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Postoperative Pain Management (postoperative + pain_management)
Selected AbstractsConsent and Ethics in Postoperative Pain ManagementANAESTHESIA, Issue 12 2002Michael Harmer No abstract is available for this article. [source] Barriers to, and facilitators of post-operative pain management in Iranian nursing: a qualitative research studyINTERNATIONAL NURSING REVIEW, Issue 4 2008N. Rejeh bscn, mscn Background:, Unrelieved post-operative pain continues to be a major clinical challenge, despite advances in management. Although nurses have embraced a crucial role in pain management, its extent is often limited in Iranian nursing practice. Aim:, To determine Iranian nurses' perceptions of the barriers and facilitators influencing their management of post-operative pain. Methods:, This study was qualitative with 26 participant nurses. Data were obtained through semi-structured serial interviews and analysed using the content analysis method. Findings:, Several themes emerged to describe the factors that hindered or facilitated post-operative pain management. These were grouped into two main themes: (1) barriers to pain management after surgery with subgroups such as powerlessness, policies and rules of organization, physicians leading practice, time constraints, limited communication, interruption of activities relating to pain, and (2) factors that facilitated post-operative pain management that included the nurse,patient relationship, nurses' responsibility, the physician as a colleague, and nurses' knowledge and skills. Conclusion:, Postoperative pain management in Iran is contextually complex, and may be controversial. Participants believed that in this context accurate pain management is difficult for nurses due to the barriers mentioned. Therefore, nurses make decisions and act as a patient comforter for pain after surgery because of the barriers to effective pain management. [source] Postoperative pain management: Study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of painNURSING & HEALTH SCIENCES, Issue 1 2003Joanne W. Y. Chung RN Abstract The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for ,worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management. [source] Chronic, painful lower extremity wounds: postoperative pain management through the use of continuous infusion of regional anaesthesia supplied by a portable pump deviceINTERNATIONAL WOUND JOURNAL, Issue 3 2010Christy L Scimeca Reducing and preventing postoperative pain are currently a topic of great interest. There are different modalities for providing analgesia that can provide an alternative or adjunct to opioid therapy. One mode of therapy involves the use of portable pain pump devices that can deliver continuous local anaesthesia directly to the site of interest. A considerable amount of attention in literature has been dedicated to using regional anaesthesia postoperatively for various surgical applications. However, to our knowledge, little or no work has been published concerning the use of infusion of regional anaesthesia in the treatment of painful lower extremity wounds. We present a case report of a 55-year-old gentleman with a complex past medical history, 2-year history of opioid dependency and a 2-week history of intractable pain associated with the combination of debilitating painful diabetic neuropathy and painful lower extremity wounds. After surgical debridement of the lower extremity wounds, substantial analgesia was achieved postoperatively through the implantation of a portable direct infusion pump device. The device supplied 2 ml/hour of 0·25% bupivacaine and resulted in a reduction in pain within the first hour of implantation. Although the device achieved maximal analgesia at 6 hours, we found that this could have been likely reduced through the use of a 5-ml bolus dose of 0·25% bupivacaine at the time of implantation. The device provided sufficient analgesia to the patient without any observed adverse effects, and showed significant potential in avoiding an increase in his requirement for other systemic analgesia including opioids. [source] The Norwegian version of the American pain society patient outcome questionnaire: reliability and validity of three subscalesJOURNAL OF CLINICAL NURSING, Issue 15 2008Alfhild Dihle MSc Aims and objectives., To examine some psychometric properties of the Norwegian version of the American Pain Society's Patient Outcome Questionnaire (APS-POQ-N). Background., This study is part of an investigation of Norwegian orthopaedic surgical patients, where the overall aim is to evaluate the quality of postoperative pain management. Therefore, an adequate questionnaire on the quality of postoperative pain management was needed. Methods., The sample included 114 orthopaedic postoperative patients. The instrument consists of three main subscales, namely the modified Brief Pain Inventory (modified BPI subscale), the subscale on satisfaction with pain management (Satisfaction subscale) and the subscale on beliefs about pain management (Beliefs subscale), together with six single items about pain management. The reliability of these three main subscales was estimated using Cronbach's alpha coefficients and the construct validity was evaluated using principal-axis factor analysis with oblimin rotation. Results., Face and content validity of the APS-POQ-N were satisfactory, while the modified BPI and the Beliefs subscales showed