• Egr3-­/-­ Mice, a Mouse-Model of Schizophrenia, Show Decreased Levels of Htr2a mRNA in the Anterior Frontal Cortex after Sleep Deprivation Compared to WT Mice

      Elizalde-Rodriguez, Diana; The University of Arizona College of Medicine – Phoenix; Gallitano-Medel, Amelia (The University of Arizona., 2019)
      In the U.S., 1 in 25 adults experience serious mental illness each year. Despite ongoing research efforts, the pathogenesis of schizophrenia remains unknown. The aim of this study is to answer the question “Do Egr3-­/-­ mice, a mouse-­model of schizophrenia, show decreased levels of Htr2a mRNA in the prefrontal cortex (PFC) region of the brain after sleep deprivation (SD) compared to wild type (WT) mice?” Data resulting from the study will shed light on the pathogenesis of such a disabling mental disorder. Our study investigates the interaction between two of the genes linked to increased risk of schizophrenia, the early growth response (Egr) 3 gene and Htr2a, which encodes the serotonin 2a receptor (5HT2AR) in response to SD, a form of stress. We used a cohort of age-­matched pairs of C57BL/6 Egr3-­/-­ and WT male mice. Half of these underwent a SD protocol, while the other half served as a control group. Htr2a mRNA was quantified in four different brain regions via densitometry after it was visualized using in-­situ hybridization. Our findings that Egr3-­/-­ mice show statistically significant decreased expression levels of Htr2a mRNA in the PFC support our proposed biological pathway for schizophrenia risk.
    • Evaluation of Rural Pediatric Patients with Intractable Epilepsy for Vagal Nerve Stimulation: A Telehealth Education Based Model

      Hussain, Omar; The University of Arizona College of Medicine – Phoenix; Adelson, P. David (The University of Arizona., 2019)
      Vagal Nerve Stimulation (VNS) has turned into the treatment of choice for pediatric patients with medically refractory epilepsy. It is non-invasive, has few complications, and has a significant impact on the frequency, severity, and duration of seizures. This project sought to answer three main questions. What are the epidemiologic factors that are significant (if any) for pediatric medically refractory epilepsy? What are the best outcome predictors for VNS implantation? And finally, is there a way to improve rural physicians’ decision making abilities when referring patients for evaluation of VNS implantation?
    • Evaluation of the Effects of the MOVE+ vs STAND+ Interventions in the Workplace on Snacking

      Cook, Arianna; The University of Arizona College of Medicine – Phoenix; Buman, Matthew (The University of Arizona., 2019)
      Snacking has been identified as a dietary pattern that could contribute to the prevalence of overweight and obesity. Snacking patterns can be influenced by the environment such as the workplace. The purpose of this study is to determine the effect of workplace sedentary interventions on diet, more specifically snacking, and to give more information on the nutritional value of snacking.
    • Examining the Safety and Cost of Risk-Reducing Salpingectomies as Prophylactic Treatment for Women Seeking Sterilization Who Are at Low to Moderate Risk for Ovarian Cancer

      Samareh-Jahani, Farmin; The University of Arizona College of Medicine – Phoenix; Kaufmann, Bruce (The University of Arizona., 2019)
      Ovarian cancer ranks fifth among the most common cause of cancer deaths in women. There is evidence that the site of origin for the majority of the most serious form of ovarian cancers is the fallopian tube. There is growing consensus for risk-reducing salpingectomies (RRS) to be performed for women who are at moderate risk for developing ovarian cancer especially at a time of patient desired sterilization. A retrospective chart review to determine the safety and cost of risk-reducing salpingectomies in comparison to tubal ligations was performed using the Healthcare Cost and Utilization Project inpatient database from 2008-2012. Results showed no significant difference between each procedure for length of stay in days (95%CI -0.19, 0.79 p: 0.24) or intraoperative complications (OR 4.84 (95%CI 0.38, 60.9 p: 0.22)). There was a significant difference between the total charges associated with each procedure with tubal ligation having a mean cost of $2,227.21 (95%CI $403.2, $4051.10) and the bilateral salpingectomy procedure having a mean cost of $11,189.80 (95%CI $6,582.70, $15,796.80 p<0.001). The cost difference between the two procedures should shift the conversation towards the question of whether hospital billing and insurance coverage for bilateral salpingectomy without oophorectomy should be examined more closely in order to provide RRS as a prophylactic treatment for women at moderate risk for developing ovarian cancer seeking sterilization.
    • Healthcare Charges Incurred from Scorpion Envenomation Treated with Centruroides F(ab’)2 Antivenom

