tag:blogger.com,1999:blog-30499448.post3256587074067460089..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Operation, Deconstructed. Nine: finish lineSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-30499448.post-73663667225127984052008-02-10T16:27:00.000-08:002008-02-10T16:27:00.000-08:00sterileeye: mainly because they're uncomfortable a...sterileeye: mainly because they're uncomfortable and hurt, at least a little and sometimes more, when they're removed. Sometimes they leave a permanent row of dots. They save a little time, but cost a lot more than steris.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-29702584991987706872008-02-10T15:23:00.000-08:002008-02-10T15:23:00.000-08:00I've seen both steristrips, staples and even glue ...I've seen both steristrips, staples and even glue used for skin closure. Could you elaborate on why the staples suck?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-87641402513627994182007-06-13T13:08:00.000-07:002007-06-13T13:08:00.000-07:00The Tens-unit like devices are actually pulsed ele...The Tens-unit like devices are actually pulsed electromagnetic field (PEMF) devices related to bone-stimulators.<BR/><BR/>There are two on the market (that I know of) for post-surgical tx. One by a company called Ivivi & one called Acti-Patch.<BR/><BR/>I've used both & they work. Exactly how much & in whom, I'm still trying to figure. The Ivivi PEMF device is also being studied for blunting CNS injury and post MI-ischemia. <BR/><BR/>I wrote about this last year on my blog<BR/>http://plasticsurgery101.blogspot.com/2005/12/pulsed-magnetic-fields-and-plastic.htmlDr. Rob Oliver Jr.https://www.blogger.com/profile/09059882318849767896noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-35561858546886658562007-06-04T16:53:00.000-07:002007-06-04T16:53:00.000-07:00Eric: Thanks. Another area is using constant infus...Eric: Thanks. Another area is using constant infusion into a surgical incision, through a drain left in at operation. <BR/><BR/>And I was always looking for some sort of vehicle by which bupivicaine, etc, could be induced to stay longer. Your info sounds promising.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-56148292756838688172007-06-04T12:35:00.000-07:002007-06-04T12:35:00.000-07:00Oh, Dr. S, once again, you have proven yourself th...Oh, Dr. S, once again, you have proven yourself the very model of a modern (surgeon general? - wait, that just reads oddly - well, let's hope you're more the Jocelyn Elders sort and less the current occupant...)<BR/><BR/>Being opioid-intolerant and having had the misfortune of violating several laws of physics, I've learned the benefits of instilling a little bupivacaine before closing. When your post-surgical pain relief options are pretty much Tylenol, Toradol and Celebrex, you learn to find people who are savvy about stopping things before they get worse.<BR/><BR/>Three ideas to ponder - the first I'm sure you're aware of, but might be beneficial to other readers.<BR/><BR/>Through the magic of stereoisomer separation, there's now an S-enantiomer version of bupivacaine (AKA Marcaine) called Chirocaine that may confer longer-lasting pain relief when used this way. I'm not familiar with it in clinical practice, but it might be an avenue to explore to sustain the benefit.<BR/><BR/>The really exciting development in this area is a sorta . . . gelled . . . form of mixed-enantiomer bupivacaine from Durect that is now called Posidur (it used to be SABER-Bupivacaine). By controlling the texture and release of the agent, they believe it will linger longer - up to 72 hours. It's currently in trials - I've been following their misadventures in hormonal treatment for Alzheimers and chanced upon their program. Could be really interesting going forward - imagine how much less post-surgical delirium there could be if patients had effective pain control for three days after surgery without opioids....<BR/><BR/>Finally, a really exciting area is coming from the US Army - there are protocols in place to use TENS-like devices in acute settings, in addition to opioids. The idea being that early intervention prevents the development of CRPS/RSD even in the most severe of orthopaedic injuries. There's currently a real interest in exploring the use of TENS-like devices in post-surgical analgesia as well.<BR/><BR/>E<BR/><BR/>(edited to remove flagrant error - mea culpa, mea maxima culpa)Eric, AKA The Pragmatic Caregiverhttps://www.blogger.com/profile/10006690628166460007noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-25419147557778332382007-06-02T21:47:00.000-07:002007-06-02T21:47:00.000-07:00Well-done, thank you!Well-done, thank you!