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Bae J, Shin DR, Sohn JY, Park JW, Woo KJ. Multiple intramuscular ropivacaine injections to donor sites reduces pain in deep inferior epigastric artery perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 98:82-90. [PMID: 39243715 DOI: 10.1016/j.bjps.2024.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/08/2024] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Local anesthetic infiltration at the surgical site has been studied in various surgical disciplines; however, its impact on deep inferior epigastric artery perforator (DIEP) flap breast reconstruction has not been previously assessed. This study aimed to evaluate the effects of multiple intramuscular ropivacaine injections on donor site pain during DIEP flap breast reconstruction. METHODS The study included 65 patients who received local ropivacaine injections during DIEP reconstructions between March 2022 and February 2023, compared to 55 patients who underwent surgeries without ropivacaine from October 2018 to July 2020. A total of 20 cc of 0.75% ropivacaine solution was evenly administered at 20 sites along the abdominal wall muscles. The effect of intramuscular ropivacaine injection on postoperative visual analog scale (VAS) was evaluated using linear mixed-effect model. Opioid consumption and hospital days were also compared. RESULTS The daily median VAS score was lower in the ropivacaine group (all p-values < 0.001). When analyzed using a linear mixed-effects model, those who received ropivacaine had significantly lower VAS scores over the first 5 days postoperatively (p-value < 0.001). The rate of VAS score decline was also faster in the ropivacaine group over the first 24 h postoperative (p-value = 0.045). Although opioid consumption was comparable between the groups, those receiving ropivacaine had significantly shorter hospital stay (p-value = 0.001) and no complications related to the injections were observed. CONCLUSION Multiple intramuscular injections of ropivacaine to the donor site may reduce postoperative pain and shorten hospital stays, without increasing opioid consumption.
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Affiliation(s)
- Juyoung Bae
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Mediclne, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Dong Ryeol Shin
- Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jee Yeon Sohn
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Mediclne, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Jin-Woo Park
- Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Kyong-Je Woo
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Mediclne, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
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Casas-Arroyave FD, Osorno-Upegui SC, Zamudio-Burbano MA. Therapeutic efficacy of intravenous lidocaine infusion compared with thoracic epidural analgesia in major abdominal surgery: a noninferiority randomised clinical trial. Br J Anaesth 2023; 131:947-954. [PMID: 37758623 DOI: 10.1016/j.bja.2023.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Open major abdominal surgery is one of the most risky surgical procedures for acute postoperative pain. Thoracic epidural analgesia (TEA) has been considered the standard analgesic approach. In different reports, lidocaine i.v. has been shown to have an analgesic efficacy comparable with TEA. We compared the analgesic efficacy of i.v. lidocaine with thoracic epidural analgesia using bupivacaine in patients undergoing major abdominal surgery. METHODS In this noninferiority clinical trial, 210 patients were randomised to thoracic epidural bupivacaine with morphine or i.v. lidocaine. Dynamic pain at 24 h after surgery was measured using a numerical pain rating scale (NPR), and morphine consumption was also measured. A difference in i.v. the lidocaine-epidural bupivacaine NPR of ≤1 for dynamic pain was considered a noninferiority margin. RESULTS The NPR for dynamic pain in the lidocaine group at 24 h was between 5.7 (1.8) and 5.2 (1.9) in the epidural group, with a difference of 0.53 (95% confidence interval 0.0-1.0). In the first 24 h, the average difference in morphine consumption was 1.8 mg between the i.v. lidocaine and epidural groups (95% confidence interval 1-3 mg). No differences were found in adverse events or complications associated with the procedures. CONCLUSIONS Intravenous lidocaine is noninferior to thoracic epidural analgesia for acute postoperative pain control in major abdomial surgery at 24 h postoperatively. CLINICAL TRIALS REGISTRATION NCT04017013.
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Affiliation(s)
- Fabian D Casas-Arroyave
- Department of Anaesthesiology, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Department of Surgery, University Hospital of San Vicente Foundation, Medellín, Colombia.
| | - Susana C Osorno-Upegui
- Department of Anaesthesiology, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Department of Anaesthesiology, Hospital Alma Mater de Antioquia, Medellín, Colombia
| | - Mario A Zamudio-Burbano
- Department of Anaesthesiology, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Department of Anaesthesiology, Hospital Alma Mater de Antioquia, Medellín, Colombia
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Arslan E, Gezer N. The effect of discharge training developed based on nursing interventions classification (NIC) on surgical recovery in oncology patients: Randomized controlled trial - A pilot study. Nurs Open 2022; 10:1151-1162. [PMID: 36567264 PMCID: PMC9834180 DOI: 10.1002/nop2.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 08/08/2022] [Accepted: 11/30/2022] [Indexed: 12/27/2022] Open
Abstract
AIM To investigate the effect of discharge training on surgical recovery in oncology patients. DESIGN A two-arm parallel-group randomized controlled trial (RCT) registered at clinicaltrials.gov (NCT04862104) and reporting according to the CONSORT checklist. METHODS The study was conducted with 78 patients who had undergone cancer surgery in a university hospital. The intervention group took discharge training; the control group received routine care. The surgical recovery was measured before discharge and 2, 4 and 8 weeks after the discharge. RESULTS There was a higher surgical recovery score in the intervention group compared with the usual care group at the second, fourth and eighth week after discharge. This study is expected to support discharge training as enhancing recovery in oncology surgical patients. CONCLUSION This pilot study shows that discharge training developed based on the Nursing Intervention Classification can be used in clinics to enhance the surgical recovery of patients.
