Multimodal analgesia and opioids after hip surgery

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Edward R. Mariano, MD

This document discusses multimodal analgesia and opioids after hip surgery. It notes the opioid epidemic in the United States and examines studies on how long postoperative pain lasts after surgery. The document advocates for a personalized approach to pain medicine after surgery using multimodal analgesia to improve outcomes and reduce opioid use.

Saúde e medicina

Multimodal analgesia and
opioids after hip surgery
Edward R. Mariano, M.D., M.A.S.
Professor of Anesthesiology, Perioperative & Pain Medicine
Stanford University School of Medicine
Chief, Anesthesiology and Perioperative Care
Veterans Affairs Palo Alto Health Care System
@EMARIANOMD

@EMARIANOMD
Disclosures
 None

@EMARIANOMD
The opioid epidemic
https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0
https://www.cdc.gov/drugoverdose/epidemic/index.html

@EMARIANOMD

@EMARIANOMD

@EMARIANOMD
Brummett, et al. JAMA 2017
Klueh, et al. JGIM 2018
The role of surgery

@EMARIANOMD

@EMARIANOMD
How long does pain last?
Mariano, El-Boghdadly, Ilfeld. Anaesthesia 2020

@EMARIANOMD
Postoperative pain varies by patient
TEMPOS Group (Tighe PJ). Anesthesiology 2021

@EMARIANOMD

@EMARIANOMD
Mariano, Schatman. J Pain Res 2019

@EMARIANOMD
@DrChadB

@EMARIANOMD
Tamboli, Mariano, et al. Pain Med 2019

@EMARIANOMD

@EMARIANOMD

@EMARIANOMD
Opportunities to improve
Mariano, Walters, Kim, Kain. A&A 2015
Walters, Mariano, Clark. Pain Med 2015

@EMARIANOMD
Goal to “personalise” pain medicine

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Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

Cardiac Output, Venous Return, and Their Regulation

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In this lecture on circulatory shock, Dr. Faiza, an Assistant Professor of Physiology, delves into the profound implications of inadequate blood flow throughout the body, leading to tissue damage. The session begins by defining circulatory shock and elucidating its physiological causes, including decreased cardiac output, diminished blood volume, decreased vascular tone, obstruction to blood flow, excess metabolic rate, and abnormal perfusion patterns. Dr. Faiza categorizes shock into various types, such as cardiogenic shock, hypovolemic shock, neurogenic shock, obstructive shock, anaphylactic shock, and septic shock, and explores the pathophysiological basis of each. Furthermore, the lecture examines the stages of shock, from the non-progressive phase where compensatory mechanisms aim for full recovery to the progressive phase where shock worsens steadily without intervention, potentially leading to irreversible damage. Dr. Faiza discusses therapeutic interventions for shock, including replacement therapy, blood and plasma transfusion, sympathomimetic drugs, and other adjunctive treatments like head-down positioning, oxygen therapy, and glucocorticoids.

Circulatory Shock, types and stages, compensatory mechanisms

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Circulatory Shock, types and stages, compensatory mechanisms

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Difference Between Skeletal Smooth and Cardiac Muscles

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Multimodal analgesia and opioids after hip surgery

1. Multimodal analgesia and opioids after hip surgery Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System @EMARIANOMD

2. @EMARIANOMD Disclosures  None

3. @EMARIANOMD The opioid epidemic https://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html?_r=0 https://www.cdc.gov/drugoverdose/epidemic/index.html

6. @EMARIANOMD Brummett, et al. JAMA 2017 Klueh, et al. JGIM 2018 The role of surgery

8. @EMARIANOMD How long does pain last? Mariano, El-Boghdadly, Ilfeld. Anaesthesia 2020

9. @EMARIANOMD Postoperative pain varies by patient TEMPOS Group (Tighe PJ). Anesthesiology 2021

10. @EMARIANOMD

11. @EMARIANOMD Mariano, Schatman. J Pain Res 2019

12. @EMARIANOMD @DrChadB

13. @EMARIANOMD Tamboli, Mariano, et al. Pain Med 2019

14. @EMARIANOMD

15. @EMARIANOMD

16. @EMARIANOMD Opportunities to improve Mariano, Walters, Kim, Kain. A&A 2015 Walters, Mariano, Clark. Pain Med 2015

17. @EMARIANOMD Goal to “personalise” pain medicine