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Tong L, Solla C, Staack JB, May K, Tran B. Perioperative Pain Management for Thoracic Surgery: A Multi-Layered Approach. Semin Cardiothorac Vasc Anesth 2024:10892532241235750. [PMID: 38506340 DOI: 10.1177/10892532241235750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Cardiothoracic surgeries frequently pose unique challenges in the management of perioperative acute pain that require a multifaceted and personalized approach in order to optimize patient outcomes. This article discusses various analgesic strategies including regional anesthesia techniques such as thoracic epidurals, erector spinae plane blocks, and serratus anterior plane blocks and underscores the significance of perioperative multimodal medications, while providing nuanced recommendations for their use. This article further attempts to provide evidence for the efficacy of the different modalities and compares the effectiveness of the choice of analgesia. The roles of Acute Pain Services (APS) and Transitional Pain Services (TPS) in mitigating opioid dependence and chronic postsurgical pain are also discussed. Precision medicine is also presented as a potential way to offer a patient tailored analgesic strategy. Supported by various randomized controlled trials and meta-analyses, the article concludes that an integrated, patient-specific approach encompassing regional anesthesia and multimodal medications, while also utilizing the services of the Acute Pain Service can help to enhance pain management outcomes in cardiothoracic surgery.
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Affiliation(s)
- Larry Tong
- Virginia Commonwealth University, Richmond, VA, USA
| | - Che Solla
- University of Tennessee, Knoxville, TN, USA
| | | | - Keith May
- University of Tennessee, Knoxville, TN, USA
| | - Bryant Tran
- Virginia Commonwealth University, Richmond, VA, USA
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Hashemi SM, Rajaei S, Falsafi M, Golmakani E, Behnaz F, Zali A, Asgari S. S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study. Anesth Pain Med 2023; 13:e131746. [PMID: 38023997 PMCID: PMC10676656 DOI: 10.5812/aapm-131746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/29/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable. Objectives This study investigated the efficiency of the S1 transforaminal epidural block. Methods This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block. All patients had clinical symptoms associated with unilateral radiculopathy and were candidates for surgery. Percutaneous transforaminal endoscopy and S1 epidural block were performed by a surgeon for all patients. Results Of the 60 evaluated cases, 61.7% and 38.3% were female and male, respectively, with a mean age of 42.98 ± 10.79 years. The mean pain score before surgery was 7.83 ± 0.69, which decreased to 2.58 ± 0.65 during surgery and 0.50 ± 0.50 48 hours after surgery (P < 0.001). The mean duration of operation in these patients was 58.58 ± 16.95 minutes, and the mean onset time was 10.08 ± 3.12 minutes. Moreover, the mean bleeding was 124.17 ± 25.20 cc. Conclusions The PTED with S1 epidural anesthesia is a simple, safe, and effective method that causes good analgesia during the operation and cooperates well with the surgeon in neurological monitoring due to patient consciousness.
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Affiliation(s)
- Seyed Masoud Hashemi
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Rajaei
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mani Falsafi
- Department of Surgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran
- Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ebrahim Golmakani
- Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Faranak Behnaz
- Department of Anesthesiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sogol Asgari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Almatrodi M, Aldammas F, Alqarni A, Alwarhi F, Alotaibi A, Alqarni A, Bedaiwi R. Applicant Selection for Anesthesiology Residency Programs in Saudi Arabia. Cureus 2022; 14:e30071. [PMID: 36381686 PMCID: PMC9639706 DOI: 10.7759/cureus.30071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background Anesthesiology is a medical specialty that involves pre, intra, and postoperative surgical and medical procedures; it is a profession shaped by the clinician’s medical knowledge and manual dexterity. To date, very few studies have addressed the selection criteria and factors associated with the applicant selection process for anesthesia residency programs in Saudi Arabia. Objectives We aimed to define the criteria, factors, and guidelines for candidate selection in anesthesia residency programs in Saudi Arabia. Methodology This was a cross-sectional study conducted using electronic questionnaires that were distributed to anesthesiology program directors in Saudi Arabia via email. The questionnaire was divided into six sections, and each section included various parameters such as demographic data, cognitive/academic activities, non-cognitive/non-academic activities, individual qualities, and red flags or negative factors of the individual. The participants rated each parameter, and the collected data were analyzed for statistical significance (p≤0.05). Results A total of 28 programs were included in this survey. All 14 parameters associated with individual qualities were found to be significantly important for applicant selection (p≤0.05). Except for delayed entry into residency after graduation, all 12 parameters associated with red flags or negative characteristics of individuals were significant for candidate selection (p≤0.05). Conclusion The results showed that academic/cognitive factors and non-academic/non-cognitive factors, along with the individual characteristics of the applicant, were given priority when selecting candidates for anesthesiology residency programs in Saudi Arabia.