acceptable internal consistency but the Satisfaction subscale did not. Factor analyses yielded a three-factor solution for the modified BPI, a one-factor solution for the Satisfaction subscale and a two-factor solution for the Beliefs subscale. Conclusions., The APS-POQ-N appears, in general, to be an acceptable method of evaluating postoperative pain management in orthopaedic postoperative patients. However, the alpha value of the Satisfaction subscale was low, and thus the subscale is not recommended for this purpose. Relevance to clinical practice., Reliable and valid instruments are important when performing clinical research. This instrument is applicable as an indicator of quality of postoperative pain management in clinical practice and research. [source] Acute Pain Teams in England: current provision and their role in postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 3 2003Ann Mcdonnell BSc Summary ,,This survey describes the current provision of multidisciplinary Acute Pain Teams (APTs) in acute English hospitals performing adult in-patient surgery (excluding maternity). Associations between the presence of an APT and a number of organizational and clinical initiatives for the management of postoperative pain are also explored. ,,Postal questionnaires were sent to the Clinical Director of Anaesthetics or head of the APT at every acute English hospital providing separate anaesthetic services. ,,After written and telephone reminders, the response rate was 86% (n = 226). ,,Eighty-four per cent (n = 190) of respondents had an APT in their hospital. The presence of an APT was associated (P,0.05) with higher estimates of patient controlled analgesia and epidural use, regular in-service training for nurses and junior doctors, written guidelines/protocols for management of postoperative pain, routine use of postoperative pain measurement systems and audit/research in relation to postoperative pain issues. ,,Acute Pain Teams, in which nurses play a major role, have a pivotal influence not only in relation to postoperative analgesia but also in wider service development. Since 1995, the number of hospitals offering in-patient surgery that are covered by an APT has risen. However, despite repeated endorsements from professional bodies, some acute hospitals still have no APT and recent evidence indicates that some APTs face financial problems and provide a ,token' service only. Recent policy recommendations may have little impact on the current situation. [source] Nursing documentation of postoperative pain managementJOURNAL OF CLINICAL NURSING, Issue 6 2002Ewa Idvall PhD Summary ?,Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. ?,The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. ?,The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. ?,The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. ?,The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. ?,The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware. [source] Anterior sciatic nerve block , new landmarks and clinical experienceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2005M. Wiegel Background: Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult. Methods: In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients. Results: Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5,14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI. Conclusion: Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement. [source] Spinal anesthesia for emergency abdominal surgery in uncontrolled hyperthyroidismACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2005A. Varela Patients with uncontrolled hyperthyroidism presenting as an emergency are at considerable risk. The anesthetic management of a thyrotoxic patient undergoing incidental emergency surgery is discussed. We focus on the intraoperative problems and, above all, postoperative pain management with regional anesthesia. [source] Corticosteroids in postoperative pain management: Future research directions for a multifaceted therapyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2004I. Gilron No abstract is available for this article. [source] Analgesic effects of preincisional administration of dextromethorphan and tenoxicam following laparoscopic cholecystectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2004C-C. Yeh Background:, Pre-incisional treatment with either N -methyl-D-aspartate (NMDA) receptor antagonists or non-steroidal anti-inflammatory drugs (NSAIDs) improves postoperative pain relief. This study examines the effect on postlaparoscopic cholecystectomy (LC) pain of a combination of dextromethorphan (DM), a NMDA-receptor antagonist, and tenoxicam, a NSAID, given preoperatively. Methods:, Eighty-eight ASA I or II patients scheduled for LC were entered into a randomized, double-blind study and randomly allocated to one of four groups. Controls received 20 mg (4 ml) of chlorpheniramine maleate (CPM) IM and 4 ml of normal saline (N/S) IV. Group DM received 40 mg of DM (containing 20 mg of CPM) IM and 4 ml of N/S IV. Group T were given CPM 20 mg IM, and tenoxicam 40 mg (4 ml) IV. Group DM + T were given DM 40 mg (containing 20 mg of CPM) IM, and tenoxicam 40 mg IV. All treatments were given 30 min before skin incision. Analgesic effects were evaluated by Visual Analog Scale (VAS) pain scores at rest and during coughing, at 1, 2, 4, 12, 24 and 48 h after surgery. The time to the first request for meperidine for pain relief, and total meperidine