      Roberts, Alexa; The University of Arizona College of Medicine – Phoenix; O'Connor, Ayrn (The University of Arizona., 2019)
      Centruroides F(ab’)2 antivenom (AV) is a safe and effective treatment for bark scorpion envenomation; however, concern exists regarding the substantial charges associated with this therapy and resulting unexpected costs of treatment. This retrospective review seeks to quantitate patient charges associated with antivenom use to better understand its impact on patient and healthcare economics. This is a retrospective review of 527 patients presenting to a hospital system with severe scorpion envenomation between April 2013 and May 2015. Included patients had Centruroides scorpion envenomation and received AV. They were excluded if they were not a grade III or IV envenomation, did not receive antivenom or their clinical records were not available. Patient charges and hospital costs were acquired from institutional financial records and were included if total costs were accurate as defined by costs > $2500. Clinical manifestations, length of stay (LOS), method and amount of AV administration were abstracted. Continuous data were reported as medians with interquartile range and linear regression was utilized to determine predictors of outcomes. All patients had a grade 3 or 4 envenomation and received AV. The total number of vials received were 1 (18.2%) to a maximum of 7 (0.4%) with most patients receiving three vials (46.7%). Most patients received three vials of antivenom initially (52.6%) as compared to one vial (43.6%) and only few receiving two vials (3.8%). Median total charges were $28,060 ($18,805 - $33,742). Linear regression showed that total charges were predicted by total number of vials administered and LOS (adjusted R2 of 0.75). Charges of care were found to increase by $7901.59 per vial of AV and by $415.48 for each hour of LOS. The only predictors of total charges were age, number of vials and total length of stay. Correlation between total charges and costs was poor. Despite established safety and efficacy, anticipated patient charges appear to influence the manner in which bark scorpion antivenom is administered by healthcare providers.
    • Hepatitis C Virus Knowledge, Attitudes, and Practices among Arizona Providers

      Appleton, Leslie; The University of Arizona College of Medicine – Phoenix; Villarroel, Lisa (The University of Arizona., 2019)
      Hepatitis C virus (HCV) is the most common chronic blood borne infection in the U.S. and it is estimated that there are 80,000 Arizonans infected with HCV (ADHS). HCV is the leading cause of liver cancer and transplants (Ly et al., 2012). Research shows vast variation in the availability and uptake of HCV testing, screening, and treatment (Jones et. al, 2013), in part because HCV literacy is low among healthcare professionals (Bruggman, Grebely, 2014). A Knowledge, Attitudes, and Practices (KAP) survey elicits quantitative and qualitative information that can reveal misunderstandings or misconceptions regarding a certain topic (USAID, 2011). Through this, we aimed to better understand the extent to which Arizona providers serve as a barrier to care for HCV patients.
    • Implicit Bias Toward Cervical Cancer: Provider and Training Differences