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Local infiltration of HYR-PB21, a sustained-release formulation of bupivacaine, provides analgesia and reduces opioid requirement after haemorrhoidectomy: a randomised controlled trial. Br J Anaesth 2022; 129:970-976. [DOI: 10.1016/j.bja.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/19/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
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Suwannalert P, Chanthasenanont A, Pongrojpaw D. Effect of applying cold gel pack on reduction of postoperative pain in cesarean section, low midline skin incision: A randomized controlled trial. J Obstet Gynaecol Res 2021; 47:2653-2658. [PMID: 34008228 DOI: 10.1111/jog.14855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
AIM The present study aims to investigate the efficacy of cryotherapy in pain reduction following low midline cesarean section. METHODS This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Thammasat University Hospital, Thailand from December 2019 to February 2020. Participants were term pregnant women who were indicated for low midline cesarean section. The control group received standard postoperative care while cold pack was applied to the intervention group for 6 h after the operation. The primary outcome was the postoperative visual analog scale (VAS) score in both the control and intervention groups. The secondary outcomes consisted of the amount of intravenous pain reliever each participant required and the length of hospital stay. RESULTS All 100 pregnant women were recruited into the study. They were equally allocated into intervention or control groups. Both groups underwent cesarean section under spinal anesthesia. The demographic characteristics of both groups were comparable. VAS of intervention and control group were 3.2 ± 2.4 versus 5.3 ± 2.2, 3.0 ± 2.4 versus 5.6 ± 2.0, 2.0 ± 2.3 versus 5.3 ± 2.2, and 1.1 ± 1.7 versus 4.8 ± 2.4 at 6, 8, 12, and 24 h postoperatively (p-value <0.05), respectively. Moreover, the intervention group showed a statistically significantly lower number of participants who needed intravenous meperidine or tramadol (14% vs. 24%, p-value <0.05) and lower intravenous meperidine or tramadol usage than in control group (13.2 ± 0.9 vs. 19.9 ± 4.0 mg, p-value <0.05). CONCLUSIONS Cryotherapy could reduce postoperative pain from 6 h to within 24 h of the postoperative period, as well as lower overall opioid requirement.
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Affiliation(s)
- Pawitra Suwannalert
- Department of Obstetrics and Gynecology, Thammasat University Hospital, Pathumthani, Thailand
| | - Athita Chanthasenanont
- Department of Obstetrics and Gynecology, Thammasat University Hospital, Pathumthani, Thailand
| | - Densak Pongrojpaw
- Department of Obstetrics and Gynecology, Thammasat University Hospital, Pathumthani, Thailand
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Liu Y, Hu Q, Yang J. Oliceridine for the Management of Acute Postoperative Pain. Ann Pharmacother 2021; 55:1283-1289. [PMID: 33423508 DOI: 10.1177/1060028020987679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To review the pharmacological characteristics, clinical evidence, and place in the management of acute postoperative pain severe enough to require an intravenous opioid. DATA SOURCES A comprehensive literature search was conducted in PubMed (January 2000 to December 1, 2020). Key search terms included oliceridine or acute postoperative pain. Other sources were derived from product labeling and ClinicalTrials.gov. STUDY SELECTION AND DATA EXTRACTION All English-language articles identified from the data sources were reviewed and evaluated. Phase I, II, and III clinical trials were included. DATA SYNTHESIS Oliceridine is a novel selective µ-receptor G-protein pathway modulator. It has the property of activating G-protein signaling while causing low β-arrestin recruitment to the µ-receptor. Intravenous oliceridine showed statistically superior analgesia than placebo in patients with moderate or severe pain after surgery, with a favorable safety and tolerability profile regarding respiratory and gastrointestinal adverse effects, compared with morphine. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The analgesic capacity of oliceridine is at least comparable to that of morphine at clinically relevant dosages, with a rapid onset of action. Also, it may be associated with a lower incidence of adverse events at dosing regimens associated with comparable analgesia. These data suggest that oliceridine may provide an important new treatment option for the management of moderate to severe postoperative pain where an intravenous opioid is warranted. CONCLUSION Oliceridine has obvious analgesic effects in patients with moderate or severe pain after surgery; additionally, it has a favorable safety and tolerability profile.
