No abstract

WHAT'S KNOWN ON THIS SUBJECT:The role of inhaled nitric oxide (INO)

Introduction: Nuss procedure, a minimally invasive thoracoscopic approach to repair pectus excavatum, results in a smaller scar but significant pain. The purpose of this Institutional Review Boardapproved retrospective study was to compare postoperative pain management outcomes of adolescents who self-selected to receive or not receive preoperative self-hypnosis training before Nuss procedure. Self-hypnosis, an integrative medicine approach to pain management, may be more effective than traditional analgesics alone for managing postoperative pain. Methods:In 2011, 8 of 22 patients who underwent Nuss procedure received preoperative self-hypnosis training and postoperative self-hypnosis coaching. Postoperatively, patients received epidural analgesia with local anesthetic, intravenous patient-controlled opioid analgesia, and intravenous nonsteroidal anti-inflammatory drugs and transitioned to oral opioids and nonsteroidal anti-inflammatory drugs.Results: Self-hypnosis training was associated with use of fewer milligrams per hour of morphine equivalents ( p = .005) and lower mean pain intensity over the first 5 days of hospital stay ( p = .041). Despite the opioid-sparing effect of self-hypnosis training, nausea, vomiting, constipation, and hypoventilation were adverse effects experienced by patients in both groups. Discussion:The results of this retrospective study suggest that selfhypnosis provides an opioid-sparing effect for managing moderateto-severe pediatric postoperative pain after Nuss procedure. Further clinical studies are needed to validate the effectiveness of self-hypnosis for symptom management after painful pediatric surgical procedures.

Hypothesis: Structured communication curricula will improve surgical residents' ability to communicate effectively with patients. Design and Setting:A prospective study approved by the institutional review board involved 44 University of Connecticut general surgery residents. Residents initially completed a written baseline survey to assess general communication skills awareness. In step 1 of the study, residents were randomized to 1 of 2 simulations using standardized patient instructors to mimic patients receiving a diagnosis of either breast or rectal cancer. The standardized patient instructors scored residents' communication skills using a case-specific content checklist and Master Interview Rating Scale. In step 2 of the study, residents attended a 3-part interactive program that comprised (1) principles of patient communication; (2) experiences of a surgeon (role as physician, patient, and patient's spouse); and (3) role-playing (3-resident groups played patient, physician, and observer roles and rated their own performance). In step 3, residents were retested as in step 1, using a crossover case design. Scores were analyzed using Wilcoxon signed rank test with a Bonferroni correction.Results: Case-specific performance improved significantly, from a pretest content checklist median score of 8.5 (65%) to a posttest median of 11.0 (84%) (P=.005 by Wilcoxon signed rank test for paired ordinal data)(n=44). Median Master Interview Rating Scale scores changed from 58.0 before testing (P=.10) to 61.5 after testing (P=.94). Difference between overall rectal cancer scores and breast cancer scores also were not significant. Conclusions: Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills.

Knowledge of the effectiveness of multimodal analgesic treatments to manage children's postoperative pain during hospital stays is limited. Our retrospective chart review of a convenience sample of 200 pediatric surgical patients' pain experiences during the first 24 hours after laparoscopic appendectomy demonstrates the benefits of a multimodal analgesic approach. We found that pediatric patients who received perioperative IV ketorolac in addition to opioids reported statistically significantly lower mean pain intensity (n = 134, mean [M] = 2.9, standard deviation [SD] = 1.7) during the first 24 hours after surgery when compared with the pain intensity of patients who did not receive perioperative IV ketorolac (n = 66, M = 3.7, SD = 1.7, t = 3.14, P = .002). Patients who received perioperative IV ketorolac (M = 0.94, SD = 0.71) also received significantly fewer morphine equivalents of postoperative opioids during the first 24 hours after surgery than those who did not (M = 1.21, SD = 0.78, t = 2.41, P = .02). We will use data from these patients to introduce the potential for a personalized medicine approach to postoperative pain.

SHT before pectus excavatum repair by Nuss procedure results in less postoperative pain and requires less morphine equivalents over time for postoperative pain management. Opioid-sparing CILA, when paired with SHT, results in shorter LOS.

No abstract

No abstract