consumption, were recorded for 48 h after surgery. Results:, Compared to controls, patients given DM and DM + T first requested meperidine significantly later, had lower meperidine consumption, made fewer requests for meperidine, and had lower pain scores. There were significant differences between the DM + T and T groups at 2 and 4 h in both resting and incident VAS pain scores, the incidence of meperidine requests and the time to first meperidine injection. There were significant differences between groups DM and T at 1 h for resting pain and at 2 and 4 h for incident pain. Except for a significant difference in the incident pain score 1 h after surgery, there were no other differences in pain scores between the DM and DM + T groups. Neither synergistic nor antagonistic interaction was observed between DM and tenoxicam. Conclusions:, The results suggest that pretreatment with DM, but not tenoxicam, provides significant pre-emptive analgesia for postoperative pain management in patients after LC surgery. Combining DM and tenoxicam also gives good pain relief. [source] Postoperative pain management: Study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of painNURSING & HEALTH SCIENCES, Issue 1 2003Joanne W. Y. Chung RN Abstract The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for ,worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management. [source] Preoperative ropivacaine infiltration in breast surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2000A. Johansson Purpose: The aim of the study was to investigate whether preoperative infiltration with ropivacaine in conjunction with breast surgery improves postoperative pain management and attenuates postoperative nausea and vomiting. Method: Prospective, randomised, double-blind study, including 60 healthy women (ASA 1,2) allocated to one of two groups. Thirty patients were given 0.3 ml/kg saline in the operating field before surgery. Another 30 patients received a similar volume of ropivacaine 3.75 mg/ml. A visual analogue scale (0,100 mm) was used for evaluation of postoperative pain, nausea and vomiting. If the score was more than 30 mm at rest, the patients were given ketobemidone i.v. as treatment for postoperative pain, and dixyrazine i.v. against nausea and vomiting. The intra- and postoperative analgesic requirements and postoperative nausea and vomiting were registered. Results: The intraoperative fentanyl consumption was similar in the saline group 81±22 ,g vs 76±28 ,g; (ns) in the ropivacaine group. The postoperative 24-h ketobemidone consumption was also similar to those treated with ropivacaine (4.2±2.6 mg vs 4.2±4.3 mg; ns). Postoperative nausea and vomiting (PONV) occurred with similar frequencies in both groups. The 24-h dixyrazine consumption was the same in the two groups (2.1±2.7 mg in the saline group compared to 2.4±2.8 mg in the ropivacaine group; ns). After 6 h recovery, 41% of all patients had experienced nausea and 20% vomiting. Conclusion: We found no differences in postoperative pain management between 3.75 mg/ml ropivacaine and saline wound infiltration before breast surgery. The data show similar postoperative needs of analgesics and antiemetics with a similar frequency of PONV. [source] An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomyPEDIATRIC ANESTHESIA, Issue 12 2009CHANTAL FRIGON MSC MD Summary Background:, A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children. Methods:, We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay. Results:, Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3,3 25,75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5,5 25,75%ile) vs 6 (5,6 25,75%ile) days, P < 0.001]. Conclusions:, Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day. [source] Congenital hyperinsulinism , a review of the disorder and a discussion of the anesthesia managementPEDIATRIC ANESTHESIA, Issue 7 2007OLGA T. HARDY MD Summary Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infants and children. In most affected infants, CHI is caused by a specific genetic defect that results in the altered expression of pancreatic beta cells causing unregulated oversecretion of insulin. Infants with CHI may have either focal or diffuse abnormalities of the pancreatic , -cells. Both forms of CHI manifest as hypoglycemia, usually in the early newborn period. Focal disease can be treated effectively with surgical resection of the affected area, resulting in a total cure or rendering the patient amenable to medical management. Most children with diffuse disease are unresponsive to medical therapy, and require near-total pancreatectomy. At The Children's Hospital of Philadelphia, we have developed a multidisciplinary program for diagnosis and treatment of CHI. Anesthesiologists have played an integral role in the perioperative care of these infants, which includes diagnostic procedures, partial or near-total pancreatectomy, and postoperative pain management. In this review, we describe the clinical features, diagnostic methods and anesthetic concerns in children with CHI. [source] Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentrationANAESTHESIA, Issue 10 2010L. Ø. Andersen Summary Wound administration of local anaesthetic may be effective for postoperative pain management in knee arthroplasty, but the analgesic efficacy of local anaesthetic in relation to volume vs concentration has not been determined. In a double-blinded trial, 48 patients scheduled for total knee arthroplasty