      Liang, Juliana; The University of Arizona College of Medicine – Phoenix; Chase, Dana (The University of Arizona., 2019)
      Implicit prejudice and stereotyping may exist in health care providers automatically without their awareness. These biases often correlate with outcomes that are consequential for the patient. This study examined gynecologic oncology care providers' implicit prejudice and stereotyping toward cervical cancer. Members of professional gynecologic oncology organizations were asked to complete two Implicit Association Tests (IAT) to determine if they implicitly associate cervical cancer with feelings of anger (prejudice) or beliefs about culpability for the disease (stereotypes), compared to ovarian cancer. Linear regression models and Student t-tests examined average levels of implicit bias and moderators of the implicit bias effects. One-hundred seventy-six (132 female, 43 male, 1 nonresponse; mean age = 39.18 years, SD age = 10.58 years) providers were recruited and the final sample included 151 participants (93 physicians and 58 nurses, mean age=38.93, SD age=10.59). Gynecologic oncology providers showed significant levels of implicit prejudice, X = 0.17, SD = 0.47, 95% CI: (0.10, 0.25), toward cervical cancer patients. They also showed significant levels of implicit stereotyping of cervical cancer patients, X=0.15, SD=0.42, 95% CI: (0.08, 0.21). Whereas physicians did not demonstrate significant levels of implicit bias, nurses demonstrated greater levels of implicit prejudice and implicit stereotyping. Providers without cultural competency training or implicit bias training demonstrated greater implicit bias than those who had completed such training (p < .05). This study provides the first evidence that gynecologic oncology providers hold implicit biases related to cervical cancer. Interventions designed to target specific groups in gynecologic oncology may help improve interactions with patients.
    • Increasing Rates of Screening for Food Insecurity in a General Pediatrics Teaching Practice

      Romo, Ryan; The University of Arizona College of Medicine – Phoenix; Samaddar, Kristen (The University of Arizona., 2019)
      Food insecurity is a widespread and complex problem that affects approximately 21% of the nation’s children. Demographic and socioeconomic data alone are not indicative of all families that are unable to access enough food to fully meet basic nutritional needs because of insufficient means. Screening for food insecurity is essential to identify these families so that they can be set up with resources to increase their access to resources. This study assesses if the implementation of a two-question food insecurity screen at well child checks improves screening rates through prospectively looking at patients in PCH’s General Pediatric Clinic. The validated screen includes the questions, “In the past 12 months, did you ever worry whether the food for you and your family would run out before you had enough money to buy more?” and “In the past 12 months were there times when the food for you and your family just did not last and there was no money to get more?” (Hagar et al. 2010). A family who answered positively to either of these questions was identified as food insecure and set up with resources. Three stages of data were analyzed for identification of food insecurity. These included: 1) previous practices, 2) following provider education, and 3) following integration of the validated screening tool in the EMR. 60 well child visits, 20 from each age group (<1yr, 1-4yr, and 5-11yr), were randomly selected and reviewed for each stage. The integration of the screening tool into the EMR showed statistically significant improvement of screening rates and consequently more families were able to be identified as food insecure. This increase in identification improved overall quality of care by allowing providers to then share resources with families to gain access to food. The screen also has the potential to lower the cost of care through prevention of poor/fair health, hospitalizations, and developmental risks that are associated with FI in children. The next steps include identifying more resources to provide the families, improve follow up to see if the resources are actually being accessed, and encourage the use of the screen in other clinical settings seeing how not everyone presents for primary care.
    • Investigating the Role of p53 in Herpes Simplex Virus - 1 Replication

      McMahon, Savanah; The University of Arizona College of Medicine – Phoenix; Boehmer, Paul E. (The University of Arizona., 2019)
      Herpes simplex virus 1 (HSV-1) is a common human virus that can cause a variety of pathologies, including oral lesions and invariably fatal encephalitis. As there is currently no cure for HSV-1 infection, worldwide morbidity and mortality rates remain high. HSV-1 replication is under intricate control by both viral and cellular factors that dictate whether the virus undergoes productive lytic replication or enters a state of latency during which there is decreased viral gene expression and virus production. The intricate mechanisms that determine the fate of the virus are not completely understood. p53, the well-known tumor suppressor gene, is involved in various cellular responses to stress, such as viral infection. We hypothesized that p53 plays a role in the establishment of HSV-1 latency by negatively regulating HSV-1 replication through repression of viral gene expression via the ATM/ATR damage response pathway leading to expression of p53 and regulation of gene expression via p53 response elements (RE). Viral yields were determined for HSV-1 strain KOS grown on HCT116 wild-type (p53 +/+) and HCT116 p53-deficient (p53 -/-) cells at a multiplicity of infection (MOI) of 1 and at 72 hours post-infection, with the prediction that the viral titer would be higher for the virus derived from the HCT116 p53-deficient cells. Our results demonstrate that there is no significant difference in HSV-1 titer between p53-deficient cells and wildtype cells under these conditions. This suggests that p53 does not play a vital role in promoting HSV-1 latency overall; rather, p53 may exert both positive and negative effects on HSV-1 replication at varying points in time without favoring one cycle over another. Future research, such as determining viral yield harvested from cells in which the levels of p53 have been increased by both overexpression and the use of pharmacological agents to stabilize endogenous p53, should be conducted to further elucidate these complexities.
    • Is Ketamine an Effective Sedative in the Acutely Agitated Patient in the Prehospital Setting?

