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Aytolign HA, Mersha AT, Ferede YA. Analgesic efficacy of posterior and anterior psoas compartment block: Lumbar plexus versus three -in-one nerve block after lower limb orthopedic surgery under spinal anesthesia: A prospective cohort study. Ann Med Surg (Lond) 2022; 73:103160. [PMID: 35003723 PMCID: PMC8717444 DOI: 10.1016/j.amsu.2021.103160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Postoperative pain is the most common complaint in patients who underwent orthopedic surgery. Regarding with the severity of pain, orthopedic patients suffered more than non-orthopedic patients in the immediate post-operative period. Therefore, pain management is crucial for better patient outcome. Lumbar plexus (LB) and three -in-one (3IN1) nerve blocks have been routinely practiced as pain management techniques in the study area but the analgesic efficacy was not studied yet. Thus, this study was aimed to compare the analgesic efficacy of the LBP versus 3IN1B as postoperative pain management after thigh orthopedic surgery under spinal anesthesia. Method An institutional-based prospective cohort study was conducted from October 10, 2020 to March 30, 2021 at the University comprehensive specialized hospital. Non-probability convenient sampling was used to select participants in both groups. The time to first analgesic request, severity of pain and total analgesia consumption within the first postoperative 24 h were measured. Result The mean and standard deviation to seek the first analgesia request time was 11. 55 ± 2. 82hr and 13. 35 ± 2. 58hr (p- 0.07) in patients who received LPB and 3IN1B respectively. Pain severity at rest and on movement was also comparable. The total tramadol consumption was 67. 65 ± 27. 20 mg and 70. 59 ± 37. 19 mg (p- 0.71), while total Diclofenac consumption was 63. 23 ± 45. 74 mg and 44. 88 ± 34. 72 mg (p-0.07) in LPB and 3IN1B groups respectively. Conclusion The study showed that there was no significant difference in the time to first analgesia request, postoperative pain, both at rest and movement and total analgesic consumption, between the LPB and 3IN1B. Orthopedic patients suffered more than non-orthopedic patients in the immediate post-operative period. Nerve blocks provide effective analgesic options. There are controversies comparing the efficacy of lumbar plexus and three in one femoral nerve block. Lumbar plexus and three in one nerve blocks have comparable time to seek 1st analgesia. Lumbar plexus and three in one nerve blocks have comparable pain severity and comparable analgesic consumption.
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Bonkowski SL, Gagne JCD, Cade MB, Bulla SA. Evaluation of a Pain Management Education Program and Operational Guideline on Nursing Practice, Attitudes, and Pain Management. J Contin Educ Nurs 2018; 49:178-185. [DOI: 10.3928/00220124-20180320-08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
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Andersson V, Bergman S, Henoch I, Ene KW, Otterström-Rydberg E, Simonsson H, Ahlberg K. Pain and pain management in hospitalized patients before and after an intervention. Scand J Pain 2017; 15:22-29. [DOI: 10.1016/j.sjpain.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 11/30/2022]
Abstract
Abstract
Background and aim
Studies have shown that pain is common among hospitalized patients and that there is a lack of compliance with pain management guidelines. Improving pain management does not only involve developing new drugs or technology; even more important is an effective organisation that utilises existing expertise. The aim of this study was to investigate whether pain in hospitalized patients can be reduced by implementing evidence-based pain management guidelines, providing education for staff and an organisation that includes pain responsibility nurses.
Methods
A cross-sectional study was carried out between 2009 and 2010 at two hospitals in southwest Sweden, comprising a baseline survey followed by an intervention. The study involved 306 patients, who answered questions about pain intensity at rest and while moving, disturbed sleep due to pain and whether they had used a pain rating scale while in hospital. Medical records were scrutinised for analgesic prescriptions. An intervention then took place, involving implementation of evidence-based guidelines, staff education and the introduction of pain responsibility nurses. A follow-up survey was carried out in 2012, in which 293 patients answered the same questions and their medical records were also reviewed. The baseline results were then compared with those of the follow-up survey.
Results
When compared with the baseline survey, the follow-up survey revealed significant differences in the use of validated pain rating instruments as well as the prescription of more appropriate analgesics. Prescription of paracetamol increased significantly in the follow-up survey; 56% of the patients were prescribed paracetamol on a regular basis, compared with 42% at baseline. There was also a significant increase in the use of strong opioids, from 38% at baseline to 55% at follow-up. Prescriptions of weak opioids decreased from 16% at baseline to 4% at follow-up. No significant differences were observed in patient pain levels in the follow-up survey. At baseline, 29% of the patients reported moderate to severe pain at rest (NRS 4–10) and at follow-up that figure was 24% (NRS 4–10). In both surveys, 41% reported moderate to severe pain (NRS 5–10) during movement. Thirty-nine percent reported disturbed sleep at night at both baseline and follow-up.
Conclusions
This study demonstrates that evidence-based guidelines made accessible to all staff as a pocket size booklet and on the intranet, in combination with staff education, pain responsibility nurses who informed other staff on their own wards, improved the prescription of analgesics in the hospitals studied. In order to achieve a noticeable effect for patients, i.e., reduced pain levels, an intervention containing more components than those employed in the present study is required.
Implications
Nurses and physicians need greater knowledge about the importance of pain rating. A vital part of pain management at hospitals is continuous evaluation of treatment outcomes to prevent severe pain and disturbed sleep. The complexity of pain and pain management requires commitment, time and knowledge on the part of healthcare staff. Multi-professional pain teams that support ward staff in pain management are necessary in order to reduce suffering and unnecessary pain in hospitalized patients.