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-67412662012033569462007-06-02T09:07:00.000-07:002007-06-02T09:07:00.000-07:00MWAK: nahh, the world need more gyns who love OB, ...MWAK: nahh, the world need more gyns who love OB, not less!Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-63015431388566442052007-06-02T08:01:00.000-07:002007-06-02T08:01:00.000-07:00That was a cool series. Almost enough to make me ...That was a cool series. Almost enough to make me go back to residency to be a general surgeon. Not quite though. :)Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-2302079081467628562007-06-02T00:20:00.000-07:002007-06-02T00:20:00.000-07:00Fantastic series of posts!They will be on some sor...Fantastic series of posts!<BR/>They will be on some sort of 'Best of Blogs' list.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-33418036005908471372007-06-01T17:26:00.000-07:002007-06-01T17:26:00.000-07:00Well I slogged my way through this along with you....Well I slogged my way through this along with you. As usual it was fascinating. Half way through, I heard that my BIL, in Australia, has colon cancer and will have a bowel resection soon, providing there is enough healthy colon left (hopefully) or a colostomy. However, I can't believe he would want to read this, but if it was me I certainly would.<BR/>Thanksjmbhttps://www.blogger.com/profile/13563252743976699923noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-80020282866695328662007-06-01T15:27:00.000-07:002007-06-01T15:27:00.000-07:00Dr. Schwab: a fantastic end to the series. You've ...Dr. Schwab: a fantastic end to the series. You've outdone yourself, now what do I look forward to? ;)<BR/><BR/><I>I'm kidding of course, your blog is on my daily read list. </I>Lisahttps://www.blogger.com/profile/15508518592917445895noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-7032992936349275302007-06-01T13:17:00.000-07:002007-06-01T13:17:00.000-07:00There is so little OR time in undergraduate nursin...There is so little OR time in undergraduate nursing programs now that your series would make excellent background reading prior to students dipping their toe into the OR pool.<BR/><BR/>You bring the surgeon's passion and excitement in wide screen technicolor! Thanks so much for writing and sharing this series.N=1https://www.blogger.com/profile/02256479234981292080noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-26531040461269257412007-06-01T12:10:00.000-07:002007-06-01T12:10:00.000-07:00Tom: thank YOU!Tom: thank YOU!Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-6370911791304593992007-06-01T11:56:00.000-07:002007-06-01T11:56:00.000-07:00A wonderful series -- I'm still pushing for a book...A wonderful series -- I'm still pushing for a book of these -- and a great ending. I now have a number of obnoxious questions for the next surgeon that enters my life: "What, you use NS to irrigate just before you close? Are you <I>trying</I> to protect the stray cancer cells? And what technique do you use for peritoneal closure???"<BR/>Many thanks for all the threads that ran through this: the emotional, the technical, and the artistic.Tom McNameehttps://www.blogger.com/profile/17338587526596437871noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-38472195219337569512007-06-01T11:23:00.000-07:002007-06-01T11:23:00.000-07:00I only remember one PACU conversation after major ...I only remember one PACU conversation after major surgery. It wasn't with the surgeon, though. It was with the xray tech. Went something like this:<BR/><BR/>Me: Why are you doing this xray?<BR/><BR/>Tech: (lying through her teeth)I don't know. I just take the pictures. <BR/><BR/>She knew quite well why she was there. I had a pretty good idea myself. It was a chest xray that did not include the abdomen after an appy. <BR/><BR/>When I asked the doc the next day, he got a funny look on his face - probably didn't expect me to remember -- and told me I'd tossed my cookies when I was extubated and they just wanted to make sure I hadn't aspirated.Judyhttps://www.blogger.com/profile/08237756183010257014noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-50787433929877715822007-06-01T07:50:00.000-07:002007-06-01T07:50:00.000-07:00Thanks again Dr Schwab for a great series- a littl...Thanks again Dr Schwab for a great series- a little inspiration to motivate me as I slog through endless Step One crammingDerrickhttps://www.blogger.com/profile/12308265696047804210noreply@blogger.com