scholarly journals A Multimodal Approach for Opioid-Free Analgesia after Cesarean Section using Surgical Site Infiltration with Liposomal Bupivacaine

2019 ◽  
Vol 4 (1) ◽  
pp. 1-5
Author(s):  
Richard Chudacoff ◽  
2015 ◽  
Vol 5 (1) ◽  
pp. 6-9
Author(s):  
Vani Sabesan ◽  
Timothy R Jelsema ◽  
Daniel J Lombardo

ABSTRACT Adequate postoperative pain management after an orthopaedic procedure is critical for patient well-being, acceptable clinical outcomes and patient satisfaction. Current literature suggests over 80% of surgical patients’ state they have moderate to severe pain within 24 hours postoperatively. The standard in pain management for more than 40 years has been opioids, medications known for their many adverse effects and limited efficacy. Recently, a multimodal approach to pain control has been sought after for optimal postoperative pain management. This approach utilizes multiple methods of pain management, such as nerve blocks, wound infiltration with local anesthetics and oral analgesics, to concomitantly reduce postoperative pain. Liposomal bupivacaine, EXPAREL, has been shown to reduce pain for as long as 96 hours postoperatively in select studies. These studies have included both hard and soft-tissue procedures. The goal of this review is to examine the literature on EXPAREL and provide a comprehensive presentation for orthopaedic surgeons to apply to their practices. Sabesan V, Jelsema TR, Lombardo DJ. Proper Postsurgical Pain Management in Orthopaedics: Reviewing the Efficacy of Wound Infiltration with Liposomal Bupivacaine (EXPAREL). The Duke Orthop J 2015;5(1):6-9.


Author(s):  
Hala Ali ◽  
Sabah Ramadan Hussein Ahmed ◽  
Nadia Hussien Ahmed ◽  
Nagat Salah ◽  
Gehan Ahmed Mohmed Elbahlowan

2020 ◽  
Vol 29 (4) ◽  
pp. 2109-2130
Author(s):  
Lauren Bislick

Purpose This study continued Phase I investigation of a modified Phonomotor Treatment (PMT) Program on motor planning in two individuals with apraxia of speech (AOS) and aphasia and, with support from prior work, refined Phase I methodology for treatment intensity and duration, a measure of communicative participation, and the use of effect size benchmarks specific to AOS. Method A single-case experimental design with multiple baselines across behaviors and participants was used to examine acquisition, generalization, and maintenance of treatment effects 8–10 weeks posttreatment. Treatment was distributed 3 days a week, and duration of treatment was specific to each participant (criterion based). Experimental stimuli consisted of target sounds or clusters embedded nonwords and real words, specific to each participants' deficit. Results Findings show improved repetition accuracy for targets in trained nonwords, generalization to targets in untrained nonwords and real words, and maintenance of treatment effects at 10 weeks posttreatment for one participant and more variable outcomes for the other participant. Conclusions Results indicate that a modified version of PMT can promote generalization and maintenance of treatment gains for trained speech targets via a multimodal approach emphasizing repeated exposure and practice. While these results are promising, the frequent co-occurrence of AOS and aphasia warrants a treatment that addresses both motor planning and linguistic deficits. Thus, the application of traditional PMT with participant-specific modifications for AOS embedded into the treatment program may be a more effective approach. Future work will continue to examine and maximize improvements in motor planning, while also treating anomia in aphasia.


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