the management of acute post-operative dental pain

Dental Update ◽  
2021 ◽  
Vol 48 (10) ◽  
pp. 859-864
Author(s):  
Daniel Merrick ◽  
Michael O'Sullivan ◽  
Mary Clarke
Keyword(s):  
Management Strategies ◽  
Opioid Analgesics ◽  
Dental Pain ◽  
Opioid Analgesia ◽  
Dental Practice ◽  
Opioid Use ◽  
Safety And Efficacy ◽  
Post Operative Pain ◽  
The Us ◽  
The Uk

The use and misuse of opioid analgesics have been highlighted in recent years. This review assesses dental opioid use, the effectiveness of opioid-containing analgesics versus non-opioid alternatives and the implications for post-operative pain management strategies in the dental practice. Guidelines for the management of acute post-operative dental pain differ from country to country. The UK has a low dental opioid use rate when compared to the US. The combination of paracetamol and ibuprofen has similar, if not better, analgesic properties compared to opioid-containing alternatives, with fewer adverse effects. CPD/Clinical Relevance: Non-opioid analgesics are both a safe and effective alternative to opioid analgesics in the management of post-operative dental pain.

scholarly journals Single incision laparoscopic surgery in general surgery: a review

2011 ◽  
Vol 93 (6) ◽  
pp. 437-440 ◽  
Author(s):  
N Greaves ◽  
J Nicholson
Keyword(s):  
Laparoscopic Surgery ◽  
General Surgery ◽  
Single Incision ◽  
Case Series ◽  
Published Data ◽  
Single Incision Laparoscopic Surgery ◽  
Complication Rates ◽  
Post Operative Pain ◽  
Randomised Controlled ◽  
Standard Laparoscopic Surgery

Single incision laparoscopic surgery (SILS) is a rapidly developing field that may represent the future of laparoscopic surgery. The major advantage of SILS over standard laparoscopic surgery is in cosmesis, with surgery becoming essentially scarless if the incision is hidden within the umbilicus. Only one incision is required so the risk of potential complications like port site hernias, haematomas and wound infection is reduced. The trade-off for this is a technically more challenging procedure with different underlying principles to that of traditional laparoscopic surgery. A wide variety of new equipment has been developed to support SILS and the range of procedures that are amenable to the technique is increasing. To date most of the published data relating to SILS are in the form of case series, with the first large randomised controlled trials due to be completed by the end of 2012. The existing evidence suggests that SILS is similar to standard laparoscopic surgery in terms of complication rates, completion rates and post-operative pain scores. However, the duration of SILS is longer than equivalent laparoscopic procedures. This article discusses SILS with regard to its applications in general surgery and reviews the evidence currently available.

scholarly journals Surgical treatment of hemorrhoids: a critical appraisal of the current options

2014 ◽  
Vol 27 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Marlise Mello CERATO ◽  
Nilo Luiz CERATO ◽  
Patrícia PASSOS ◽  
Alberto TREIGUE ◽  
Daniel C. DAMIN
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Long Term Results ◽  
Published Data ◽  
Complication Rates ◽  
Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

The Methodistical way: Revivalism and popular resistance to the Wesleyan Church discipline in the Stanstead Circuit, Lower Canada, 1821-52

2002 ◽  
Vol 31 (2) ◽  
pp. 171-194
Author(s):  
J.I. Little
Keyword(s):  
Local Community ◽  
Local Population ◽  
Central Feature ◽  
Religious Revival ◽  
Church Discipline ◽  
Popular Resistance ◽  
Lower Canada ◽  
The Face ◽  
Wesleyan Church ◽  
The 19Th Century

This essay examines the dynamic between the British Wesleyan missionaries and the American-origin population of the Stanstead Circuit within Lower Canada's Eastern Townships. It finds that early revivals were followed by years of slow church growth and stagnation as the missionaries were unable, or unwilling, to develop the lay leadership network that was a central feature of the Methodist system. By the middle of the 19th century, attempts to impose the church discipline on the local population had made relatively little progress in the face of the Rebellions of 1837-38, the Millerite religious revival, the incursion of radical Methodist splinter groups, and ongoing popular resistance to an externally dictated denominational exclusivism that posed a threat to local community bonds.

scholarly journals The role of Jazzar Pasha in the destruction of the sacral monuments on Kosovo: An example of tradition entering historiography

2018 ◽  
pp. 849-872
Author(s):  
Uros Sesum
Keyword(s):  
19Th Century ◽  
Oral Tradition ◽  
Building Materials ◽  
Local Population ◽  
Construction Materials ◽  
Historical Sources ◽  
Early 19Th Century ◽  
Inaccurate Information ◽  
Historical Fact ◽  
The 19Th Century

lore from Kosovo, regarding systematic destruction of Serbian medieval churches and monasteries, committed by the local and semi-independent Jashar pasha in the early 19th century, was introduced in Serbian historiography by way of Serbian travelogue literature during the second half of 19th and early 20th century. According to lore, Pasha destroyed monasteries Vojsilovica and Burinci, Samodreza church and several other village churches for the purpose of using building materials for his water mills. Allegedly, construction materials of destroyed church in Lipljan and several surrounding village churches were used for construction of the bridge on river Sitnica, while, also allegedly, he took the floor from Gracanica monastery for his hamam. Lead from the monastery roof was used to cover the mosque in Pristina. After a critical analysis of such lore, it can be stated that Pasha did not demolish a singe church or monastery, but in fact, for his projects, he used materials from the already destroyed temples. These writings of lore, combined with the local population?s perception of him as a cruel master, left a historic view of him as being the main destroyer of Serbian medieval churches and monasteries. Release of lore version of Serbian history, made by folklore writers, contributed to the rapid dissemination of inaccurate information. This had an encouraging affect which, as time went on, associated Pasha?s name with the large number of destroyed churches. In Serbian historiography such usage of travelogue literature from the 19th century and further developed oral tradition recorded by ethnologists as relevant historical sources, have led to the adoption of unverified data as historical fact.

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