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Tata TK, Ohene LA, Dzansi GA, Aziato L. Factors influencing nurses' pain assessment and management of road traffic casualties: a qualitative study at a military hospital in Ghana. BMC Emerg Med 2024; 24:100. [PMID: 38886656 PMCID: PMC11184758 DOI: 10.1186/s12873-024-01016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana. METHODS Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes. RESULTS Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management. CONCLUSIONS Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.
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Affiliation(s)
- Thomas Kwame Tata
- 37 Military Hospital, Neghelli Barracks Liberation Rd 37, Accra, Ghana
| | - Lillian Akorfa Ohene
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Ghana, P. O Box LG 43, Legon, Accra, Ghana.
| | - Gladys Akorfa Dzansi
- Department of Adult Health Nursing, School of Nursing and Midwifery of Ghana, P. O Box LG 43, Legon, Accra, Ghana
| | - Lydia Aziato
- University of Health and Allied Sciences, PMB 31, Volta Region, Ho, Ghana
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Medairos R, Lankford J, Everett R, Berger G, Weierstahl K, Woehlck H, Jacobsohn K, Johnson S. Impact of Acetazolamide on Perioperative Pain Control in Robotic Assisted Laparoscopic Prostatectomy. Urology 2023; 172:126-130. [PMID: 36481203 DOI: 10.1016/j.urology.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the efficacy of peri-operative acetazolamide for pain control in robotic assisted laparoscopic prostatectomy (RALP). Prior studies have demonstrated that preoperative acetazolamide decreased postoperative referred pain in the postsurgical period for laparoscopic procedures. The proposed mechanism is acetazolamide mediated inhibition of carbonic anhydrase, thereby preventing formation of carbonic acid and subsequent peritoneal acidosis with referred pain. This has yet to be demonstrated in the setting of RALP. METHODS AND MATERIALS Patients undergoing RALP were randomized to receive either preoperative saline or acetazolamide prior to the procedure. Overall pain scores were recorded at multiple time points post operatively, as well as total morphine equivalents administered for adjunctive pain control. RESULTS Thirty-one patients were included in the study: 16 patients (51.6%) received perioperative acetazolamide, and 15 patients (48.4%) received perioperative saline as placebo. Overall pain scores were similar for patients receiving acetazolamide compared to placebo at various time points: first responsive (3.5 ± 3.1 vs 4.1 ± 1.7, P = .28), immediately prior to leaving PACU (2.8 ± 2.9 vs 2.9 ± 2.9, P = .48), at 4 hours post-procedure (3.1 ± 3.0 vs 2.9 ± 1.8, P = .362), or at 24 hours post-procedure (2.3 ± 1.7 vs 2.2 ± 1.6, P = .5). Shoulder tip pain was not present in either cohort. No statistically significant difference was observed for total morphine equivalents delivered between acetazolamide and placebo (17.3 vs 20.5, P= .2, respectively). CONCLUSION Acetazolamide does not appear to impact overall pain or shoulder tip pain in the observed cohort of patients undergoing RALP.
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Affiliation(s)
| | | | - Ross Everett
- Medical College of Wisconsin in Milwaukee, Milwaukee, WI
| | - Garrett Berger
- Medical College of Wisconsin in Milwaukee, Milwaukee, WI
| | | | - Harvey Woehlck
- Medical College of Wisconsin in Milwaukee, Milwaukee, WI
| | | | - Scott Johnson
- Medical College of Wisconsin in Milwaukee, Milwaukee, WI
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Abbasnia F, Aghebati N, Miri HH, Etezadpour M. Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy. Pain Manag Nurs 2023; 24:280-288. [PMID: 36658058 DOI: 10.1016/j.pmn.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC). AIM The present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC. METHOD This randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire. RESULTS The results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001). CONCLUSIONS As evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.
