New approach to manage post surgical pain with less opioids

A new study has reported that the post-surgical pain can be effectively managed with minimal or no opioids.

The study revealed that the number of opioid medications prescribed after surgery can be drastically reduced without negatively affecting pain scores, postoperative complications or patient requests for additional opioids, demonstrating that alternative approaches to pain management can be both safe and highly effective.

Researchers conducted a case control cohort study evaluating whether , after hospital discharge, post surgical acute pain can be effectively managed with a markedly reduced number of opioid doses.

The cohort study included 1231 patients undergoing gynecologic oncology surgery. Patients undergoing ambulatory or minimally invasive surgery ( laparoscopic or robotic approach), were not prescribed opioids at discharge unless they required more than 5 doses of oral or intravenous opioids while in the hospital. Patients who underwent laparotomy were provided with a 3 day opioid pain medication at discharge.

The study found that during its first year alone,  the restrictive protocol eliminated the circulation of 16,374 opioid tablets ( 5 mg oxycodone equivalent) significantly reducing the volume of opioids that could be misused or diverted. The results of the full 2 year study of 1231 patients demonstrated that because postoperative pain can be managed effectively without opioids for minor or minimally invasive surgical procedures or with only 3-day supply for major surgery, the risks of chronic opioid misuse can be managed by reducing or eliminating opioid prescription in the first place.

Using ultra-restrictive opioid prescription protocol (UROPP) to manage post-surgical pain after discharge did not result in any negative health consequences and we advocate for adopting radical opioid sparing approaches for managing postoperative pain nationwide, writes the authors.

The study concluded that the implementation of  UROPP in a large surgical service is feasible and safe and was associated with a significantly decreased number of opioids dispensed during the perioperative period , particularly among opioid naive patients.

Opioids are routinely prescribed for postoperative pain management for most patients with limited evidence of the amount needed to be dispensed. Opioid based treatment often adversely affects recovery. Prescribed opioids increase the risk of chronic opioid use, and diversion and contribute to the current opioid epidemic.

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Read more at Speciality Medical Dialogues: Study finds new approach to manage post surgical pain with less opioids https://speciality.medicaldialogues.in/study-finds-new-approach-to-manage-post-surgical-pain-with-less-opioids/

Read more at Speciality Medical Dialogues: Study finds new approach to manage post surgical pain with less opioids https://speciality.medicaldialogues.in/study-finds-new-approach-to-manage-post-surgical-pain-with-less-opioids/

Read more at Speciality Medical Dialogues: Study finds new approach to manage post surgical pain with less opioids https://speciality.medicaldialogues.in/study-finds-new-approach-to-manage-post-surgical-pain-with-less-opioids/

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Experts and doctors from all over the world  have gathered to deliberate on rectal cancer treatment outcome in an effort to find protocols to standardise and optimise cancer treatment in the country.

 

At the day-long meet, doctors discussed and shared opinions on standards and protocols for diagnosis, pathological reporting, chemotherapy, new surgical procedures including robotic surgery, recording complications and follow-up.

 

The experts emphasised on multi-modality approach for better outcomes.

Like in the west, rectal cancer is becoming a major problem in our country. Incidence of rectal cancer has increased in the country during the last two decades.
    It is supposed to be third-most common cancer. The reason for increasing incidence is urbanisation, junk food, smoking, alcohol, red meat, genetic predisposition and obesity.

A Dr. said, "To treat rectal cancer effectively multiple specialties like radiology, pathology, GI surgeons, medical and radiation oncologist have to come together and formalise a strategy. This is called multi-modality approach."
 

Nearly 50 doctors participated in the meeting. The move will help health institutions in delivering standardise treatment through set guidelines for rectal cancer patient.

According to a Surgical Gastroentero Onco, Bariatric and Minimal Access Surgery, "This is an effort which is being done first time in the country and first meeting of RCTOG was very promising in achieving its set goals. In absence of standards and protocols, treatment for rectal cancer could not be optimised and that resulted in varied outcomes".

