Differences in analgesia in opioid naïve and tolerant patients with sciatic nerve blockade following elective foot and ankle surgery

1.1 Introduction and Purpose: Adequate postoperative analgesia in the opioid tolerant with chronic non-malignant pain is challenging. Multimodal pain relief regimens include regional anesthesia but opioid tolerant patients report increased postoperative pain and opioid consumption. This study compared analgesia in opioid naïve and tolerant patients receiving postoperative sciatic nerve blockade for foot and ankle surgery. 1.2 Method: Preoperative pain scores, trauma, maintenance and intraoperative opioid doses and following postoperative sciatic nerve blockade, patient self-reported pain scores and opioid consumption at discharge from the post-anesthesia unit and 24 hours were recorded. 1.3 Results: 191 patients enrolled. 40.3% were opioid tolerant and 33% had lower extremity trauma. Preoperative, immediate and delayed postoperative pain scores and intraoperative, immediate and 24 hour postoperative consumption of opioids were increased in opioid tolerant patients. Trauma and continuous infusion in opioid naïve and tolerant groups did not result in differences in 24 hour opioid consumption. 1.4 Limitations: Small subgroups and use of the pain score limited the accuracy of results. 1.5 Conclusion: Opioid tolerant patients require greater analgesic doses following sciatic nerve blockade for foot and ankle surgery. 24 hour opioid consumption for opioid naïve and tolerant patients is neither influenced by lower extremity injury nor continuous infusion.

Computing Hydraulic Conductivity from Borehole Infiltration Tests and Grain-Size Distribution in Advance Glacial Outwash Deposits, Puget Lowland, Washington

This study evaluates two methods for estimating a soilís hydraulic conductivity: in-situ infiltration tests and grain-size analyses. There are numerous formulas in the literature that relate hydraulic conductivity to various parameters of the infiltrating medium, but studies have shown that these formulas do not perform well when applied to depositional environments that differ from those used to derive the formulas. Thus, there exists a need to specialize infiltration tests and related grain-size analyses for the Vashon advance outwash in the Puget Lowland. I evaluated 134 infiltration tests and 119 soil samples to find a correlation between grain-size parameters and hydraulic conductivity. This work shows that a constant-head borehole infiltration test that accounts for capillarity with alpha approximately 5m^-1 is an effective method for calculating hydraulic conductivity from our flow tests. Then, by conducting grain-size analysis and applying a multiple linear regression, I show that the hydraulic conductivity can also be estimated by log(K) = 1.906 + 0.102D_10 + 0.039D_60 - 0.034D_90 - 7.952F_fines. This result predicts the infiltration rate with a 95% confidence interval of 20 ft/day. The results of study are for application in the Puget Lowland.