Auburn Research Day 2022

Cl i n i ca l Resea rch | Med i ca l St udent Regional Anesthesia for Total Hip Arthroplasty: Essential Anatomy, Techniques and Current Literature Review 31

Lauren Mason 1 ; Promil Kukreja MD 2 ; Joel Feinstein MD 2 ; Elizabeth Morris MD 2 ; Hari Kalagara MD 2 Edward Via College of Osteopathic Medicine-Auburn Campus; UAB Department of Anesthesiology and Perioperative Medicine 2

Purpose of Review: Total hip arthroplasty (THA) related to osteoarthritis is one of the most common joint arthroplasty surgical procedures. The purpose of this literature review was to examine the different modes of analgesia that are used to manage post-operative pain in patients undergoing hip surgery, primarily THA. Discussion: To date, there exists no gold standard regional or multimodal pain regimen used for patients undergoing THA. Our review examined the different modes of analgesia that are used to manage post-operative pain in patients undergoing THA. The updated Procedure Specific Postoperative Pain Management (PROSPECT) guideline from 2021 [70] recommends pre-operative analgesic regimen of acetaminophen and COX-2 inhibitors or NSAIDs, spinal or general anesthesia and continued postoperatively with opioids used as rescue analgesics. Intrathecal morphine 0.1 mg can be used or patients receiving spinal anesthesia. In addition, regional anesthesia techniques such as fascia iliaca or local infiltration analgesia and intra-operative intravenous dexamethasone 8-10 mg are recommended. Considering multiple perioperative outcomes, the ICAROS (International consensus on anesthesia-related outcomes after surgery) consensus was that neuraxial anesthesia is the preferred anesthetic technique, and that this reduces the risk of most complications [71]. The use of regional nerve blockade as discussed in this review has been supported in the literature. In fact, peri-operative regional anesthesia has demonstrated by several large studies to decrease patient mortality, major morbidity,

post-op complications, and length of hospital stay [1, 7, 9, 16, 65]. However, careful consideration should be made regarding the type of regional block performed, specifically because some traditional blocks are being replaced by newer, safer and faster techniques. Regardless of the type of regional nerve block performed, a multimodal pain regimen must be used in order to provide optimal pain control. Combining peripheral nerve blocks (PNB) with adjunctive measures such as local infiltration analgesia, gabapentenoids, systemic non-steroidal anti- inflammatory drugs (NSAIDs), and spinal (intrathecal) opioids allows the anesthesiologist to provide optimal analgesia with potential for minimal adverse effects, as well as prolonging the duration of pain control. This is crucial, as adequate post-operative analgesia is correlated with improved patient outcomes, time to recovery, and overall satisfaction. Summary: Choosing the correct multimodal analgesic regimen (MMA) in patients undergoing THA is of utmost importance, as this can minimize side effects, optimize recovery, reduce the use of opioid consumption, and decrease overall postoperative morbidity and mortality.

Kiveum Kim, OMS III; (1) Robert Chory, OMS III; (1) Jacob Greenspan, OMS III; (2) David Wynne, MD VCOM-Auburn Campus; (2) Grandview Medical Center 32 Cl i n i ca l Case Repor t | Med i ca l St udent

Nesidioblastosis- A Rare Complication of Roux-En-Y Gastric Bypass Surgery

Adult-Onset Nesidioblastosis is a rare condition that occurs almost exclusively following Roux-en-Y gastric bypass surgery. As little as 90 patients were identified with this condition up until 2011, and now the annual incidence of adult-onset nesidioblastosis is 0.09/100,000 with the mean age being 47 years old. Nesidioblastosis is characterized by diffuse proliferation of the β -cells of the pancreas and results in the hypersecretion of the insulin leading to Persistent Hyperinsulinemia Hypoglycemia. Postprandial hypoglycemia is a key distinguishing feature of this disorder. In this report, we outline 47-year-old Caucasian female who underwent a Roux-en-Y gastric bypass surgery and years later developed severe symptomatic hypoglycemia. She was referred to Mayo clinic where she underwent extensive workup. She was diagnosed with Nesidioblastosis. Subtotal surgical Resection of pancreas was

performed and she was given Acarbose 50 mg po with every meal and she was carefully monitored by her primary care doctor through the course of next 13 years. With the obesity epidemic on the rise, the need for greater understanding complications of Roux-en-Y gastric bypass surgery and other treatment will be critical. With such few cases having been reported up to date, this publication is essential to the advancement of understanding of this disease process.

21 2022 Via Research Recognit ion Day