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Affiliation(s)
- Fatemeh Abbasnia
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Aghebati
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Hamid Heidarian Miri
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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Vincenzi P, Stronati M, Garelli P, Gaudenzi D, Boccoli G, Starnari R. Segmental Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy with the "Hypobaric" Technique: A Case Series. Local Reg Anesth 2023; 16:31-40. [PMID: 37188284 PMCID: PMC10178898 DOI: 10.2147/lra.s395376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/19/2023] [Indexed: 05/17/2023] Open
Abstract
Purpose Several studies have applied lumbar spinal anesthesia (SA) with isobaric/hyperbaric bupivacaine and opioids in elective laparoscopic cholecystectomy (LC), documenting a superiority of the methodic over general anesthesia (GA) in terms of perioperative pain, nausea, and vomiting, though with a notable incidence of intraoperative right shoulder pain, potentially responsible for conversion to GA. This case series presents an opioid-free scheme of segmental thoracic spinal anesthesia (STSA) with hypobaric ropivacaine, reporting its benefits mainly in terms of shoulder pain occurrence. Patients and Methods Hypobaric STSA was performed in nine patients undergoing elective LC between May 1 and September 1, 2022. The level of the needle insertion was included between T8 and T9, via a median or a paramedian approach. Midazolam (0.03 mg/kg) and Ketamine (0.3 mg/kg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 5 mg and then isobaric ropivacaine at a dose of 10 mg. Patients were placed in anti-Trendelenburg position for the entire duration of surgery. LC was conducted through the standard 3 or 4 ports technique with pneumoperitoneum maintained at a pressure of 8-10 mmHg. Results Mean patient age was 75.7 (±17.5) years, with a mean ASA score and Charlson comorbidity index (CCI) of 2.7 (±0.7) and 4.9 (±2.7), respectively. STSA was completed without complications in all patients, with no need for conversion to GA. Mean operative time and SA duration were 37.5 (±8.7) and 145.2 (±21.8) min, respectively. Intraoperatively, no shoulder or abdominal pain and nausea were reported, with only four and two patients requiring vasopressor and sedative intravenous drugs, respectively. Postoperatively, overall mean VAS pain score and within the first 12 hafter surgery were 3 (±2) and 4 (±2), respectively. Median length of stay was 2 (range = 1-3) days. Conclusion Hypobaric opioid-free STSA appears to be a promising approach for laparoscopic surgeries, with minimal to null occurrence of shoulder pain. Larger prospective studies are required to validate these findings.
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Affiliation(s)
- Paolo Vincenzi
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
- Correspondence: Paolo Vincenzi, Department of General Surgery, Ospedali Riuniti Marche Nord, Piazzale Cinelli n 1, Pesaro, 61121, Italy, Tel +39 3394578495, Email
| | | | - Paolo Garelli
- Department of General Surgery, IRCSS-INRCA, Ancona, Italy
| | - Diletta Gaudenzi
- Department of Perioperative Services, AOU “Ospedali Riuniti di Ancona”, Ancona, Italy
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Jiang Y, Wu Y, Lu S, Que Y, Chi Y, Liu Q. Patients with low body mass index are more likely to develop shoulder pain after laparoscopy. Acta Obstet Gynecol Scand 2022; 102:99-104. [PMID: 36324236 PMCID: PMC9780717 DOI: 10.1111/aogs.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Shoulder pain is one of the most common complications after laparoscopy. Previous studies have found a number of methods to reduce shoulder pain after laparoscopic surgery, but these methods have not been targeted to specific populations. The purpose of this study was to identify people who are more likely to develop shoulder pain. MATERIAL AND METHODS A total of 203 patients underwent laparoscopy for benign gynecological diseases between July 2020 and February 2021. Patients were divided into two groups according to the Chinese overweight standard, body mass index less than 24 kg/m2 group and 24 kg/m2 or more group. The baseline characteristics and intraoperative data between the two groups were compared. The intensity of the shoulder pain was quantified using a visual analog scale (VAS). RESULTS The incidence and the VAS scores of shoulder pain were significantly higher in the less than 24 kg/m2 group (63.64% vs 38.03%, p < 0.001 in incidence; median 5 (interquartile range [IQR] 3-7) vs 3 (IQR 2-5), p < 0.001 in VAS scores), and the chance of shoulder pain within 24 hours after laparoscopy was higher in the less than 24 kg/m2 group (89.29% vs 66.67%, p = 0.013). In univariate and multivariate logistic regression analysis, BMI less than 24 kg/m2 was an independent risk factor of shoulder pain after laparoscopic surgery (p = 0.001, p = 0.031, respectively). Shoulder pain scores were inversely correlated with BMI (r = -0.300, p = 0.001). CONCLUSIONS Patients with low body mass index are more likely to develop shoulder pain after laparoscopy, with earlier onset and higher pain scores.