"There was an urgent need to standardise and protocolise treatment for uniformity and better outcomes. Multi-modality approach will bring in immense benefits to the people suffering from rectal cancer," he added.
 

"This group is also going to initiate a registry in which multiple institutes and specialists will share their data which will help us in creating awareness, joint research protocol, training of younger medical professionals and better treatment outcome," the Dr. said.

 

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Amputees can learn to control robotic limbs with minds

Amputees can learn to control a robotic arm with their mind even several years after an amputation, through electrodes implanted in the brain, according to a study led by an Indian-origin scientist. 

Researchers showed that the areas of the brain used to control the amputated limb and the remaining, intact limb can create new connections to learn how to control the device. 

"That is the novel aspect to this study, seeing that chronic, long-term amputees can learn to control a robotic limb," said a professor. 
 
"But what was also interesting was the brains plasticity over long-term exposure, and seeing what happened to the connectivity of the network as they learned to control the device," said a senior author of the study. 

Previous experiments have shown how paralysed human patients can move robotic limbs through a brain machine interface. 

The study is one of the first to test the viability of these devices in amputees as well. 

Researchers worked with three rhesus monkeys who suffered injuries at a young age and had to have an arm amputated to rescue them four, nine and 10 years ago respectively. 

In two of the animals, they implanted electrode arrays in the side of the brain opposite, or contralateral, to the amputated limb. This is the side that used to control the amputated limb. 

In the third animal, the electrodes were implanted on the same side, or ipsilateral, to the amputated limb. This is the side that still controlled the intact limb. 

The monkeys were then trained to move a robotic arm and grasp a ball using only their thoughts. 

The scientists recorded the activity of neurons where the electrodes were placed, and used a statistical model to calculate how the neurons were connected to each other before the experiments, during training and once the monkeys mastered the activity. 

The connections between neurons on the contralateral side - the side that had been controlling the amputated arm - were sparse before the training, most likely because they had not been used for that function in a long time. 

However, as training progressed, these connections became more robust and dense in areas used for both reaching and grasping. 

Researchers found that first the connections were pruned and the networks thinned, before rebuilding into a new, dense network. 

"That means connections were shedding off as the animal was trying to learn a new task, because there is already a network controlling some other behavior," said a researcher who led the study. 

"But after a few days it started rebuilding into a new network that can control both the intact limb and the neuroprosthetic," said the researcher.

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Kidney transplant performed with the assistance of robots

  Kidney transplant procedures involve a deep cut on the patient's belly button, which helps in placing the new organ in the body. However, the surgery can be performed by inflicting little more than a small keyhole size cut, with the assistance of robot during the procedure. A Bengaluru-based hospital has successfully performed two kidney transplants through this procedure.

Failure of her kidneys saw 35-year-old lady lose a lot of weight, besides a rapid deterioration in her overall health condition. When it seemed as if regular dialysis was the only option left for her, her mother-in-law volunteered to donate a kidney, which gave her a new lease of life.

A 29 year old man, from Odisha too was diagnosed with complete renal failure. His 50-year-old mother came forward to donate one of her kidneys, and saved her son from a difficult life. 

Neither of the two patients had to undergo the complicated surgeries that kidney transplant procedures are commonly associated with, advanced robotic technology ensured that they suffered very little; they also had to endure very short stays at the hospital following the surgery.

'Robotic instruments have 360 degree rotational capacity, compared with the human wrist, which is just 270 degrees. Also, they provide us a three dimensional view of the human anatomy The images are high definition and magnified," said Dr Deepak Dubey, consultant urologist and renal transplant surgeon at Manipal Hospital, where the procedure was performed. 

 He added that the surgical team had rehearsed the procedure thoroughly the previous day, and the patients and family members were provided with all the necessary formation.

Chairman of Manipal Hospitals, Dr H Sudarshan Ballal said that heightened awareness, the modest cost of procedures and the promise of a speedy recovery had helped put India on the global map, as far as robot-assisted surgeries were concerned. "Such procedures have started to cover a wide spectrum of procedures - cardiac, urology, general surgery, thoracic, gynaecology, et al," he added. 

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