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Affiliation(s)
- Yang Liu
- Linyi Central Hospital, Shandong, China
| | - Qiang Hu
- Linyi Central Hospital, Shandong, China
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Khan H, Pervaiz A, Intagliata S, Das N, Nagulapalli Venkata KC, Atanasov AG, Najda A, Nabavi SM, Wang D, Pittalà V, Bishayee A. The analgesic potential of glycosides derived from medicinal plants. Daru 2020; 28:387-401. [PMID: 32060737 PMCID: PMC7214601 DOI: 10.1007/s40199-019-00319-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
Pain represents an unpleasant sensation linked to actual or potential tissue damage. In the early phase, the sensation of pain is caused due to direct stimulation of the sensory nerve fibers. On the other hand, the pain in the late phase is attributed to inflammatory mediators. Current medicines used to treat inflammation and pain are effective; however, they cause severe side effects, such as ulcer, anemia, osteoporosis, and endocrine disruption. Increased attention is recently being focused on the examination of the analgesic potential of phytoconstituents, such as glycosides of traditional medicinal plants, because they often have suitable biological activities with fewer side effects as compared to synthetic drugs. The purpose of this article is to review for the first time the current state of knowledge on the use of glycosides from medicinal plants to induce analgesia and anti-inflammatory effect. Various databases and search engines, including PubMed, ScienceDirect, Scopus, Web of Science and Google Scholar, were used to search and collect relevant studies on glycosides with antinociceptive activities. The results led to the identification of several glycosides that exhibited marked inhibition of various pain mediators based on different well-established assays. Additionally, these glycosides were found to induce most of the analgesic effects through cyclooxygenase and lipoxygenase pathways. These findings can be useful to identify new candidates which can be clinically developed as analgesics with better bioavailability and reduced side effects. Graphical abstract Analgesic mechanisms of plant glycosides.
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Affiliation(s)
- Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan.
| | - Aini Pervaiz
- Department of Pharmacy, Abdul Wali Khan University, Mardan, 23200, Pakistan
| | | | - Niranjan Das
- Department of Chemistry, Netaji Subhas Mahavidyalaya, Tripura University, Udaipur, 799 114, Tripura, India
- Department of Chemistry, Iswar Chandra Vidyasagar College, Tripura University, Belonia, 799 155, Tripura, India
| | - Kalyan C Nagulapalli Venkata
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, St. Louis, MO, 63110, USA
| | - Atanas G Atanasov
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, 05-552, Magdalenka, Poland
- Department of Pharmacognosy, University of Vienna, 1010, Vienna, Austria
- Institute of Neurobiology, Bulgarian Academy of Sciences, 1113, Sofia, Bulgaria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, 1090, Vienna, Austria
| | - Agnieszka Najda
- Quality Laboratory of Vegetable and Medicinal Materials, Department of Vegetable Crops and Medicinal Plants, University of Life Sciences in Lublin, 20-033, Lublin, Poland
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, 1435916471, Iran
| | - Dongdong Wang
- Institute of Genetics and Animal Breeding of the Polish Academy of Sciences, Jastrzebiec, 05-552, Magdalenka, Poland
- Department of Pharmacognosy, University of Vienna, 1010, Vienna, Austria
| | - Valeria Pittalà
- Department of Drug Sciences, University of Catania, 95125, Catania, Italy
| | - Anupam Bishayee
- Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Boulevard, Bradenton, FL, 34211, USA.