      Hawk, Katie; The University of Arizona College of Medicine – Phoenix; Gallagher, John (The University of Arizona., 2019)
      Excited Delirium Syndrome: disorder characterized by hallucinations, aggressive and peculiar behaviors, a catecholaminergic surge and secondary risk for sudden cardiac death (Gerold, 2015). The development of sedatives and antipsychotics lead to a decreased incidence until the 1980s. With increasing use of stimulants such as cocaine and methamphetamines, the rates of “undetermined cause of death” has increased in patients exhibiting acute agitated delirium who were in police custody. Patients in this state may be in danger of avoidable death. Emergent medical treatment may prevent death in these patients as suggested by a retrospective review of deceased patients; indicating a need for sedation that minimizes the use of physical restraint and sedates the patient chemically. Ketamine, which functions as a noncompetitive antagonist to NMDA receptors and releases of glutamate, is an option for chemical sedation. The safety profile is ideal as it has a wide therapeutic index and does not act on opioid or GABA receptors. This study asks if Phoenix Fire Department paramedics assessments indicate that IV/IM ketamine administration to patients with Excited Delirium Syndrome is more effective at sedation than Midazolam alone for prehospital transport to an acute care facility?
    • Isotonic Intravenous Fluids and Blood Pressure in Pediatric Patients

      Keller, Lindsay; The University of Arizona College of Medicine – Phoenix; Allen, Edith (The University of Arizona., 2019)
      The standard of care for pediatric intravenous (IV) fluids was previously hypotonic IV fluids as maintenance therapy. Following evidence showing hypotonic fluids leading to an increased risk of iatrogenic hyponatremia, isotonic IV fluids have become the current standard of care maintenance fluids. This study examines the safety of administering isotonic IV fluids for constipation by comparing incidences of iatrogenic high blood pressure in pediatric patients with constipation receiving isotonic vs hypotonic fluids. This pre-post study examines the records of children aged 1 to 5 years diagnosed with constipation and admitted to Phoenix Children’s Hospital during July 1, 2009 to June 30th 2012 and July 1st 2013 to June 30th 2016 who received hypotonic and isotonic fluids, respectively, according to standard of care protocols. The primary outcome was the proportion of patients developing high blood pressure after receiving IV fluids for at least 24 hours. Blood pressures were collected on admission (baseline), 24 hours, 48 hours, 72 hours, 96 hours, and 120 hours after hospitalization. Incidences of elevated blood pressure were calculated at baseline, 24 hours, 48 hours, 72 hours, 96 hours, and 120 hours after hospitalization for both groups. When compared to baseline, the isotonic group was not more likely to develop high blood pressure than the hypotonic group at all time points (p value > 0.05). There is no significant increase in rates of high blood pressure in pediatric patients receiving isotonic IV fluids compared to patients receiving hypotonic IV fluids. This supports the current guidelines for using isotonic IV fluids in pediatric patients as maintenance fluids.
    • Outcomes after massive honeybee envenomation in patients with comorbid conditions during hospital admission: a retrospective review