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Affiliation(s)
- Viveka Andersson
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Department of Medicine , Hallands Hospital Varberg , Träslövsvägen 68, 432 37 , Varberg , Sweden
| | - Stefan Bergman
- Primary Health Care Unit, Department of Public Health and Community Medicine , Institute of Medicine, The Sahlgrenska Academy , University of Gothenburg , Box 457, 405 30 , Gothenborg , Sweden
- Spenshult Research and Development Centre , Bäckagårdsvägen 47, 302 74 , Halmstad , Sweden
| | - Ingela Henoch
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
- Angered Local Hospital , Halmtorget 1, 424 65 , Gothenburg , Sweden
| | - Kerstin Wickström Ene
- Department of Research, Development and Education , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Eva Otterström-Rydberg
- Department of Anesthesia and Intensive Care , Hallands Hospital , Varberg , Träslövsvägen 68, 432 37 Varberg , Sweden
| | - Hanna Simonsson
- Department of Surgery , Hallands Hospital , Halmstad , Lasarettsvägen, 302 33 Halmstad , Sweden
| | - Karin Ahlberg
- The Sahlgrenska Academy , University of Gothenburg , Institute of Health and Care Sciences , Box 457, 405 30 Gothenborg , Gothenburg , Sweden
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Asmat-Abanto AS, Aguirre AA, Minchón CA, Espejo-Carrera RE. Analgesic effectiveness of prophylactic therapy and continued therapy with naproxen sodium post simple extraction. JOURNAL OF ORAL RESEARCH 2015. [DOI: 10.17126/joralres.2015.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Carr ECJ, Meredith P, Chumbley G, Killen R, Prytherch DR, Smith GB. Pain: a quality of care issue during patients' admission to hospital. J Adv Nurs 2013; 70:1391-403. [PMID: 24224703 DOI: 10.1111/jan.12301] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/22/2022]
Abstract
AIM To determine the extent of clinically significant pain suffered by hospitalized patients during their stay and at discharge. BACKGROUND The management of pain in hospitals continues to be problematic, despite long-standing awareness of the problem and improvements, e.g. acute pain teams and patient-controlled analgesia, epidural analgesia. Poorly managed pain, especially acute pain, often leads to adverse physical and psychological outcomes including persistent pain and disability. A systems approach may improve the management of pain in hospitals. DESIGN A descriptive cross-sectional exploratory design. METHOD A large electronic pain score database of vital signs and pain scores was interrogated between 1st January 2010 and 31st December 2010 to establish the proportion of hospital inpatient stays with clinically significant pain during the hospital stay and at discharge. FINDINGS A total of 810,774 pain scores were analysed, representing 38,451 patient stays. Clinically significant pain was present in 38·4% of patient stays. Across surgical categories, 54·0% of emergency admissions experienced clinically significant pain, compared with 48·0% of elective admissions. Medical areas had a summary figure of 26·5%. For 30% patients, clinically significant pain was followed by a consecutive clinically significant pain score. Only 0·2% of pain assessments were made independently of vital signs. CONCLUSION Reducing the risk of long-term persistent pain should be seen as integral to improving patient safety and can be achieved by harnessing organizational pain management processes with quality improvement initiatives. The assessment of pain alongside vital signs should be reviewed. Setting quality targets for pain are essential for improving the patient's experience.
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Affiliation(s)
- Eloise C J Carr
- Faculty of Graduate Studies, University of Calgary, Alberta, Canada
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de la Cruz Carranza HO, Asmat Abanto AS, Guerrero Guevara R. Efectividad del tratamiento profiláctico con dexametasona de 8 y 4 mg para controlar el edema poscirugía de terceros molares incluidos: ensayo clínico aleatorizado de grupos en paralelo. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.maxilo.2013.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Christensen J, Matzen LH, Vaeth M, Wenzel A, Schou S. Efficiency of Bupivacaine Versus Lidocaine and Methylprednisolone Versus Placebo to Reduce Postoperative Pain and Swelling After Surgical Removal of Mandibular Third Molars: A Randomized, Double-Blinded, Crossover Clinical Trial. J Oral Maxillofac Surg 2013; 71:1490-9. [DOI: 10.1016/j.joms.2013.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/03/2013] [Accepted: 05/05/2013] [Indexed: 11/15/2022]
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Arakeri G, Colbert S, Rosenbaum G, Brennan PA. Full length articles published in BJOMS during 2010-11--an analysis by sub-specialty and study type. Br J Oral Maxillofac Surg 2012; 50:749-56. [PMID: 23021639 DOI: 10.1016/j.bjoms.2012.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/23/2012] [Indexed: 11/24/2022]
Abstract
Full length articles such as prospective and retrospective studies, case series, laboratory-based research and reviews form the majority of papers published in the British Journal of Oral and Maxillofacial Surgery (BJOMS). We were interested to evaluate the breakdown of these types of articles both by sub-specialty and the type of study as well as the proportion that are written by UK colleagues compared to overseas authors over a 2 year period (2010-11). A total of 191 full length articles across all sub-specialties of our discipline were published, with 107 papers (56%) coming from UK authors. There were proportionately more oncology papers arising from the UK than overseas (60 and 30% of total respectively) while the opposite was found for cleft/deformity studies (10% and 22%). There was only one laboratory-based study published from the UK compared with 27 papers from overseas. The number of quality papers being submitted to the Journal continues to increase, and the type of article being published between UK and overseas probably reflects different practices and case-loads amongst colleagues. The relatively few UK laboratory based studies published in BJOMS compared to overseas authors are most likely due to authors seeking the most prestigious journals possible for their work.
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Affiliation(s)
- Gururaj Arakeri
- Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur, Karnataka, India
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