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Introduction: Managing acute postoperative pain in patients on chronic opioid therapy is challenging. There is little data regarding optimal perioperative chronic opioid management. We hypothesized that continuing the home dose of opioid while inpatient following ventral hernia repair (VHR) would reduce total opioid consumption postoperatively., Methods: Chronic opioid users were ordered their home opioid scheduled and our standard multimodal analgesia regimen. At time of discharge, we reviewed inpatient opioid use and prescribed opioids based on morphine milligram equivalent (MME) consumed per our established protocol., Results: VHR was performed in 658 patients with 117 utilizing chronic opioid medications from June 2017 through March 2022; 43 patients were managed on protocol and 74 were not. Inpatient daily MME consumption was similar between groups (34 vs 36 MME; p ​= ​0.285). Patients treated according to protocol received significantly lower MME prescriptions at discharge (80 vs 225 MME; p ​< ​0.001) with similar refills (21.4 vs 25.4 ​%; p ​= ​0.820)., Conclusion: Continuing home opioids for chronic opioid users following VHR resulted in less opioid prescribing with no increase in refills., Competing Interests: Declaration of competing interest The following authors have outside financial interests: Warren (Intuitive – consulting fees, Ethicon/Johnson & Johnson – honorarium for speaking). The authors used no AI or AI assisted technologies in the writing process. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Multimodal analgesia is now a mainstay of perioperative care. Our aim is to assess the impact of adding methocarbamol on opioid use for patients undergoing primary ventral (umbilical and epigastric) hernia repair (PVHR) and inguinal hernia repair (IHR)., Methods: Retrospective review of patients undergoing PVHR and IHR who received methocarbamol, propensity score matched in a 2:1 fashion to patients not receiving methocarbamol., Results: Fifty-two PVHR patients receiving methocarbamol were matched to 104 control patients. Study patients were prescribed fewer opioids (55.8 vs 90.4%; p < 0.001) and received lower MME (20 vs 50; p < 0.001), with no difference in refills or rescue opioids. For IHR, study patients received fewer prescriptions (67.3 vs 87.5%; p < 0.001) and received lower MME (25 vs 40; p < 0.001), with no difference in rescue opioid (5.9 vs 0%; p = 0.374)., Conclusions: Methocarbamol significantly reduced opioid prescribing in patients undergoing PVHR and IHR without increasing the risk of refill or rescue opioid., Competing Interests: Declaration of competing interest Drs. Warren and Carbonell have received honoraria from Intuitive for consulting/speaking. Dr. Warren has also received honoraria from Ethicon for consulting/speaking. Dr. Cobb has received honoraria from W.L. Gore for consulting/speaking. The authors used no AI or AI assisted technologies in the writing process. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Alternatives to opioid analgesia are needed to reduce the risk of abuse, misuse, and diversion. Musculoskeletal pain is a significant contributor to postoperative pain after ventral hernia repair (VHR). We report the impact of methocarbamol on opioid prescribing after VHR., Methods: Review of all robotic and open VHR, Jan 2020-July 2022. Data was collected in the Abdominal Core Health Quality Collaborative (ACHQC) with additional chart review to assess for opioid refills. A 2:1 propensity score match was performed comparing opioid prescribing in patients prescribed vs not prescribed methocarbamol., Results: 101 patients received methocarbamol compared with 202 without. Similar number of patients received an opioid prescription (87.1 vs 86.6%; p = 0.904). Study patients received significantly lower MME prescription at discharge (60 v 75; p = 0.021) with no difference in refills (12.5 vs 16.6%; p = 0.386)., Conclusion: Addition of methocarbamol to a multimodal analgesic regimen after VHR facilitates reduction in prescribed opioid with no increase in refills., Competing Interests: Declaration of competing interest Drs. Warren and Carbonell have received honoraria from Intuitive for consulting/speaking. Dr. Warren has also received honoraria from Ethicon for consulting/speaking. Dr. Cobb has received honoraria from W.L. Gore for consulting/speaking. The authors used no AI or AI assisted technologies in the writing process. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To investigate demographics and causes of pediatric uveitis in a Swiss tertiary reference center over a 20-year period., Materials and Methods: Retrospective cohort study on patients with uveitis aged less than 16 years seen at Jules-Gonin Eye Hospital between 1 January 2000 and 31 December 2019., Results: Out of 2846 patients with uveitis seen in the Jules-Gonin Eye Hospital Ocular Immune-Infectiology Department, 317 (11.1%) were under 16 years of age and were included in this study. Median age at onset of the uveitis was 8.9 years (range 0 - 16). Anterior uveitis was the most frequent presentation (45.1%) followed by posterior uveitis in 26.2%, intermediate uveitis in 23.3%, and panuveitis in 5.4%. The inflammation was most frequently bilateral and non-granulomatous. A systemic inflammatory disease was found in 34% of the cases and an infectious cause in 24%., Conclusion: The repartition of the location of the uveitis was similar to previous reports from Western countries. Uveitis in juvenile idiopathic arthritis is the most frequent etiology related to a systemic disease in children. An infectious cause was found in 24% of our patients, which is a greater proportion than in adult cohorts., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: To prospectively investigate patients with seasonal allergic conjunctivitis (SAC) during the pollen season and test associations between tears total IgE, eotaxin concentrations, and SAC severity., Methods: Enrolled patients presented ocular symptoms and clinical signs of SAC at the time of presentation. Ocular itching, hyperaemia, chemosis, eyelid swelling, and tearing were scored, and the sum of these scores was defined as the clinical score. Conjunctival papillae were separately graded. We measured eotaxin concentration in tears by an enzyme-linked immunosorbent assay (ELISA) and total tear IgE by Lacrytest strip., Results: Among thirty patients (30 eyes), 11 showed neither tear IgE nor tear eotaxin, while 15 out of 19 patients with positive IgE values presented a positive amount of eotaxin in their tears (Fisher's test: p < 0.001). The mean eotaxin concentration was 641 ± 154 (SEM) pg/ml. In patients with no amount of tear IgE, we observed a lower conjunctival papilla grade than in patients whose tears contained some amount of IgE (trend test: p = 0.032). In the 15 patients whose tear eotaxin concentration was null, tear IgE concentration was 5.3 ± 3.5 arbitrary units; in the other 15 patients whose eotaxin was positive, IgE reached 21 ± 4.3 arbitrary U (Mann-Whitney: p < 0.001). We measured 127 ± 47 pg/ml eotaxin in patients with no history of SAC but newly diagnosed as suffering from SAC, and 852 ± 218 pg/ml eotaxin in patients with a known SAC (p = 0.008). In contrast, tear IgE concentrations of both groups did not differ statistically significantly (p = 0.947)., Conclusions: If IgE and eotaxin secreted in tears are major contributors in SAC pathogenesis, they however act at different steps of the process.