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Alatassi A, Albabtain H, Alrashid A, Almaidan M, Mahmoud AH. Factors impacting anesthesiology residents in Saudi Arabia when they are planning their future. Saudi J Anaesth 2020; 14:1-6. [PMID: 31998012 PMCID: PMC6970378 DOI: 10.4103/sja.sja_123_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 11/07/2022] Open
Abstract
Purpose: This study is undertaken to examine the factors that influence Saudi Board anesthesia residents' preferences in terms of future practice location, fellowship training, and research. Methods: A cross-sectional study was conducted. Data on fellowship training, research, and future practice location preferences, as well as demographics, were collected using surveys distributed to all anesthesia residents enrolled at Saudi anesthesiology residency program (N = 302). Results: A total of 117 residents (38.7%) responded to the survey. Of those 88.5% of residents planned on further subspecializing. The most highly sought fellowships were acute and chronic pain, regional anesthesia, simulation, and pediatric anesthesia. Residents pursuing fellowship training were mostly affected by personal interest, improving employment prospects, and future income. Only 11.5% of residents intended to incorporate research into their next practice—personal interest, employability, and lifestyle were the most influential in their decision. Conclusion: Most anesthesia residents training in Saudi Arabia choose to pursue fellowship training. However, less than one-fifth have an interest in incorporating research into their future careers.
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Affiliation(s)
- Abdulaleem Alatassi
- Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hesham Albabtain
- Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Aljazi Alrashid
- Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maryam Almaidan
- Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ahmed Haroun Mahmoud
- Department of Pediatric Anesthesia, King Abdullah Specialized Children Hospital, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Jackson HJ, Reneau M. Complementary therapies for acute pain management: What does the evidence say? Nurse Pract 2019; 44:8-11. [PMID: 31764469 DOI: 10.1097/01.npr.0000605532.19434.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Heather J Jackson
- Heather J. Jackson is an NP and administrative director of advanced practice, Vanderbilt Ingram Cancer Center and associate in anesthesiology, pain division at Vanderbilt University Medical Center, Nashville, Tenn. Marcelaine Reneau is an NP at Ralph H. Johnson Veterans Administration Medical Center, Integrative Pain Clinic, Department of Anesthesia, Charleston, S.C
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Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study. Pain 2017; 157:2739-2746. [PMID: 27548045 PMCID: PMC5113285 DOI: 10.1097/j.pain.0000000000000693] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pain care for hospitalized patients is often suboptimal. Representing pain scores as a graphical trajectory may provide insights into the understanding and treatment of pain. We describe a 1-year, retrospective, observational study to characterize pain trajectories of hospitalized adults during the first 48 hours after admission at an urban academic medical center. Using a subgroup of patients who presented with significant pain (pain score >4; n = 7762 encounters), we characterized pain trajectories and measured area under the curve, slope of the trajectory for the first 2 hours after admission, and pain intensity at plateau. We used mixed-effects regression to assess the association between pain score and sociodemographics (age, race, and gender), pain medication orders (opioids, nonopioids, and no medications), and medical service (obstetrics, psychiatry, surgery, sickle cell, intensive care unit, and medicine). K-means clustering was used to identify patient subgroups with similar trajectories. Trajectories showed differences based on race, gender, service, and initial pain score. Patients presumed to have dissimilar pain experiences (eg, sickle vs obstetrical) had markedly different pain trajectories. Patients with higher initial pain had a more rapid reduction during their first 2 hours of treatment. Pain reduction achieved in the 48 hours after admission was approximately 50% of the initial pain, regardless of the initial pain. Most patients' pain failed to fully resolve, plateauing at a pain score of 4 or greater. Visualizing pain scores as graphical trajectories illustrates the dynamic variability in pain, highlighting pain responses over a period of observation, and may yield new insights for quality improvement and research.
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Gaspar MP, Kane PM, Jacoby SM, Gaspar PS, Osterman AL. Evaluation and Management of Sleep Disorders in the Hand Surgery Patient. J Hand Surg Am 2016; 41:1019-1026. [PMID: 27702465 DOI: 10.1016/j.jhsa.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/11/2016] [Accepted: 08/19/2016] [Indexed: 02/02/2023]
Abstract
Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition.
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Affiliation(s)
- Michael P Gaspar
- Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA.
| | - Patrick M Kane
- Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Sidney M Jacoby
- Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Patrick S Gaspar
- Department of Anesthesiology, Harborside Surgical Center, Oxon Hill, MD
| | - A Lee Osterman
- Philadelphia Hand Center, PC, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA
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