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Affiliation(s)
- Yuxia Jiang
- Department of GynecologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Yijun Wu
- Department of GynecologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Shentao Lu
- Department of Obstetrics and GynecologyChongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University)ChongqingChina
| | - Yuni Que
- Department of GynecologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Yugang Chi
- Department of Obstetrics and GynecologyChongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University)ChongqingChina
| | - Qianfen Liu
- Department of Obstetrics and GynecologyChongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University)ChongqingChina
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The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:14-20. [PMID: 34570072 DOI: 10.1097/sle.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized. MATERIALS AND METHODS This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n=42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n=42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS). RESULTS At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I. CONCLUSIONS IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.
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Zeeni C, Chamsy D, Khalil A, Abu Musa A, Al Hassanieh M, Shebbo F, Nassif J. Effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures: a randomized clinical trial. BMC Anesthesiol 2020; 20:27. [PMID: 31996139 PMCID: PMC6988196 DOI: 10.1186/s12871-020-0946-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Laparoscopic surgery has become a standard of care for many gynecological surgeries due to its lower morbidity, pain and cost compared to open techniques. Unfortunately, the use of carbon dioxide (CO2) to insufflate the abdomen is the main contributor to post-operative shoulder pain. METHODS We aim to assess the effect of postoperative Trendelenburg position on shoulder pain after gynecological laparoscopic procedures. We hypothesize that maintaining the patient in Trendelenburg for 24 h postoperatively will significantly decrease postoperative shoulder pain and analgesic consumption. After obtaining written informed consent, 108 patients were prospectively randomized into two groups. In the control group, patients underwent standard gynecologic laparoscopic procedures; then after passive deflation of the pneumoperitoneum at the end of the surgery, the patients were placed in supine head up position in the post anesthesia care unit (PACU) and received our institution's common postoperative care. Patients in the intervention group were subjected to the same maneuver but were positioned in a Trendelenburg position (20 °) once fully awake and cooperative in the PACU and retained this position for the first 24 h. Numerical rating scale (NRS) was used to assess shoulder pain and nausea upon patient arrival to the PACU, at 4, 6, 12 (primary outcome) and 24 h postoperatively. Time to first rescue pain medication, total rescue pain medications and overall satisfaction with pain control were recorded. 101 patients were included in the final data analysis. RESULTS Both groups were comparable in terms of baseline characteristics. NRS pain scores were significantly lower in the intervention group at 12 h compared to the control group (0 [0-1] versus 5 [1-4], p < 0.001), furthermore improvement in postoperative shoulder pain between time of arrival to PACU (time zero) and 12 h postoperatively was significantly higher in patients allocated to the experimental group compared to the control group. Pain scores were significantly lower in patients allocated to the experimental group versus the control group (0 [0-1] versus 5 [1-4], p < 0.001). CONCLUSION In conclusion, Trendelenburg position is an easy non-pharmacologic intervention that is beneficial in reducing postoperative shoulder pain following gynecologic laparoscopic surgery. TRIAL REGISTRATION Retrospectively registered at Clinicaltrials.gov, registration number NCT04129385, date of registration: June 28, 2019.
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Affiliation(s)
- Carine Zeeni
- Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Dina Chamsy
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Khalil
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Antoine Abu Musa
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Majed Al Hassanieh
- Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Fadia Shebbo
- Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Joseph Nassif
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
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