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PURPOSES: To determine if opioid-free anesthesia, opioid-sparing anesthesia, or multimodal analgesia improved outcomes in patients undergoing spinal fusion. DESIGN: A literature review was performed by searching PubMed, CINAHL, Embase, Web of Science, and Cochrane Library. METHODS: MeSH terms included "opioid free" AND "spine surgery," with alternative terms used including: regional anesthesia, multimodal analgesia, opioid-free anesthesia, enhanced recovery after surgery (ERAS), spinal surgery, spinal fusion, ACDF, cervical fusion, lumbar fusion, etc. Seven studies were deemed appropriate for inclusion with a combined sample size of n = 2,102. FINDINGS: All of the seven included articles evaluated total opioid administration and found a reduction in total opioid administered in the research groups versus control groups. Six of the seven included articles evaluated postoperative pain scores with mixed results. Various additional benefits of opioid-free, opioid-sparing, or multimodal analgesia included: decreased hospital length of stay (LOS), decreased post-anesthesia care unit (PACU) LOS, decreased post-operative nausea and vomiting (PONV), and decreased post-operative opioid use through 30 days. CONCLUSIONS: For patients undergoing spine surgery, opioid-free, opioid-sparing, and multimodal analgesia will be less likely to experience the adverse effects of opioid analgesics and ultimately lead to better patient outcomes and reduced hospital stays.

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PURPOSE: As the scope of motor development and learning knowledge has successfully broadened over the years, there is an increased need to identify the content and learning experiences that are essential in preparing preservice physical educators. The purpose of this study was to generate expert consensus regarding the most critical motor development and learning competencies that prospective physical educators need to learn within the physical education teacher education (PETE) curriculum and to identify learning environments and instructional methods for delivering core knowledge. METHOD: The study employed a 2-round, modified Delphi procedure involving the repeated circulation of a questionnaire to a panel of motor development specialists, motor learning specialists, teacher educators, and K-12 physical education teachers. Panel members rated an initial list of theoretical and applied motor development and learning competencies derived from various curricular guidelines and textbook sources. An open-response question was incorporated into the 2nd round asking panel members to recommend specific instructional methods and settings for delivering core motor development and learning content to prospective physical educators within the PETE curriculum. RESULTS: Expert consensus determined that 64 out of the initial 159 motor development and learning competencies were critical in preparing preservice physical educators. Early field experiences and peer practice in a variety of settings were recommended by panelists for delivering the identified competencies. CONCLUSIONS: The Discussion section represents an important link between the motor development and learning body of knowledge and physical education teachers' role in promoting skillful movement, physical activity, and fitness among youth in the school setting.

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Surgical therapy of ulcerative colitis is effective, safe, and provides an improved quality of life in those whose disease cannot be managed medically. In the elective setting, widespread acceptance of restorative proctocolectomy has made surgical therapy an attractive option in the overall management of ulcerative colitis. Enthusiasm for this procedure should be tempered by the acknowledgment of the significant incidence of pouchitis in the long term, however. Proctocolectomy with ileostomy remains a good surgical option for patients who are unsuitable for restorative procedures. The standard therapy for fulminant colitis or toxic megacolon remains subtotal colectomy with ileostomy. Patients undergoing subtotal colectomy are candidates for conversion to restorative procedures.

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Anal fissure is a common condition with a characteristic presentation. Despite increased pharmaceutical options in the medical management of anal fissures, surgical therapy is not in danger of becoming obsolete. Lateral internal sphincterotomy remains an attractive option for many patients suffering from this painful condition.

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Preview Both patients and physicians tend to ascribe all anorectal symptoms to hemorrhoids, but many are caused by other common conditions. Anal fissure, perianal abscess, pruritus ani, and condylomata acuminata that have reached a large size also cause considerable discomfort. Dr Metcalf summarizes identifying characteristics of the disorders, treatments that can be performed in an office visit, and circumstances that may warrant more extensive surgical procedures.