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  Pilot Study: Assessing Chair Yoga Therapy Compliance in Chronic Pain Patients

  Andrew Glaza, Merzia Subhan, and Rebecca Clemans

  Publication Date: 5-2025

  • Chronic pain affects over 30% of the global population, imposing substantial personal and economic burdens.1
  • Multifaceted treatment plans, including pharmacological, physical rehabilitation, and interventional strategies, are recommended; however, barriers to care persist.2
  • This pilot prospective cohort study evaluated the feasibility of chair yoga therapy—a nonpharmacological, breath-centric intervention—for managing chronic pain and anxiety.

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  Procalcitonin as a biomarker of acute kidney injury in patients with suspected bacterial sepsis in the acute care setting

  Austin Kantola, Jose Navas Blanco, and Jacob Keeley

  Publication Date: 5-2025

  Acute kidney injury (AKI) is a common, life-threatening complication in patients with sepsis and septic shock.→ Approximately one-half of patients with sepsis experience an AKI.4 → One-third of all acute kidney injuries are related to sepsis.4 → Sepsis-associated AKI raises in-hospital mortality eightfold and the risk of chronic kidney disease development threefold.1,2,3. Early identification of AKI could save time and resources, lower costs, improve patient outcomes. Therefore, a biomarker for earlier AKI detection in patients with sepsis would serve an outstanding role in health care.In the setting of bacterial infection, an upregulation of innate immune system gene transcription and translation causes the surge in procalcitonin (PCT). This can be observed within 2-4 hours of an immune response, peaking within 12-24 hours.5.Procalcitonin is often used to monitor both the presence and resolution of bacterial infection.6 PCT algorithms are also a biomarker for preventing antibiotic overconsumption, and allow reassurance during antibiotic cessation.7 Due to the utility of procalcitonin in monitoring bacterial sepsis incidence and resolution, the authors hypothesize that its concentration in serum could serve as a biomarker for AKI risk stratification in patients suspected of bacterial sepsis.

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  Implementation of an Opioid Free Pediatric Hernia Repair Protocol

  Corey Shafer, Antonela Muca, Randy Hilleary, Kristin LeMarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2025

  Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

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  Effects of Changing the Frequency of Epidural Steroid Injections for Elderly Patients with Lumbar Radiculopathy/Lumbar Spinal Stenosis

  Nitin Venkatesh, Rebecca Clemans, and Roy Soto

  Publication Date: 5-2025

  Lower back pain is highly prevalent and a significant cause of disability.

  50-84% of adults experiencing back pain at some point.

  Previously, patients with chronic lumbar radiculopathy received a maximum of 6 injections a year (q8w).

  On Dec 2021, Medicare Coverage of ESIs was updated to limit ESIs to a max of 4 a year (q12w).

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  Diagnosis and Management of Acute Chest Syndrome

  Zachary Awad, Hashem Mohilldean, Nataly Salman, and Roy Soto

  Publication Date: 10-20-2024

  A 36-year-old male with a PMH of asthma, hemoglobin SC disease, and bilateral avascular necrosis of the femoral heads presented with a productive cough, shortness of breath, pleuritic chest pain, and fever of 102.2°C. He was hypoxemic with an SaO2 of 92% on room air, and CXR revealed new bilateral infiltrates, thus meeting diagnostic criteria for Acute Chest Syndrome (ACS). ACS is the most common cause of death amongst patients with sickle cell disease, prompting clinicians to maintain a high index of suspicion. We will discuss the mechanism, diagnosis, and management of ACS.