      Zelic, Maximilian; The University of Arizona College of Medicine – Phoenix; Ruha, Michelle (The University of Arizona., 2019)
      This study’s aim was to discover the outcomes associated with massive honeybee envenomation. Additionally, we wanted to observe what trends might be seen with regard to outcomes in patients with comorbidities and those without. Honeybees belong to the insect family of Hymenoptera, which includes wasps, yellow jackets and hornets. Hymenoptera are responsible for more deaths than any other venomous insects and pose a risk to the public due to the emergence of well-established populations of Africanized honeybees. These honeybees are prevalent in southwestern states such as Arizona. Africanized bees are more aggressive and take less to provoke stings than non-hybridized bees, and mass envenomations can cause fatal accidents. This study was a retrospective review of patient charts based on ICD-9 and ICD-10 records indicating massive honeybee envenomation and screened to include only patients meeting our inclusion criteria of ≥ 50 stings over a 10 year period at Banner – University Medical Center Phoenix. 25 total patients were included and epidemiological, clinical, and therapeutic data were obtained and compared for noticeable trends in the data with regard to demographics and comorbidities. The 25 patients ranged in age from 16 to 82 years old. Total number of stings varied from an estimated 50 stings, to over 1000. The majority of patients were estimated to have been stung by between 100 to 500 bees representing thirteen patients (52%). Four patients (16%) had a history of CAD, fourteen patients had hypertension (56%), nine patients had diabetes (36%), and one patient had asthma. In terms of outcomes, five patients (20%) required intubation for airway management, two patients were dialyzed (8%), and the average length of stay was 84.2 hours over the course of hospital admission. Our results showed that there was no obvious trend in the outcomes of patients with and without CAD, asthma, hypertension, and diabetes. Significant trends were primarily seen in the total number of stings sustained. In patients with a greater number of stings, the total length of stay increased dramatically. Number of stings also seemed to indicate a greater risk of requiring intubation as well. Finally, creatine kinase levels were also significantly elevated in patients with a higher sting count, supporting prior work done regarding the effect of mass envenomations with resulting rhabdomyolysis. This research supports that fact that ultimately the biggest determinant of a patient’s clinical course is the number of stings that they present with. It seems safe to assume that a mass envenomation on the scale of hundreds to thousands of stings will greatly increase the chance that this particular patient is going to have significant rhabdomyolysis, be at greater risk of requiring advanced airway measures such as intubation, and be admitted to the hospital for a longer period. Future work would be enhanced by implementing a multicenter review to increase the power of the study to allow for statistical comparisons to be made, creating an opportunity to delineate potential differences in outcomes based on comorbid conditions.
    • Patient Activation Through Community Paramedicine – Initial Assessment and Future Directions

      Goff, Nathan; The University of Arizona College of Medicine – Phoenix; Clever, M. Todd (The University of Arizona., 2019)
      Community paramedicine (CP) is an evolving concept that promises to expand the role of emergency medical services to support patients beyond the conventional emergency activation. Community paramedics engage in a variety of activities during visits to patient homes including post hospital discharge follow up, medication reconciliation and monitoring of health parameters such as body weight and blood pressure. As CP programs develop, it is important to have a mechanism by which to measure their success. Patient activation is a holistic concept that describes a patient’s ownership of his or her health and healthcare. The survey based Patient Activation Measure (PAM) is a quantitative means to assess a patient’s level of activation. Is it possible that participation in a CP program could increase patient activation, which in turn could act to describe the success of the CP intervention? This study analyzed data derived from a PAM survey used in association with a CP program at Buckeye Fire Department in Buckeye, Arizona. It was expected that patient activation would increase among patients participating in the program. A clear correlation was not found however several insights were gained which hold promise to better define a future study.
    • Pediatric RSV Patients: Radiographic Findings on Admission and Clinical Outcomes

      Shoshan, Dor; The University of Arizona College of Medicine – Phoenix; Connell, Mary (The University of Arizona., 2019)
      Respiratory Syncytial Virus (RSV) is a common cause of respiratory tract infection in children. This retrospective review attempts to evaluate the association of admission chest radiographs with severity of clinical outcome. Radiographic findings were correlated with ‘severe’ and ’non-severe’ clinical outcomes, whereby a severe outcome was defined as hospitalization > 2 days, PICU admission, or mechanical ventilation during hospitalization. A non-severe outcome was defined as absence of the previous criteria. The most common abnormal chest radiograph findings were: interstitial prominence (n=182 [61.5%]), airspace opacity (n=106 [35.8%]), and hyperinflation (n=78 [26.3%]). The radiographic findings found to be associated with a severe clinical outcome were hyperinflation (p=0.033) and airspace opacity (p<0.001). Clinicians should consider more aggressive treatment and closer monitoring when these findings are present on admission chest radiography.
    • Physical, Emotional/Psychological and Sexual Abuse Analysis based on Victim Characteristics

