Acupuncture before surgery may reduce pain, opioid use

A new pilot study concludes that using acupuncture before surgery can reduce a person’s need for opioids following surgery. The Detroit-based researchers believe that acupuncture is a low-cost, safe method that reduces pain and anxiety in some people.

In the United States, the opioid crisis claimed the lives of 47,000 people in 2018, and almost a third of those deaths involved prescription opioids.

According to the Centers for Disease Control and Prevention (CDC), in 2018, two-thirds of drug overdose deaths involved an opioid. A 2018 report from Substances Abuse and Mental Health Services Administration (SAMHSA) states that 10.3 million people in the U.S. aged 12 or older misused opioids in the past year.

Opioids are a class of drugs that include the illegal drug heroin and the prescription drug fentanyl. Other prescription opioids include oxycodone, hydrocodone, morphine, and codeine.

According to a 2017 paper, over 80% of people receive a prescription for opioids after low-risk surgery. Almost 87% of these prescriptions include oxycodone or hydrocodone, which are the most common culprits in drug overdose deaths.

Doctors often use these opioids in inpatient settings and prescribe them to people when they leave the hospital.

In 2020, researchers found that opioid-related overdoses are 28% higher than reported because of incomplete death records.

Veterans are twice as likely to die from an accidental overdose compared with the general U.S. population. One study showed that the number of veterans’ who died due to an opioid overdose increased by 65% from 2010 to 2016.

In light of this opioid epidemic, there is an urgent need to decrease opioid use before or during surgeries.

In a recent pilot study, a team of researchers evaluated the efficacy of two different acupuncture techniques before a group of veterans underwent surgeries: battlefield acupuncture and traditional acupuncture.

They presented their findings at the Anesthesiology 2020 annual meeting in Chicago, IL, on October 5.

The researchers conducted two experiments. In the first, they divided participants into two groups of 21 veterans due to undergo hip replacement surgery.

The first group received traditional acupuncture before their surgery, and the second group received sham acupuncture. Sham acupuncture, or placebo acupuncture, mimics acupuncture.

People in the control group needed an average of 56 of morphine milligram equivalent (MME) in the first 24 hours after surgery. MME is a method of calculating a patient’s cumulative intake of any opioid drugs over 24 hours.

In comparison, those who had traditional acupuncture received an average of only 20.4 MME. Almost two-hirds less than the control group.

The veterans who underwent traditional acupuncture also reported higher satisfaction with their pain management 24 hours post-surgery.

After rating their treatment satisfaction on a scale of 1–10, those who had acupuncture reported less pain. They also experienced 15% less anxiety than the control group, although this was not statistically significant.

In the second experiment, 28 veterans scheduled for general surgery procedures received battlefield acupuncture. In the control group, 36 participants received sham acupuncture.

Battlefield acupuncture involves putting needles on ear acupoints.

‘Obsessed’ dentist stalker found outside surgery

Arrest in Chepstow of Thomas BaddeleyImage copyright
James C

Image caption

Baddeley was arrested near the surgery in Chepstow

A man who secretly stalked his dentist for years has been sent back to prison after being found outside his surgery.

Thomas Baddeley, 42, from Bristol, was sentenced in August after being found with a ‘murder kit’, near the home of his former dentist Ian Hutchinson.

On Friday, he pleaded guilty to breaching a restraining order by going to Dr Hutchinson’s surgery.

District Judge Martin Brown said his “obsession” was continuing and he would be sentenced on 23 October.

Baddeley was previously jailed for 16 months at Cardiff Crown Court after admitting stalking Dr Hutchinson without fear, alarm or distress, and two offences of possessing offensive weapons.

He had been arrested near Dr Hutchinson’s home in November 2019, wearing a balaclava and carrying what was described in court as a “murder kit”.

It contained items including a large knife, crossbow with bolts, bleach and a hammer, and his car seats were covered in plastic sheeting.

Image copyright
Gwent Police

Image caption

A crossbow was among the weapons found in Thomas Baddeley’s car in 2019

He was released from prison on licence after sentencing in August 2020, due to time served on remand.

In October 2020, a police officer saw Baddeley near Dr Hutchinson’s surgery in Chepstow.

The officer, who was aware of the restraining order, noted Baddeley was riding a bike and had made efforts to disguise himself.

Huge impact

He was walking “in the general direction” of the surgery when he was arrested.