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  Near-Surface Dose Correlates With Moist Desquamation and Unplanned Reconstructive Surgery in Patients With Implant-Based Reconstruction Receiving Postmastectomy Radiation Therapy

  Patrick Thrasher, Ronald Levitin, Bryan S. Squires, Allison J. Hazy, Michael J. Maywood, Anthony P. Delise, Muayad F. Almahariq, Nayana Dekhne, Lauren Oliver, Peter Y. Chen, Kailee J. Walters, Diane Dudley, and Joshua T. Dilworth

  Publication Date: 5-2024

  Postmastectomy radiation therapy (PMRT) utilized as part of a breast cancer treatment regimen reduces the risk of disease recurrence in appropriately selected patients.1,2,3,4,5 However, PMRT increases risk of radiationrelated toxicities that can interfere with breast reconstruction post-mastectomy.6 Following mastectomy, implant-based reconstruction can increase patient satisfaction and quality of life7,8; complications induced by PMRT such as infection and tissue contracture, though, increase risk for implant loss and may ultimately require further surgeries for the patient.

  PMRT is delivered based on treatment plans that are optimized to provide appropriate radiation dosages to tissues along the chest wall while simultaneously limiting exposure of surrounding sensitive structures. Subcutaneous lymphatic structures and residual glandular tissue are of major importance as they may harbor microscopic disease that can lead to recurrence.9 The skin and immediate surrounding tissue, therefore, is often exposed to higher doses of radiation to ensure appropriate therapeutic coverage of these structures. How this increased dose delivery may affect a patient’s risk for radiation-related toxicities, however, is currently not well characterized. We hypothesize that near-surface dose to the reconstructed chest wall predicts for an increased risk of significant breast pain as well as the development of acute skin toxicities such as moist desquamation. Identifying dosimetric correlates for these acute toxicities may allow for optimization of radiation treatment planning aimed at reducing the incidence of acute toxicities and further associated complications.

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  Elimination Of Postoperative Narcotics In Infant Robotic Pyeloplasty Using Caudal Anesthesia And A Non-Narcotic Pain Pathway

  Kwesi Asantey, Kristen Meier, Zachary Rollins, Andrew B. Banooni, and Zachary J. Liss

  Publication Date: 5-2-2022

  INTRODUCTION
  /="/">Research suggests that narcotic pain medications are dramatically overprescribed. We hypothesize that narcotics are unnecessary in the majority of infants for postoperative pain control. In this series, we report our experience combining caudal blocks with a non-narcotic postoperative pathway as a means of completely eliminating postoperative narcotics following infant robotic pyeloplasty.

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  ERAS vs Non-ERAS: A Hospital Performance Metrics Comparsion in Patients Undergoing Spinal Fusion

  Richard W. Easton, Gregory Smith, Matthew Lipphardt, Nai-Wei Chen, Pestano Cecile, Hermeli Mateo, Austin Ahlgren, Brady Vibert, Andrew Sagante, and Susan Vander Beek

  Publication Date: 5-2022

  Hospital metrics are measures used to evaluate surgical quality. The goal is to improve standards of care (SOC). Hospital performance is made publicly available and has reimbursement ramifications.

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  Intraoperative MAP, Vasopressors, and Opioids in TF-TAVR patients undergoing Conscious Sedation vs General Anesthesia

  Brett J Friedman, Patrick Karabon, and Wei C Lau

  Publication Date: 5-2-2022

  INTRODUCTION
  Aortic stenosis is a progressive narrowing of the aortic valve that can cause serious cardiovascular harm such as syncope, heart failure, and death if left untreated. Transfemoral-transcatheter aortic valve replacement (TF-TAVR) emerged in the last 10 years as an alternative for previously inoperable, high-risk patients. Studies suggest that monitored anesthesia for TF-TAVR using minimalist conscious sedation results in better outcomes (e.g., shorter length of stay, lower 30-day mortality) when compared to general anesthesia. However, there is a gap in knowledge of why conscious sedation is more successful. Recent studies have demonstrated the association of intraoperative mean arterial pressure (MAP) variables including MAP variability (MAPV) and time-weighted average MAP (TWA-MAP) with 30-day mortality in non-cardiac surgery. We compared intraoperative variables for TF-TAVR patients that underwent conscious sedation versus general anesthesia.