      Salefsky, Sherilyn; The University of Arizona College of Medicine – Phoenix; Hussaini, Khaleel (The University of Arizona., 2019)
      It is estimated that 25-35% of women and men in Western countries have experienced Intimate Partner Violence (IPV). Research has been performed indicating that there are long term effects of physical and emotional problems including associations with higher rates of mental illness and substance abuse. However, most research has been geared towards females as the victims of abuse. Research looking at the risk factors and long-term outcomes of male abuse victims has been limited. For this reason, this study was designed to determine the associated diagnoses and demographic factors which are associated in victims of physical, emotional/psychological and sexual abuse in both males and females presenting to Emergency Departments in Arizona.
    • Pre-Hospital Factors that Lead to Increased Mortality and Morbidity in Trauma Patients in Developing Countries: A Systematic Review

      Smith, Gabriella; The University of Arizona College of Medicine – Phoenix; Beyda, David (The University of Arizona., 2019)
      Trauma is a growing global concern and the WHO estimates that injuries account for one-sixth of the global adult disease burden. Furthermore, there is a disproportionate number of trauma related deaths that occur lower middle-income countries compared to higher income countries. Studies show that deficiencies in care in preventable related deaths include pre-hospital delays, delays in treatment and inadequate resuscitation. Additionally, most trauma related deaths occur in the prehospital setting and it is in the lower to middle income countries where structured emergency medical services are lacking. This review seeks to identify and categorize the contributing prehospital factors that lead to increased mortality and morbidity in trauma patients in developing countries. A systematic review was performed using primary journal articles (written in English) that report pre-hospital interventions and morbidity and mortality outcomes in trauma patients in developing countries. PubMed/MEDLINE and other literature databases were used to locate these primary journal articles by utilizing combinations of search terms “developing countries (MeSH),” “Emergency Medical Services (MeSH),” “pre-hospital emergency response,” and “third world countries.” Our analysis found that patients who experienced a prehospital delay had an 86% increase in mortality. Regarding prehospital care, which was not a well-defined factor across all three papers, one papers found that patients who did not experience adequate prehospital care had a 226% increase in mortality while the other papers only included frequency rates of interventions and corresponding data on mortality. Regarding intubation, one study showed that prehospital intubation was associated with increased mortality compared to emergency department intubation. This study adds to the scarce literature how a lack of prehospital infrastructure is associated with an increased likelihood of mortality. It also highlights the importance and necessity of an increase in quality primary research conducted in developing countries. Only prehospital delay had enough papers with data and thus was the only factor we were able to perform a meta-analysis. Our analysis found that patients who experienced a prehospital delay had an 86% increase in mortality.
    • Quality of Bowel Preparation does not Influence Adenoma Detection Rate

      Barendrick, Lindsay; The University of Arizona College of Medicine – Phoenix; Guha, Sushovan (The University of Arizona., 2019)
      Adenoma detection rate (ADR) is the gold standard and quality measure for screening colonoscopies, however the impact of bowel preparation quality on ADR is not clearly understood. The aim of our study was to investigate the influence of bowel preparation quality on ADR in screening colonoscopies.
    • Readability of After Visit Summaries: Comparing the Level of Information in After Visit Summaries from Internal Medicine and Family Medicine Residencies

      Amundsen, Tyson; The University of Arizona College of Medicine – Phoenix; Coles, Sarah (The University of Arizona., 2019)
      Written advice can improve compliance with medical instructions. The Centers for Medicaid and Medicare Services expect physicians to provide a summarized report following at least most patient encounters. We analyzed 400 after visit summaries (AVS) provided to patients at Internal Medicine and Family Medicine residency clinics. The Flesch-Kincaid Grade Level Test and the Flesch Reading Ease Score were used to evaluate readability. We demonstrated that AVS are usually written at a level that is too high to be helpful to patients. We conclude that patient visit summaries are not written to the appropriate recommended grade levels of <-8th grade for the average patient population. Further studies are needed to show if appropriate grade level summaries will improve quality of care.
    • Retention Rates of Sex trafficked and At-risk Youth in a Rehabilitation Center