Steve Jones, defending, told the court there had been no contact with Dr Hutchinson and that the dentist had not seen Baddeley.

However, Judge Brown said the case had had a huge impact on Dr Hutchinson.

“This is a very unhealthy obsession because there has been no other explanation presented to the court,” he said.

“The only reason you were in the Chepstow area was to continue your obsession.”

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Virtual care after surgery may be more convenient for patients

Virtual follow-up care for surgical patients provides as much face time with doctors as in-person care, according to a new study.

Due to the coronavirus pandemic, many surgical patients are being offered virtual follow-up appointments instead of in-person visits, the researchers noted.

Their study included 400 patients who had minimally invasive laparoscopic removal of their appendix or gallbladder at two North Carolina hospitals. They were randomly assigned to a post-discharge virtual or in-person visit.

The study began in August 2017 but was put on hold in March 2020 due to the coronavirus pandemic, and only 64% of patients completed the follow-up visit.

Lead author Dr. Carolina Reinke said sometimes people are feeling so well after minimally invasive surgery that they don’t bother with the follow-up.

Total clinic time was longer for in-person visits than virtual visits — 58 minutes versus 19 minutes — but patients in both groups spent the same amount of time with a member of their surgical team — 8.3 minutes versus 8.2 minutes — discussing their recovery.

The findings were presented this month at a virtual meeting of the American College of Surgeons. Research presented at meetings is typically considered preliminary.

“I think it’s really valuable for patients to understand that, in the virtual space scenario, they are still going to get quality time with their surgical team,” said Reinke, an associate professor of surgery at Atrium Health in Charlotte, N.C. “A virtual appointment does not shorten that time, and there is still an ability to answer questions, connect, and address ongoing medical care.”

This is one of the first studies to compare virtual follow-up visits and face-to-face surgery follow-ups, according to the researchers.

“Other studies have looked at the total visit time, but they haven’t been able to break down the specific amount of time the patient spends with the provider. And we wanted to know if that was the same or different between a virtual visit and an in-person visit,” Reinke said.

More information

The American Academy of Family Physicians has more on telemedicine.

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Surgery for benign breast conditions unlikely to harm breastfeeding ability

Having surgery for benign breast conditions won’t harm a woman’s future ability to breastfeed, new research suggests.

The study included 85 women, aged 18 to 45. Fifteen had a prior history of benign breast conditions, including cysts, benign tumors and enlarged breasts. Sixteen had had breast surgery, including breast augmentation, reduction mammoplasty and biopsy.

Whether they’d had surgery or not, 80% were able to breastfeed or obtain breast milk for bottle-feeding, according to findings presented Saturday at a virtual meeting of the American College of Surgeons. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

Each year, nearly one million women in the United States are diagnosed with benign breast conditions. About half of women will have a benign breast lesion in their lifetime.

Many of these conditions are managed with surgery. Other common breast procedures include surgery to reduce enlarged breast tissue or augmentation for asymmetry or developmental breast conditions.

“Pediatricians and obstetrician-gynecologists who refer teenage patients for treatment of breast conditions, as well as parents, are concerned that surgery may impact breast development and eventual lactation,” said study co-author Laura Nuzzi, clinical research manager at Boston Children’s Hospital.

There is limited research on how surgery for benign breast conditions may affect later breastfeeding. The authors are continuing their research in this area, they noted in an ACS news release.

Study co-author Shannon Malloy is a clinical research associate in the hospital’s Adolescent Breast Clinic.

Malloy said, “We hope to augment the conclusions from this study that suggest plastic reconstructive surgeons, primary care practitioners, and any provider who comes in contact with women who have a benign breast condition can reassure them that an operation for a benign breast condition is safe and should not preclude them from enjoying the benefits of surgery for fear of impairing future breastfeeding satisfaction and lactation.”

More information

The American Academy of Pediatrics has more on breastfeeding.

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Virtual Care After Surgery May Be More Convenient For Patients | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 7, 2020 (HealthDay News) — Virtual follow-up care for surgical patients provides as much face time with doctors as in-person care, according to a new study.

Due to the coronavirus pandemic, many surgical patients are being offered virtual follow-up appointments instead of in-person visits, the researchers noted.

Their study included 400 patients who had minimally invasive laparoscopic removal of their appendix or gallbladder at two North Carolina hospitals. They were randomly assigned to a post-discharge virtual or in-person visit.