were randomly assigned to receive either a high volume/low concentration solution of ropivacaine (20 ml, 0.5%) or a low volume/high concentration solution of ropivacaine (10 ml, 1%), 6 and 24 h postoperatively through an intracapsular catheter. Pain was assessed for 2 h after administration. Pain was reduced in both groups with ropivacaine administration 24 h postoperatively (p < 0.02), but with no difference in analgesia between groups at all time intervals. No reduction in pain scores was observed with ropivacaine injection 6 h postoperatively. The median (IQR [range]) dose of oxycodone administered was 12.5 (10,19 [0,35]) mg in the high volume/low concentration group, and 20 mg (16,40 [0,65]) mg in the low volume/high concentration group (p = 0.005). In conclusion, intracapsular administration of local anaesthetic may have limited analgesic efficacy with no volume vs concentration relationship after total knee arthroplasty. [source] Association of human ,-opioid receptor gene polymorphism A118G with fentanyl analgesia consumption in Chinese gynaecological patientsANAESTHESIA, Issue 2 2010W. Zhang Summary One hundred and seventy-four Chinese gynaecology patients were studied for the impact of A118G polymorphism in the ,-opioid receptor gene (OPRM1) on pain sensitivity and postoperative fentanyl consumption. Pre-operatively, the pain threshold and pain tolerance threshold were measured using electrical stimulation. A118G polymorphism was genotyped using the polymerase chain reaction,restriction fragment length polymorphism method. Intravenous fentanyl patient-controlled analgesia provided postoperative pain management, assessed using a visual analogue scale and fentanyl consumed in the first 24 h after surgery was noted. We found the prevalence of G118 allele was 31.3%. The A118G polymorphism had a gene-dose-dependent effect on electrical pain tolerance threshold. Fentanyl consumption was also significantly different in patients with different OPRM1 genotypes (homozygotes for 118G consumed more than did heterozygotes or homozygotes for 118A). Fentanyl consumption increased in accordance with the number of 118G alleles. We conclude that OPRM1 gene analysis may help predict individual opioid sensitivity and so optimise postoperative pain control. [source] POST-SURGICAL NEUROPATHIC PAINANZ JOURNAL OF SURGERY, Issue 7 2008Edward Shipton Surgeons and anaesthetists are involved in Pain Medicine, as they have a responsibility to contribute to postoperative pain management and are often consulted about longer-term pain problems as well. A large component of persistent pain after surgery can be defined as neuropathic pain (NP). Nerves are injured during surgery and pain can persist after the surgical wound has healed. NP is because of a primary lesion or dysfunction of the peripheral or central nervous system. Prevalence estimates indicate that 2,3% of the population in the developed world experience NP. Persistent post-surgical NP is a mostly unrecognized clinical problem. The chronicity and persistence of post-surgical NP is often severely debilitating and impinges on the psychosocial, physical, economic and emotional well-being of patients. Options for treatment of any neuropathic factors are based on understanding the pain mechanisms involved. The current understandings of the mechanisms involved are presented. There is reasonable evidence for the efficacy of pharmacological management for NP. The aim of this article was to appraise the prevention, diagnostic work-up, the physical and particularly the pharmacological management of post-surgical NP and to provide a glimpse of advances in the field. It is a practical approach to post-surgical NP for all surgeons and anaesthetists. The take-home message is that prevention is better than waiting for post-surgical NP to become persistent. [source] Postoperative analgesic requirements , total laparoscopic hysterectomy versus vaginal hysterectomyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2005Marcelo Carraro NASCIMENTO Abstract Background:, There is limited information available on the requirement for postoperative analgesic drugs in patients submitted to total laparoscopic hysterectomy (TLH) compared with patients undergoing vaginal hysterectomy (VH). Aim:, To compare the postoperative analgesic requirements in patients who underwent a TLH with patients who had a VH. Methods:, Chart review of 53 patients who had TLH and 47 who had VH and were seen postoperatively by an acute pain management service in order to assess postoperative analgesic requirements. Patient controlled analgesia (PCA) was part of the standard protocol for postoperative pain management. Analgesic requirement was recorded as the mean doses of morphine and number of days that patients used non-steroidal anti-inflammatory drugs (NSAIDs), oxycodone and tramadol. Results:, The requirement for total morphine was approximately half the dose in patients who had a TLH (10.8 ± 12.6 mg) compared with patients who had a VH (19.4 ± 21.9 mg) (P 0.017). The length of use of NSAIDs was significantly reduced in patients who had undergone a TLH (2.0 ± 0.95 days) as compared with patients who had a VH (2.85 ± 1.1 days) (P < 0.0001). Conclusions:, Patients submitted to TLH require less postoperative analgesic drugs when compared with patients who had VH. Prospective randomised trials are warranted to compare analgesic requirements between patients submitted to TLH and VH. [source] | |||||||||||||||||||||||||