      Khan, Aliya; The University of Arizona College of Medicine – Phoenix; Roe-Sepowitz, Dominique; Calvin, Samantha (The University of Arizona., 2019)
      Sex trafficking is a prevalent criminal enterprise in the world. The United States has the second largest sex trafficking market in the world. There are rehabilitation facilities and interventions that exist for children and young people who experience commercial sexual exploitation (CSEC). However, there remains limited information on the most effective interventions for these young people. The study aims to report on the at-risk and sex trafficked youth in a facility in Arizona, retention, as well as risk factors that differentiate these two cohorts. By comparing 69 sex trafficked youth to 70 at-risk youth, we can further delineate how prior sexual abuse, emotional abuse and substance abuse affects rates of retention. Findings indicate that CSEC girls were more likely to run away. There was a statistically significant difference between the CSEC and non-CSEC girls with regards to substance abuse and sexual abuse. The two groups did not differ significantly in terms of emotional abuse.
    • Retrospective Study Comparing the Efficacy of Epidural Analgesia to Perineural Nerve Catheter Analgesia for Postoperative Pain Management in Pediatric Patients Following a Unilateral Lower Limb Surgery

      Trif, Daniel; The University of Arizona College of Medicine – Phoenix; Belthur, Mohan (The University of Arizona., 2019)
      The primary aim of this study was to determine if peripheral nerve catheterization offers a better analgesic alternative than an epidural catheter in pediatric patients who undergo a unilateral lower limb surgery. Postoperative pain management is not only important in promoting comfort to patients in pain but can also promote rehabilitation and optimal healing. Multimodal analgesia is the use of multiple modalities to treat patients’ pain; two of these methods include epidural and peripheral catheters. Epidural catheter infusions offer global analgesia from the waist to both of the lower extremities. Epidurals do pose side effect risks that include infection, urinary retention, hypotension, pruritus, nausea/vomiting, headaches, backaches, and respiratory depression. Peripheral nerve infusions can act more locally at a targeted area and deliver carefully dosed anesthetics to nerve fibers that can hinder the sensory function of nerves while preserving the motor function, allowing for earlier rehabilitation. The use of multimodal analgesia as a postoperative pain management plan can still vary greatly from clinician to clinician, so it would be of benefit to determine which subset of patients may benefit from having a catheter infusion as part of their treatment regimen and whether a peripheral infusion is superior to an epidural infusion. This was a retrospective study that looked at 65 pediatric patients, ages 5-15, that received either an epidural infusion (n = 53) or a peripheral nerve block infusion (n = 12) for a unilateral lower limb operation. Their charts were analyzed to determine pain scores, PCA usage, PRN morphine equivalents, total morphine equivalents, adverse events, length of catheter use, and length of hospital stay, amongst other things. The epidural group was used as the control for the study and the data analysis revealed that the patients that received a peripheral infusion had 43% higher (p = 0.35) pain scores, received 98% less (p = 0.001) continuous morphine equivalents in their infusions, required 31% less (p = 0.34) PRN morphine equivalents, had 68% less (p = 0.049) PCA usage rates, received 32% less (p = 0.39) total morphine equivalents, had 30% less (p = 0.45) adverse effects, and left the hospital 0.54 days earlier (p = 0.13) on average when compared to patients that received continuous epidural infusions. The data indicates that although the pains scores were higher for the peripheral infusion patients, these patients required less opioid exposure, which indicates relatively acceptable pain management for the patient and healthcare team while also allowing for the opportunity to engage in rehabilitation and avoid the global effects of epidural infusions and the associated increased profile risk. The conclusion of this study suggests that continuous peripheral infusions are a valid alternative to epidural infusions for pediatric patients that undergo a unilateral lower limb surgery and that a randomized control trial would be warranted to offer more definitive insight.