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1.
Surg Oncol ; 53: 102055, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38394843

ABSTRACT

BACKGROUND: Pain management following mastectomy is a significant challenge often requiring opioids. Nonopioid pain management utilizing nerve blocks has been shown in other fields to reduce postoperative opioid use and may be effective for postoperative pain in mastectomy patients. The primary purpose of this study was to compare postoperative opioid use, measured in morphine milligram equivalents (MME), between mastectomy patients who underwent interpectoral nerve block (IPNB) and a historical control group. Secondary outcomes included length of stay (LOS) and postoperative pain scores. METHODS: This is a single-center, retrospective cohort study. The charts of women who underwent mastectomy for cancer without immediate reconstruction from 10/2017-12/2019 were reviewed. Wilcoxon rank sum test was used for unadjusted analysis and multiple linear regression for adjusted analysis. RESULTS: There were 105 patients included in this study, of which 37 (35%) underwent IPNB. In unadjusted analysis, median MME use was significantly lower in patients that received IPNB compared to the control group (IPNB = 5, controls = 17, p = 0.03). Patients that received IPNB had an observed reduction in LOS and postoperative pain, though these results failed to reach statistical significance. There were no IPNB-related complications. CONCLUSIONS: IPNB may be an effective strategy to decrease postoperative opioid use in mastectomy patients. Larger, prospective studies are needed to further investigate the effectiveness of IPNB.


Subject(s)
Breast Neoplasms , Endrin/analogs & derivatives , Nerve Block , Humans , Female , Mastectomy/adverse effects , Analgesics, Opioid/therapeutic use , Retrospective Studies , Breast Neoplasms/surgery , Breast Neoplasms/complications , Nerve Block/methods , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & control , Pain, Postoperative/etiology
2.
Semin Ultrasound CT MR ; 44(1): 12-17, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36792268

ABSTRACT

Breast-conserving surgery or lumpectomy requires localization of the lesion prior to surgery, which is traditionally accomplished by imaging-guided wire localization. Over the last decade, alternatives to wire localization have emerged. This work reviews the literature on one such wireless technology, SaviScout radar (SSR) system, and shares our experience with using this technology for presurgical tumor localization. The SSR surgical guidance system is non-radioactive. The radiologist implants a reflector device in the breast under mammography or ultrasound guidance at any time prior to surgery. The placement of this reflector can be confirmed from the cadence of a handheld percutaneous probe of a handpiece and console system. Results from several studies show that the surgical outcomes from SSR and wire-localization are similar. SSR provides operational advantages as the scheduling for reflector placement by radiologists is decoupled from surgery, but at an increased cost compared to wire-localization.


Subject(s)
Breast Neoplasms , Mastectomy, Segmental , Humans , Female , Mastectomy, Segmental/methods , Radar , Wireless Technology , Breast/diagnostic imaging , Mammography/methods , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Breast Neoplasms/pathology
4.
Ann Surg Oncol ; 27(12): 4828-4834, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32748151

ABSTRACT

BACKGROUND: Enhanced Recovery Protocols (ERPs) provide a multimodal approach to perioperative care, with the aims of improving patient outcomes while decreasing perioperative antiemetic and narcotic requirements. With high rates of post-operative nausea or vomiting (PONV) following total mastectomy (TM), we hypothesized that our institutional designed ERP would reduce PONV while improving pain control and decrease opioid use. METHODS: An ERP was implemented at a single institution for patients undergoing TM with or without implant-based reconstruction. Patients from the first two months of implementation (ERP group, N = 72) were compared with a retrospective usual-care cohort from a three-month period before implementation (UC group, N = 83). Outcomes included PONV incidence, measured with antiemetic use; patient-reported pain scores; perioperative opioid consumption, measured by oral morphine equivalents (OME); and length of stay (LOS). RESULTS: The characteristics of the two groups were similar. PONV incidence and perioperative opioid consumption were lower in the ERP than the UC group (21% vs. 40%, p 0.011 and mean 44.1 OME vs. 104.3 OME, p < 0.001), respectively. These differences in opioid consumption were observed in the operating room and post-anesthesia care unit (PACU); opioid consumption on the floor was similar between the two groups. Patient-reported pain scores were lower in the ERP than the UC group (mean highest pain score 6.4 vs. 7.4, p 0.003). PACU and hospital LOS were similar between the two groups. CONCLUSION: ERP implementation was successful in decreasing PONV following TM with and without reconstruction, while simultaneously decreasing overall opioid consumption without compromising patient comfort.


