Outcomes of a nursing intervention to improve post-operative pain control at night

Perioperative Intravenous Ketamine Infusion for the Prevention of Persistent Post-amputation Pain: A Randomized, Controlled Trial

We hypothesized that perioperative ketamine administration would modify acute central sensitization following amputation and hence reduce the incidence and severity of persistent post-amputation pain (both phantom limb and stump pain). In a randomized, controlled trial, 45 patients undergoing above- or below-knee amputation received ketamine 0.5 mg.kg–1 or placebo as a pre-induction bolus followed by an intravenous infusion of ketamine 0.15 mg.kg–1.h–1 or normal saline for 72 hours postoperatively. Both groups received standardized general anaesthesia followed by patient-controlled intravenous morphine. The surface area of allodynia over the stump was mapped at days 3 and 6. Postamputation pain was assessed at days 3 and 6 and at 6 months postoperatively.

We found no significant difference between groups in the surface area of stump allodynia or in morphine consumption. There was an unexplained, but significant, increase in the incidence of stump pain in the ketamine group at day 3. At six-month review, the incidence of phantom pain was 47% in the ketamine group and 71% in the control group. This did not reach statistical significance (P=0.28) as the power of the study was based on the search for a large treatment effect. The incidence of stump pain at six months was 47% in the ketamine group and 35% in the control group (P=0.72). There were no significant between-group differences in pain severity throughout the study period.

Ketamine at the dose administered did not significantly reduce acute central sensitization or the incidence and severity of post-amputation pain.

Pain measurement in oral and maxillofacial surgery

Regardless of whether it is acute or chronic, the assessment of pain should be simple and practical. Since the intensity of pain is thought to be one of the primary factors that determine its effect on a human's overall function and sense, there are many scales to assess pain. The aim of the current article was to review pain intensity scales that are commonly used in dental and oral and maxillofacial surgery (OMFS). Previous studies demonstrated that multidimensional scales, such as the McGill Pain Questionnaire, Short form of the McGill Pain Questionnaire, and Wisconsin Brief Pain Questionnaire were suitable for assessing chronic pain, while unidimensional scales, like the Visual Analogue Scales (VAS), Verbal descriptor scale, Verbal rating scale, Numerical rating Scale, Faces Pain Scale, Wong-Baker Faces Pain Rating Scale (WBS), and Full Cup Test, were used to evaluate acute pain. The WBS is widely used to assess pain in children and elderly because other scales are often difficult to understand, which could consequently lead to an overestimation of the pain intensity. In dental or OMFS research, the use of the VAS is more common because it is more reliable, valid, sensitive, and appropriate. However, some researchers use NRS to evaluate OMFS pain in adults because this scale is easier to use than VAS and yields relatively similar pain scores. This review only assessed pain scales used for post-operative OMFS or dental pain.

An ethnographic exploration of postoperative pain experiences among Ghanaian surgical patients

BACKGROUND

The experience of pain associated with surgery has been a challenge for health care professionals for many years, and culture is said to influence pain.

PURPOSE

This study focused on patients' experiences of postoperative pain (POP) and factors that affect POP.

DESIGN

The study employed qualitative ethnographic principles.

METHOD

Data were collected through individual face-to-face interviews. Data were saturated after analyzing data from 13 patients from two hospitals in Ghana.

FINDINGS

Themes that emerged were the subjective nature of pain, which described pain dimensions and communication; psycho-sociocultural factors, such as personal inclinations and sociocultural background; and health system factors, such as personnel attitudes and health financing.

IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE

Health professionals need to understand the sociocultural effects of pain in order to give effective care.

CONCLUSION

The study highlighted the need for patient education and the importance that health care professionals understand context-specific factors that influence POP management.

A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients

Visual analogue scales (VAS) and verbal rating scales (VRS) are widely used to assess pain. This paper presents a secondary analysis of a subsection of data collected as part of an evaluation of an intervention to improve nighttime pain. The aims were to describe the relationship between the VAS and VRS; to compare characteristics of the noncompliant groups in terms of age, gender, type of surgery, and analgesics; to explore the reasons for noncompletion of the VAS or VRS; and to determine the noncompliance rates with each assessment scale. Worst and average pain scores were obtained for the second postoperative night for 417 patients. Fifty-nine patients (14.2%) did not complete the VAS. In contrast, two patients did not complete the VRS (0.5%). The scores generated from the VAS and VRS correlated well, although the range of VAS scores corresponding to each VRS category was wide. We conclude that the VRS was more suitable for use in this clinical setting.