Postoperative pain control and opioid use with transversus abdominis plane block and scheduled multimodal pain management in patients undergoing cesarean section.

OBJECTIVE: The impact of a transversus abdominis plane (TAP) block in patients undergoing cesarean section requires further evaluation. The aim of this study was to compare postoperative pain scores and opioid use in cesarean surgery patients undergoing either a TAP block and scheduled multimodal pain management (SMPM) or SMPM alone. METHODS: In this retrospective, dual cohort study, cesarean surgery patients underwent neuraxial anesthesia and a TAP block (SMPM/TAP) or SMPM; the TAP block incorporated ropivacaine (20-30 mL) administered bilaterally. The group analyses involved a comparison of postoperative pain scores using the visual analog scale and opioid consumption at 24 and 24-48 h. RESULTS: There were 94 (52.8%) patients in the SMPM/TAP group and 84 (47.2%) subjects in the SMPM alone group. At 24 h postoperatively, the SMPM/TAP group exhibited significantly lower pain scores (4.07 vs 4.54) than the SMPM group (P < 0.001) and reduced opioid consumption (2.29 vs 3.28 mg; P < 0.001). However, at 24-48 h, the SMPM group demonstrated lower pain scores (5.46 vs 5.98) compared to the SMPM/TAP group (P < 0.001) and reduced opioid consumption (8.75 vs 10.21 mg; P < 0.001); overall opioid consumption was higher (12.50 vs 12.02 mg) in the SMPM/TAP group (P < 0.001). CONCLUSION: The TAP block improved cesarean surgery patients' pain scores and reduced opioid consumption at 24 h postoperatively but the effect of the TAP block was ephemeral as the SMPM/TAP group exhibited inferior pain scores and greater opioid consumption compared to the SMPM group at 24-48 h postoperatively.

The Impact of an Enhanced Recovery After Surgery Program on Patients Treated for Gynecologic Cancer in the Community Hospital Setting.

OBJECTIVES: The purpose of this study was to compare the outcomes of gynecologic oncology patients treated in the community hospital setting either under the auspices of an enhanced recovery after surgery (ERAS) protocol or in accordance with physician discretion. METHODS: We retrospectively evaluated a series of consecutive gynecologic oncology patients who were managed via open surgery in coincident with an ERAS pathway from January 2015 to December 2016. They were compared with a historical open surgery cohort who was treated from November 2013 to December 2014. The primary clinical end points encompassed hospital length of stay, hospital costs, and patient readmission rates. RESULTS: There were 86 subjects accrued in the ERAS group and 91 patients in the historical cohort. The implementation of ERAS occasioned a greater than 3-day mean reduction in hospital stay (8.04 days for the historical group vs 4.88 days for the ERAS subjects; P = 0.001) and correspondingly diminished hospital costs ($11,877.47/patient vs $9305.26/patient; P = 0.04). Moreover, there were 2 readmissions (2.3%) in the ERAS group compared with 4 (4.4%) in the historical cohort (P = 0.282). CONCLUSIONS: The results from our investigation suggest that adhering to an ERAS protocol confers beneficial hospital length of stay and hospital cost outcomes, without compromising patient readmission rates. Additional investigation scrutinizing the impact of ERAS enactment with more defined study variables in a larger, randomized setting is warranted.

Temperature threshold models for benthic macroinvertebrates in Idaho wadeable streams and neighboring ecoregions.

Water temperatures are warming throughout the world including the Pacific Northwest, USA. Benthic macroinvertebrates are one of the most important and widely used indicators of freshwater impairment; however, their response to increased water temperatures and their use for monitoring water temperature impairment has been hindered by lack of knowledge of temperature occurrences, threshold change points, or indicator taxa. We present new analysis of a large macroinvertebrate database provided by Idaho Department of Environmental Quality from wadeable streams in Idaho that is to be used in conjunction with our previous analyses. This new analysis provides threshold change points for over 400 taxa along an increasing temperature gradient and provides a list of statistically important indicator taxa. The macroinvertebrate assemblage temperature change point for the taxa that decreased with increased temperatures was determined to be about 20.5 °C and for the taxa assemblage that increased with increased temperatures was about 11.5 °C. Results of this new analysis combined with our previous analysis will also be useful for others in neighboring regions where these taxa occur.

Relationships of surface water, pore water, and sediment chemistry in wetlands adjacent to Great Salt Lake, Utah, and potential impacts on plant community health.

We collected surface water, pore water, and sediment samples at five impounded wetlands adjacent to Great Salt Lake, Utah, during 2010 and 2011 in order to characterize pond chemistry and to compare chemistry with plant community health metrics. We also collected pore water and sediment samples along multiple transects at two sheet flow wetlands during 2011 to investigate a potential link between wetland chemistry and encroachment of invasive emergent plant species. Samples were analyzed for a suite of trace and major elements, nutrients, and relevant field parameters. The extensive sampling campaign provides a broad assessment of Great Salt Lake wetlands, including a range of conditions from reference to highly degraded. We used nonmetric multidimensional scaling (NMS) to characterize the wetland sites based on the multiple parameters measured in surface water, pore water, and sediment. NMS results showed that the impounded wetlands fall along a gradient of high salinity/low trace element concentrations to low salinity/high trace element concentrations, whereas the sheet flow wetlands have both elevated salinity and high trace element concentrations, reflecting either different sources of element loading or different biogeochemical/hydrological processes operating within the wetlands. Other geochemical distinctions were found among the wetlands, including Fe-reducing conditions at two sites and sulfate-reducing conditions at the remaining sites. Plant community health metrics in the impounded wetlands showed negative correlations with specific metal concentrations in sediment (THg, Cu, Zn, Cd, Sb, Pb, Ag, Tl), and negative correlations with nutrient concentrations in surface water (nitrite, phosphate, nitrate). In the sheet flow wetlands, invasive plant species were inversely correlated with pore water salinity. These results indicate that sediment and pore water chemistry play an important role in wetland plant community health, and that monitoring and remediation efforts should consider pore water and sediment chemistry in addition to surface water chemistry.