Perioperative Management of Buprenorphine at an Urban Academic Medical Center.

INTRODUCTION: Buprenorphine is a partial mu opioid receptor agonist with high affinity to its receptor, which raises concerns of blocking or displacing full opioid agonists when used during the perioperative period of surgical patients. However, buprenorphine itself has high analgesic potency and discontinuing buprenorphine may lead to suboptimal pain control and risk for opioid use disorder relapse. There is limited data for the continuation of buprenorphine perioperatively. METHODS: This study is a retrospective cohort study of adult surgical patients taking buprenorphine for opioid use disorder at an urban, teaching, level 1 trauma center. Patients were split into two groups based on whether buprenorphine was continued (n = 46) or held (n = 28) within the first 48 h after surgery. RESULTS: Those who had buprenorphine continued in the first 48 h postoperatively required half the dose of nonbuprenorphine opioids compared to those who had buprenorphine held (113.25 versus 255.75 oral morphine equivalents, P = 0.0040). Both groups had a similar level of analgesia and incidence of adverse events. Nearly all patients who continued buprenorphine in the first 48 h postoperatively were discharged on this agent, while only half of patients who had buprenorphine held were restarted on it at discharge (92.68% versus 56.52%, P = 0.0013). CONCLUSIONS: This present study found lower nonbuprenorphine opioid requirements in patients with continued versus held perioperative buprenorphine use with no difference in degree of analgesia.

Videothorascopic evaluation of the undeterminate pulmonary nodule: analysis of 47 operated cases

Between June 1992 and July 1993, 47 patients (13 female, 34 male) with diagnosis of Indeterminate Pulmonary Nodule (IPN) were operated on by VATS (Video-Assisted Thoracic Surgery). In all cases, the histopathologic diagnosis was obtained. In 19 patients we found solitary benign nodules, in 20 solitary malignant nodules, and in 8 multiple malignant nodules. An utility minithoracotomy (conversion) was necessary in 3/19 (15.7 percent) of the benign nodules due to difficulties in its localization, and in all (n=20) the malignant nodules in order to accomplish a complete resection, and in none of the multiple nodules (n=8). Six patients presented minor complications (morbidity = 10.6 percent) and one postoperative death was registered (mortality = 2.1 percent). We concluded that resection of the IPN by VATS is an oligotraumatic diagnostic procedure with a sensitivity and specificity of 100 percent, and with low mordibity and acceptable mortality, however it requires careful indication in patients with a high operative risk.

Tratamiento quirúrgico del cáncer de pulmón estadio III-A / Surgical treatment of lung cancer III-A stage

Se analiza la experiencia de 60 pacientes con tratamiento quirúrgico del cáncer de pulmón Estadío III-a. Se compararon dos grupos entre sí: Grupo I (T3 NO-1) y Grupo II (T3 N2) y se obtuvo una supervivencia actuarial a los 5 años del 34 por ciento y 23 por ciento respectivamente y una supervivencia para toda la población de 29 por ciento. Se analizaron distintos factores pronóstico: Tipo histológico, tamaño tumoral, tipo, número y localización de las adenopatías, etc. Se concluye que dentro del mismo Estadío III-a confluyen factores favorables y desfavorables y que el análisis de dichos factores permitirá seleccionar la mejor terapéutica, obteniendo índices de supervivencia satisfactorios con el tratamiento quirúrgico

Plástica de eventraciones abdominales con un plano de sutura contínua / Chronic abdominal wound hernia repair with a single layer continuous suture

Se evaluó en 50 enfermos consecutivos la utilidad de una sutura contínua en un plano para la reparación de eventraciones abdominales crónicas, utilizando en 47 casos nylon monofilamento n*2 y en 3 poliglicólico n*o. La técnica fue de ejecución sencilla y rápida, con un mínimo número de nudos y evitando disecciones excesivas. No hubo mortalidad operatoria. Se registró una incidencia de infección de herida comparable a otras experiencia (14%) y una menor proporción de hematomas y granulomas por nudos (2%y 4%respectivamente). Hubo un 6%de recidivas (3 enfermos), todas en casos con factores predisponentes. Se concluye que es de interés ampliar la experiencia con esta técnica, para establecer si puede ser la de elección en la reparación de eventraciones abdominales