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  Intussusception- a rare cause of non-specific chronic pain: a case report

  Nasim Shakibai and Rebecca Clemans

  Publication Date: 11-19-2022

  Introduction:

  Non-specific chronic pain is difficult to treat, especially in a patient with a complex medical history and pain in multiple regions of the body. It is important to use a multidisciplinary approach in treating such patients. In addition, it is necessary to be aware of conditions that are often non-specific in presentation such as intussusception. We describe a case report of a patient with non-specific chronic pain that was found to have intussusception.

  Case Report:

  A 42-year-old female with a past medical history of gastric adenocarcinoma status post gastrectomy with Roux-en-Y, chemotherapy that was completed the year before and left salpingo-oophorectomy for metastatic gastric carcinoma. She initially presented to the chronic pain management clinic with lower back pain for several years after failed conservative treatment. She was diagnosed with sacroiliitis and subsequently underwent bilateral sacroiliac injections of 40mg Kenalog in addition to 3ml of 0.25% Bupivacaine, which did not resolve her pain. Two weeks later, she presented to the emergency department with the chief complaint of worsening upper chest and shoulder pain that radiated to the inferior aspect of her left scapula over the past three days. Chest x-ray, troponins and EKG were all within normal limits. She was then discharged home.

  Five days later, she presented with lower abdominal pain that had been persistent for the past year and left flank pain/back pain for the past four months that suddenly became intolerable. She continued to endorse post-prandial nausea, vomiting with chronic constipation. On physical examination, she had tenderness to palpation of the left lower quadrant without rebound, guarding or distention. She also had tenderness to palpation of the left flank.

  A whole-body positron emission tomography computed tomography (CT) and an ultrasound of the kidneys and bladder done at this admission were negative. Previous MRI of the lumbar spine, bone scan and small bowel series were negative. Urine analysis and post-void residual were negative. CT of the abdomen with IV contrast, as shown in Figure 1, demonstrated segmented jejunojejunal intussusception with edematous bowel wall. She subsequently underwent an exploratory laparotomy with reduction of a retrograde intussusception wand bilateral transversus abdominis plane blocks. No obvious mass or lead point were identified. In her follow-up appointment, her abdominal, flank and back pain were minimal and she was improving overall.

  Discussion:

  Intussusception is a common cause of intestinal obstruction in children but is a rare cause in adults. Due to its non-specific presentation, it is difficult to diagnose. Some patients present with chronic or intermittent vague abdominal pain with nausea and vomiting, abdominal distension with partial obstruction, and rarely a palpable mass on physical examination. [1] While it is often idiopathic in children, adults often have a lead point to indicate another condition. Some of the causes include inflammatory bowel disease, previous Roux-en-Y, inflammatory fibroid polyp, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions and jejunostomy feeding tubes. [1,2,3] With an increase in Roux-en-Y surgeries, there has been an increase in intussusception as a complication. [4]

  Ultrasounds are useful in the diagnosis of intussusception but CT with IV contrast is the most useful diagnostic tool for the evaluation of intussusception. Surgery is the definitive treatment for adult intussusception.

  As we treat patients with chronic pain that do not have an improvement with conservative treatment in addition to more invasive treatment such as glucocorticoid injections, there needs to be a workup for medical conditions in the rare case that they are the cause.

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  What is the Incidence of QT Prolongation and Life-Threatening Arrhythmia Following IV Methadone Administration in Patients Undergoing Lumbar Fusion?

  Gregory Smith, Richard W. Easton, Kuldeep Shah, Daniel Silvasi, Matthew Lipphardt, Julie George, Shengchuan Dai, Brian Williamson, Brady Vibert, Bradley Ahlgren, and Nicholas Papakonstantinou

  Publication Date: 5-2022

  Postoperative analgesia is a significant challenge following major spine surgery. Utilizing a combination of opioid and non-opioid medications, optimizing their analgesic benefits while decreasing unwanted side effects, has been an effective multi-modal strategy in an Enhanced Recovery After Surgery (ERAS) protocol.