Subject(s)
Analgesia , Breast Neoplasms , Analgesics, Opioid/therapeutic use , Breast Neoplasms/surgery , Humans , Mastectomy/adverse effects , Pain , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Postoperative Nausea and Vomiting/epidemiology , Postoperative Nausea and Vomiting/etiology , Postoperative Nausea and Vomiting/prevention & control , Retrospective Studies
5.
J Surg Oncol ; 114(8): 947-950, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27634654

ABSTRACT

BACKGROUND AND OBJECTIVES: Lymphatic mapping (LM) and blue dye injections are essential to identification of sentinel lymph nodes (SLN) for melanoma. LM is performed the day before (DB) or the same day (SD) of surgery, but the optimal timing is unknown. Similarly, methylene blue (MB), used during SLN biopsy (SLNB), is administered diluted (dMB) or undiluted (uMB), but the relative efficacies are unknown. METHODS: Patients who underwent SLNB for melanoma from 2009 to 2013 at our institution were evaluated. Outcomes included operative correlation with LM, SLN identification, and postoperative complications. RESULTS: One hundred seventy-one patients underwent SLNB. Sixty-seven (39%) had DB LM. Sixty-seven (39%) received uMB. Operative findings correlated with both LM groups, though the DB patients had lower background count (P = 0.018) and lower highest SLN radioactive signal count (P = 0.046). More uMB patients had blue SLNs (90% vs. 68%, P = 0.001). There was no difference in the total number of SLNs or complication rates in the LM and MB groups. CONCLUSIONS: This is the first study to compare the use of DB LM with SD LM and the efficacy of uMB versus dMB. DB LM and uMB offer advantageous alternatives for patients and their surgeons without loss of accuracy or increased morbidity. J. Surg. Oncol. 2016;114:947-950. © 2016 Wiley Periodicals, Inc.


Subject(s)
Coloring Agents , Lymphoscintigraphy , Melanoma/pathology , Methylene Blue , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node/diagnostic imaging , Skin Neoplasms/pathology , Adult , Aged , Female , Humans , Lymphatic Metastasis , Male , Melanoma/diagnostic imaging , Melanoma/surgery , Middle Aged , Outcome Assessment, Health Care , Preoperative Care/methods , Retrospective Studies , Sentinel Lymph Node/pathology , Sentinel Lymph Node/surgery , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/surgery
6.
HPB (Oxford) ; 18(4): 360-6, 2016 Apr.
Article in English | MEDLINE | ID: mdl-27037206

ABSTRACT

BACKGROUND: Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy. METHODS: Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227). Subjects who underwent total pancreatectomy or pancreatitis surgery were excluded. New post-operative endocrine and exocrine insufficiency was defined as the need for new pharmacologic intervention within 1000 days from resection. RESULTS: 28 (16%) of 178 subjects without pre-existing endocrine insufficiency developed post-operative endocrine insufficiency: 7 (25%) did so within 30 days, 8 (29%) between 30 and 90 days, and 13 (46%) after 90 days. 94 (43%) of 214 subjects without pre-operative exocrine insufficiency developed exocrine insufficiency: 20 (21%) did so within 30 days, 29 (31%) between 30 and 90 days, and 45 (48%) after 90 days. Adjuvant radiation was associated with new endocrine insufficiency. On multivariate regression, pancreaticoduodenectomy and chemotherapy were associated with a greater risk of exocrine insufficiency. CONCLUSION: Reporting 30-day functional outcomes for pancreatic resection is insufficient, as nearly 45% of subjects who develop disease do so after 90 days. Reporting of at least 90-day outcomes may more reliably assess risk for post-operative endocrine and exocrine insufficiency.


Subject(s)
Exocrine Pancreatic Insufficiency/etiology , Islets of Langerhans/surgery , Pancreas, Exocrine/surgery , Pancreatectomy/adverse effects , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/adverse effects , Adult , Aged , Aged, 80 and over , Chemotherapy, Adjuvant/adverse effects , Databases, Factual , Exocrine Pancreatic Insufficiency/diagnosis , Exocrine Pancreatic Insufficiency/drug therapy , Exocrine Pancreatic Insufficiency/physiopathology , Female , Humans , Hypoglycemic Agents/therapeutic use , Islets of Langerhans/drug effects , Islets of Langerhans/pathology , Islets of Langerhans/physiopathology , Male , Middle Aged , Pancreas, Exocrine/drug effects , Pancreas, Exocrine/pathology , Pancreas, Exocrine/physiopathology , Pancreatic Neoplasms/pathology , Radiotherapy, Adjuvant/adverse effects , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Young Adult
7.
Arch Womens Ment Health ; 19(1): 187-91, 2016 Feb.
Article in English | MEDLINE | ID: mdl-25846018

ABSTRACT

We examined mental health care use in relation to depressive symptoms (Patient Health Questionnaire (PHQ-9) ≥ 10) among a nationally representative sample of pregnant women using data from the National Health and Nutrition Examination Survey 2005-2012. Logistic regression models estimated crude and adjusted odds ratios for mental health care use in the past year in relation to depressive symptoms. While 8.2 % (95 % CI 4.6-11.8) of pregnant women were depressed, only 12 % (95 % CI 1.8-22.1) of these women reported mental health care use in the past year.


Subject(s)
Depression/diagnosis , Depression/epidemiology , Mental Health Services/statistics & numerical data , Patient Acceptance of Health Care , Pregnancy Complications/psychology , Pregnant Women/psychology , Adult , Antidepressive Agents/therapeutic use , Depression/drug therapy , Female , Health Services Accessibility/statistics & numerical data , Health Surveys , Humans , Logistic Models , Mental Health , Nutrition Surveys , Pregnancy , Pregnancy Complications/epidemiology , Prevalence , Surveys and Questionnaires , United States/epidemiology
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