The study began in August 2017 but was put on hold in March 2020 due to the coronavirus pandemic, and only 64% of patients completed the follow-up visit. Lead author Dr. Carolina Reinke said sometimes people are feeling so well after minimally invasive surgery that they don’t bother with the follow-up.

Total clinic time was longer for in-person visits than virtual visits (58 minutes versus 19 minutes), but patients in both groups spent the same amount of time with a member of their surgical team (8.3 minutes versus 8.2 minutes) discussing their recovery.

The findings were presented Saturday at a virtual meeting of the American College of Surgeons (ACS). Research presented at meetings is typically considered preliminary.

“I think it’s really valuable for patients to understand that, in the virtual space scenario, they are still going to get quality time with their surgical team,” said Reinke, an associate professor of surgery at Atrium Health in Charlotte, N.C. “A virtual appointment does not shorten that time, and there is still an ability to answer questions, connect, and address ongoing medical care.”

This is one of the first studies to compare virtual follow-up visits and face-to-face surgery follow-ups, according to the researchers.

“Other studies have looked at the total visit time, but they haven’t been able to break down the specific amount of time the patient spends with the provider. And we wanted to know if that was the same or different between a virtual visit and an in-person visit,” Reinke said.

The American Academy of Family Physicians has more on telemedicine.

Copyright © 2020 HealthDay. All rights reserved.

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Man Wins $$Award for Unauthorized Penis Surgery; More

Medical Battery: Patient and Proxy Didn’t Agree to Penis Mass Excision

A California appeals court has confirmed a multimillion dollar judgment awarded to a man who sustained injuries following penis surgery neither he nor his medical proxy consented to, according to a story posted on Legal Newsline.

In 2014, Keith Burchell went to Loma Linda University Medical Center, in Loma Linda, California, to have a small scrotal mass removed for testing. The outpatient procedure was supposed to be a relatively simple one.

During the procedure, however, Burchell’s surgeon, of Faculty Physicians and Surgeons of the Loma Linda University School of Medicine (FPS), discovered that the mass was more extensive than his presurgical exams had indicated, involving not only Burchell’s scrotum but his penis as well.

Believing this larger tumor to be malignant — and convinced that even a benign one of this size posed a potential risk should it continue to grow — the surgeon elected to remove the total mass. In the process, he excised tissue not only from his patient’s scrotum but also his penis, a procedure known as a “resection of the proximal corpora.” Such a resection, the physician understood, would almost certainly cause his patient to become impotent.

Despite this, the surgeon went ahead without further consultation with either his patient (who was under anesthesia) or his patient’s designated proxy, his ex-wife. (Because he’d failed to read the entire consent form, Baker was apparently unaware that Burchell had designated his ex-wife to be his proxy.)

The excised mass turned out to be benign, but Burchell experienced substantial postsurgical side effects. Some of these — including an infection that required emergency treatment — were temporary and ultimately resolved. Other effects, though, have proven more intractable, including difficulty urinating in the standing position, constant pain and numbness, and impotence. Two reconstructive surgeries — one in 2015, another the following year — have alleviated the pain somewhat but have “only partially and unsatisfactorily” resolved Burchell’s erectile problems.

In his suit against the medical group, FPS, Burchell alleged both professional negligence and what’s known in the law as “medical battery,” which in California can be of two kinds. The kind most relevant in the Burchell case is when a doctor obtains patient consent to perform one type of procedure but ends up performing a “substantially different” type for which no consent has been obtained.

The trial jury sided with Burchell, awarding him $4 million for past noneconomic loses, $5,250,000 for future noneconomic loses, and roughly $22,000 in economic damages.

FPS appealed, arguing, among other things, that the state’s long-standing cap on noneconomic damages — the Medical Injury Compensation Reform Act (MICRA) (1975) — should limit the plaintiff’s noneconomic damages to no more than $250,000.

The appeals court disagreed. It would have been one thing, the justices said, had the surgeon, in the course of treating the patient, encountered a complication requiring a procedure for which the patient had not consented but that nevertheless constituted a life-threatening emergency requiring immediate attention.

Study: Pot users may need more anesthesia, painkillers during, after surgery

Marijuana users appear to need more anesthesia than nonusers, and also more opioids to relieve their pain after surgery, a new, preliminary study reports.

