The Effect of Vibration on Pain During Intravenous Injection of Propofol: A Randomized Controlled Trial.

PURPOSE: Pain is a common side effect of intravenous injection of propofol. We conducted a randomized, prospective, single-blinded controlled trial to assess the efficacy of vibration analgesia on pain during propofol infusion in ambulatory surgery. METHODS: After institutional review board approval, 100 patients undergoing elective ambulatory surgery with general anesthesia were randomized into 2 groups. A control group (n = 50) consisted of patients who received infusion of propofol without vibration analgesia. A treatment group (n = 50) consisted of patients who received infusion of propofol with vibration analgesia using the Buzzy device. Pain was assessed using a 4-point pain manifestation scale scored by 2 independent, blinded observers. RESULTS: Participants in the treatment group with vibration analgesia were 0.47 times less likely (95% confidence interval, 0.24-0.94; P = 0.03) to experience any pain than the control group. The median summative pain score in the treatment group was significantly less than that of the control group [1 (interquartile range, 1-2) vs 2 (interquartile range, 2-4); P < 0.01] among participants who experienced any pain. Agreement between the 2 blinded observers regarding pain scores was excellent with κw = 0.82 (P < 0.001). Age, sex, body mass index, needle location or size, and medication doses did not differ significantly between the 2 groups. CONCLUSION: Vibration analgesia is an effective, low-risk modality that reduces the pain of intravenous propofol injection in general anesthesia.

Retroperitoneal Approach for Ilioinguinal, Iliohypogastric, and Genitofemoral Neurectomies in the Treatment of Refractory Groin Pain After Inguinal Hernia Repair.

Inguinal hernia repair is one of the most commonly performed surgical procedures. Postoperative neuropathic groin pain is a potentially disabling complication and can be due to a neuroma of the ilioinguinal, iliohypogastric, and/or genitofemoral nerves. In this article, we present our operative technique-a retroperitoneal approach to the ipsilateral ilioinguinal, iliohypogastric, and genitofemoral nerves with neurectomy and proximal transposition of these nerves-for management of neuropathic pain. A retrospective review was performed of 12 of the patients who underwent this surgery at our institution. Three of 12 patients underwent a selective neurectomy, whereas 9 of 12 underwent a triple neurectomy; 3 of the 9 patients who underwent triple neurectomy also had a retroperitoneal peripheral nerve stimulator placed at the time of neurectomy. Pain visual analog scores (VASs) demonstrated significant improvement after neurectomy (preoperative pain VAS of 85 ± 11 vs postoperative pain VAS of 47 ± 32, P = 0.0027). Eight of 12 patients experienced partial or complete pain relief, whereas 4 of 12 patients had no pain relief. There were no major complications, and the minor complication rate was low for all patients and primarily related to peripheral nerve stimulator placement. This retroperitoneal approach to triple neurectomy for treatment of refractory groin pain in postoperative inguinal hernia repair patients is safe and effective for an otherwise devastating problem.

Intraoperative Fluoroscopic Imaging for Suprascapular Nerve Localization During Spinal Accessory Nerve to Suprascapular Nerve Transfer.

Distal fiber transfer of the spinal accessory nerve (SAN) to the suprascapular nerve (SSN) has been well described as an effective means to regain shoulder external rotation following upper trunk brachial plexus injuries. Both supine and prone positioning techniques have been described with comparable success. Whereas the posterior technique allows for sufficient distal length on the SAN for effective neurotization of the infraclavicular brachial plexus and SSN both proximal and distal to the suprascapular ligament, localization of the SSN within the suprascapular notch can be challenging and time intensive, especially in the obese patient. The use of intraoperative C-arm fluoroscopy is presented as a viable method for more exact suprascapular notch identification during dissection of the SSN.

Population Health Implications of Medical Tourism.

BACKGROUND: Fifteen million U.S. patients each year seek medical care abroad; however, there are no data on outcomes and follow-up of these procedures. This study aims to identify, evaluate, and survey patients presenting with complications from aesthetic procedures abroad and estimate their cost to the U.S. health care system. METHODS: A single-center retrospective review was conducted. A cohort of patients presenting with complications from aesthetic procedures performed abroad was generated. Demographic, complication, and cost data were compiled. Patients were surveyed to assess their overall experience. RESULTS: Over a 36-month period, 42 patients met inclusion criteria (one man and 41 women), with an average age of 35 ± 11.4 years (range, 20 to 60 years). Comorbidities included four active smokers, two patients with hypertension, and one patient with diabetes. Average body mass index was 29 ± 4.4 kg/m (range, 22 to 38 kg/m). Procedures performed abroad included abdominoplasty (n = 28), liposuction (n = 20), buttock augmentation (n = 10), and breast augmentation (n = 7), with several patients undergoing combined procedures. Eleven patients presented with abscesses and eight presented with wound dehiscence. Eight of the 18 patients who were surveyed were not pleased with their results and 11 would not go abroad again for subsequent procedures. Average cost of treating the complications was $18,211, with an estimated cost to the U.S. health care system of $1.33 billion. The main payer group was Medicaid. CONCLUSIONS: Complications from patients seeking aesthetic procedures abroad will continues to increase. Patients should be encouraged to undergo cosmetic surgery in the United States to improve patient outcomes and satisfaction and because it is economically advantageous. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Nerve gaps.

SUMMARY: Peripheral nerve injury is a significant problem affecting greater that 1 million people around the world each year and poses major challenges to the plastic and reconstructive surgeon. When primary nerve repair is not possible, several options for management of the nerve gap include a nerve autograft, nerve conduit, and acellular nerve allograft. For extensive and proximal nerve injuries, cellular nerve allografts and nerve transfers may be considered. This article reviews the indications and outcomes for each option, as in many cases more than one option may be acceptable.

Splenic rupture as a complication of colonoscopy: report of a case.

Colonoscopy is a common procedure with the rare complication of a splenic injury. The proposed mechanism of injury is excessive splenocolic ligament traction. The diagnosis is made by computed tomography and the treatment is determined by the patient's stability. Here we report a case of splenic injury during colonoscopy with failure to manage conservatively. A review of the literature and suggested guidelines are also provided.