Manipulation Under Anesthesia PDF

Preface

Manipulation in various forms has been performed for hundreds of years. Adjustive procedures specific to chiropractic and osteopathic practitioners have been used and practiced for more than 100 years. From the time these procedures were first used, they carried with them an aura of both allure and mystique. Scientific validation was not a prominent focus by many of the early practitioners, and techniques were passed on from one practitioner to another. The use of these manual techniques provided positive results for patients, and practitioners were not concerned with using controlled studies to prove the results. Some have referred to this as a period of anecdotal results - "Stories of improvement with no actual proof." Sadly this was the way manual practitioners approached their techniques and how they looked at the concerns of the scientific community. Today, as more research is conducted, and as more knowledge of manual therapy becomes available, the scientific community is starting to recognize that those practitioners who were scorned and scoffed at for so many years really did have something to offer.

Even so, we still see educated men and women using pragmatic discourse in their denial of the thousands of cases that have been and are daily being positively affected by the use of manual therapy.

ADVANCED MANUAL THERAPY

With the advent of more research and more specific types of manual therapy, a technique that has been used for more than 70 years by osteopathic, orthopedic, and chiropractic practitioners is being revisited with regularity. This technique is using manual/manipulative therapy while the patient is under the influence of anesthesia or, to use a more updated vernacular, medication-assisted manipulation. Today this technique is referred to as the fibrosis release procedure using medicationassisted manipulation under IV sedation.

This text is written at a time when manipulation under anesthesia (MUA) is controversial but being practiced with regularity. Third-party payors believed that if they labeled it as experimental, it would go away, even though there are some 70 years of documented proof of its efficacy.

Our greatest challenge today is to prove the efficacy of MUA beyond all reasonable doubt. Our challenges will still be present, but the argument of being experimental will not survive the scrutiny of the scientific community because there will no longer be a platform for unrealistic dialogue.

MUA has indeed been a part of the growth of our health care delivery system. It is part of our heritage now, and it is up to those who wish to study its effectiveness to continue to develop more research into its clinical validity. It is our hope that the material contained in this text will help start your discovery of this wonderful form of therapy. We also hope that it will instill in you a desire to continue your study so that future practitioners will have the benefit of your study to perpetuate the procedure known as manipulation under anesthesia.

This book focuses on all of the aspects of the MUA technique. It presents the scientific basis of the procedure; provides information on patient selection criteria; documents outcomes from patient procedures; and examines policies, protocols, and standards by which the procedure should be incorporated in treatment facilities. It also provides step-by-step guidelines of the generic procedure and policies for documenting results; addresses the "pain management" aspect of MUA; and discusses the overall use of the procedure from pre-MUA through post-MUA rehabilitation. It is my hope that this book will provide the tools needed to investigate this procedure so that it can become an acceptable addition to mainstream health care delivery.