Users of cannabis products who had surgery for a broken leg required higher doses of sevoflurane, an inhaled anesthetic that keeps you asleep during a procedure. These folks also required nearly 60% more opioid painkillers per day while recuperating in the hospital, the researchers found.

The results jibe with earlier studies indicating that marijuana users might need more anesthesia initially to put them under, said lead author Dr. Ian Holmen, a resident anesthesiologist with the University of Colorado Anschutz Medical Campus in Aurora.

“It’s similar to flying a plane. You have a takeoff section, and then you have your cruising section and then your landing. These in anesthesia are induction, maintenance and emergence,” Holmen said. “We found that it’s not just in the induction phase of anesthesia that you need more anesthesia, but even during that cruising phase you need more inhaled anesthetic.”

The findings were reported Monday at an online meeting of the American Society of Anesthesiologists. Research presented at meetings is typically considered preliminary.

The implications for most marijuana users are not dire, according to Holmen and Dr. David Dickerson, vice chair of the ASA’s Committee on Pain Medicine.

Pot users should simply be honest with their doctors about their marijuana consumption, so they can dial in their anesthetic dose more accurately, said Dickerson.

“We want to know there might be a need for more anesthesia,” he said. “The last thing we want to do is to be under-dosing if someone is going to have an increased requirement. The more information we have, the more we can react and monitor to keep a patient safe during a procedure.”

But marijuana users who have heart or lung health issues might face some danger in the operating room, depending on how much additional anesthetic they need during surgery, Holmen added.

“Sevoflurane has a very clear dose-dependent effect on blood pressure,” he said. “The more sevoflurane you receive in the OR, the more a patient’s blood pressure drops. If you have heart problems or lung problems coming into the OR, it could be dangerous.”

For this study, Holmen and his colleagues reviewed the records of 118 patients who had surgery at the University of Colorado hospital for a broken shin bone.

Of those, 30 patients reported using cannabis. Holmen said that the amount and frequency of use were not recorded, nor was the type of cannabis product used — CBD, THC, edibles or smoked pot.

During surgery, marijuana users not only needed more inhaled sevoflurane anesthetic, but also higher doses of hydromorphone painkillers, the researchers found.

They also reported higher post-surgery levels of pain that needed larger doses of opioid painkillers to quell.

There are a few potential explanations. It could be that marijuana use alters the way that anesthetic and pain medications are processed by the body, Dickerson said.

“Cannabis is metabolized in the liver. Medications

Black children twice as likely to die after surgery than White children

Black children are more than twice as likely as White kids to die from surgical complications, and minority children are about half as likely to even have surgery as white children, two new studies show.

In one study, researchers found that of nearly 277,000 children who had inpatient surgery between 2012 and 2017, 10,425 suffered a complication that required follow-up surgery and 209 subsequently died.

Of those deaths, 135 patients were White — 1.6% of all White children who suffered a complication — and 74 were Black — 3.7% of all Black children who suffered a complication.

“We don’t fully understand all of the issues that place a Black child at greater risk and how all of these issues interact with each other,” said study author Dr. Brittany Willer, a pediatric anesthesiologist at Nationwide Children’s Hospital, in Columbus, Ohio.

“Our study gives physician anesthesiologists and surgeons insight into those at highest risk, to heighten their awareness of the most vulnerable patients during the early postoperative period, which may have the biggest immediate impact on easing racial disparities,” Willer added.

In the second study, researchers analyzed U.S. National Health Interview Survey data on more than 227,000 children aged 18 or younger, including more than 11,000 who had inpatient or outpatient surgery in the previous 12 months.

After adjusting for factors such as the health of the child, poverty, insurance and the parents’ level of education, the researchers found that Black, Asian and Hispanic children were about half as likely as White children to have surgery.

The findings were presented Saturday at the virtual annual meeting of the American Society of Anesthesiologists. Such research is considered preliminary until published in a peer-reviewed journal.

There’s no evidence to suggest that White children are more likely to require surgery or to have cosmetic procedures — factors that might have helped explain the large difference, according to the researchers at UT Southwestern Medical Center in Dallas.

“All parents want the best medical care for their children, and ensuring that quality surgical care is available for minority as well as White children will require a multifaceted solution,” lead author Dr. Ethan Sanford, an assistant professor of anesthesiology and pain management, said in a meeting news release. “Clearly, we have a lot of work to do.”

More information

The Children’s Hospital of Philadelphia explains how to prepare your child for surgery.

Copyright 2020 HealthDay. All rights reserved.

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Study: Veterans with acupuncture before surgery have less pain

Oct. 5 (UPI) — Veterans who have acupuncture before surgery reported less need for opioids for pain, a pilot study presented Monday at the ANESTHESIOLOGY 2020 meeting shows.

“Six percent of patients given opioids after surgery become dependent on them, and veterans are twice as likely to die from accidental overdoses than civilians,” said study lead author Dr. Brinda Krish,.

“Clearly it is crucial to have multiple options for treating pain, and acupuncture is an excellent alternative. It is safe, cost effective and it works,” said Krish, an anesthesiology resident at Detroit Medical Center.

Researchers analyzed two groups of patients treated at John D. VA Medical Center in Detroit. The study’s principal investigator, physician anesthesiologist Dr. Padmavathi Patel, provided the acupuncture.

The first group included 21 patients who had traditional acupuncture, which involves the insertion of very thin needles at specific trigger points around the body to relieve pain, and 21 patients who did not.

The second group included 28 patients who received battlefield acupuncture, which a U.S. Air Force doctor developed to reduce pain without use of opioids on the front lines, and 36 patients in control group.

In both acupuncture groups, veterans reported significant reduction in post-operative pain and post-operative opioid use compared to control patients undergoing surgery without acupuncture.

“Some patients were open to trying acupuncture right away, and others became more interested when they learned more about the risk of opioid use,” Krish said.

“It’s easy, patients love it, it’s not just another medicine and it’s very safe. Because battlefield acupuncture was developed by an armed services doctor, veterans also were more willing to participate.”

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Hold Off Radiotherapy After Prostate Cancer Surgery

Most men who undergo radical prostatectomy can skip adjuvant radiotherapy and can be followed with observation alone. They can undergo early salvage radiotherapy if the disease shows sign of progressing, say experts reporting results from three similar clinical trials.

This approach would allow most men to avoid radiotherapy and its side effects altogether, the investigators emphasize.

The studies were published online September 28 in The Lancet and The Lancet Oncology.

“There is a strong case now that observation should be the standard approach after surgery and [that] radiotherapy should only be used if the cancer comes back,” commented Chris Parker, MD, the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom.

“Results suggest that radiotherapy is equally effective whether it is given to all men shortly after surgery or given later to those men with recurrent disease,” he said in a statement.

Parker was lead investigator on the largest of the studies, the phase 3 RADICALS-RT trial, published in The Lancet. Preliminary results were reported at a meeting last year. Similar results from two other trials were published in The Lancet Oncology. A preplanned meta-analysis of the three trials was published in The Lancet.

Despite a number of limitations to each of the studies, they represent “an important step forward” and support the use of early salvage radiotherapy for many patients following radical prostatectomy, write experts in an accompanying comment. The editorialists are Derya Tilki, MD, University Hospital Hamburg-Eppendorf, Hamburg, Germany, and Anthony D’Amico, MD, Brigham and Women’s Hospital and the Dana Farber Cancer Institute, Boston, Massachusetts.

However, the editorialists question whether the results apply to all men who have undergone a radical prostatectomy.

One possible exception are men at high risk for progression, such as patients with a Gleason score of 8 to 10 or whose tumor is of grade pT3b or higher. Such patients made up fewer than 20% of participants in the three clinical trials. For high-risk patients, the editorialists think it would be “prudent” to consider adjuvant radiotherapy rather than early salvage therapy.

Results From RADICALS-RT

The RADICALS-RT trial involved 1396 patients who were followed for a median of 4.9 years. Participants had to have at least one risk factor for biochemical progression. These factors included disease of pathologic T-stage 3 or 4, a Gleason score of 7 to 10, positive margins, or a preoperative prostate-specific antigen (PSA) level ≥10 ng/mL.

Half of the men were randomly assigned to receive adjuvant radiotherapy (delivered within 6 months of study enrollment for 90% of patients). One quarter of this group also received either neoadjuvant or adjuvant hormone therapy, the investigators note.

The other half were followed with observation and received salvage radiotherapy group only if they showed biochemical progression within 8 years following randomization.

There was no evidence of a difference in biochemical progression-free survival (bPFS) between the adjuvant and salvage groups, Parker and colleagues report. At 5 years, bPFS rates were 85% for men in the adjuvant radiotherapy group and 88%