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Affiliation(s)
- Ezgi Arslan
- Department of Surgical Nursing, Nursing FacultyAydın Adnan Menderes UniversityEfeler/AydınTurkey
| | - Nurdan Gezer
- Department of Surgical Nursing, Nursing FacultyAydın Adnan Menderes UniversityEfeler/AydınTurkey
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Othow CO, Ferede YA, Tawuye HY, Aytolign HA. The magnitude and associated factors of post-operative pain among adult patients. Ann Med Surg (Lond) 2022; 81:104406. [PMID: 36147180 PMCID: PMC9486549 DOI: 10.1016/j.amsu.2022.104406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background Postoperative pain continues to be a serious consequence of surgical intervention. Several factors may contribute to the development of postoperative pain; these could be preoperative factors, demographic factors, anesthetic factors, and surgical factors. Objective The aim of this study was to assess the magnitude and factors associated with postoperative pain among surgical patients. Methods An institutional-based prospective longitudinal study included 265 postoperative patients from the surgical wards of Gambella General Hospital from April 15, 2021, to June 30, 2021. A consecutive sampling technique was used to recruit study participants. The patients were followed up for 24 h postoperatively. A numerical rating scale (NRS-11) is used for the assessment of pain. Data analysis was done using the Statistical Package for Social Science (SPSS) 25. Logistic regression analysis was used to calculate the association between dependent and independent variables with a 95% confidence interval and a p-value<0.05 was considered statistically significant. Results A total of 270 data points were collected. Of these, a total of 265 with a 98.1% response rate were analyzed. The incidence of postoperative pain was 69%, 74%, and 77.0% at 2 h, 12 h, and 24 h, respectively. The following factors were strongly associated with the dependent variable: patient age, 18–45 years old [AOR = 2.8; (95%CI: 1.13, 6.74, p = 0.026)], skin incision length, 10 cm [AOR = 2.5; (95%CI: 1.30, 5.13, p = 0.007)], preoperative pain [AOR = 2.4, (95%CI: 1.02, 5.60, p = 0.045)], and surgeon experience [AOR = 2.1, (95%CI: Conclusion and Recommendation: In the current study the magnitude of postoperative pain was high, 220 patients were complaining POP (83%). Age of the patient, length of skin incision, preoperative pain, and experience of surgeons were the independent associated factors for the experience of postoperative pain. Preoperative pain management should exercise among adult surgical patients in order to reduce the incidence of postoperative pain, and the length of surgical skin incisions should be minimized. The overall prevalence rate of post-operative pain (POP) was high (83%). The magnitude of POP was 69%, 74% and 77.0% at 2hr, 12hr and 24hr respectively. Age of the patient, length of skin incision and significantly associated with POP. Preoperative pain and work experience of surgeons were also associated with POP.
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Castro MAD, Cunha GMF, Andrade GF, Yoshida MI, Faria ALD, Silva-Cunha A. Development and characterization of PLGA-Bupivacaine and PLGA-S75:R25 Bupivacaine (Novabupi®) biodegradable implants for postoperative pain. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e21310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Yazıcı G, Yılmaz K, Bulut H, Ömer Kaşıkçı H, Palteki T, Karabulut AB, Memişoğlu K. The Prevalence of Pain in the First 24 Hours After Surgery: A Multicenter Study. J Perianesth Nurs 2021; 37:122-129. [PMID: 34865966 DOI: 10.1016/j.jopan.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/15/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was conducted to determine the prevalence and severity of postoperative pain in the first 24 hours after surgery and to emphasize the importance of postoperative pain assessment. DESIGN A descriptive study. METHODS This study was carried out on May 21, 2019 with 898 patients who had completed the postoperative 24th hour in the surgical clinics of 10 training and research hospitals in Istanbul, the capital of Turkey. Point prevalence was used in the study. Data were collected using a questionnaire developed by the researchers and the Revised American Pain Society Patient Outcome Questionnaire. Descriptive statistics were presented as frequency, percentage, mean, and standard deviation. Nonparametric tests were used for data without normal distribution (Kolmogorov-Smirnov Test, P < .05). Two-group comparisons were performed using the Mann-Whitney U test. The Kruskal Wallis-H test was used for the comparison of three or more groups. Statistical significance was set as P < .05. FINDINGS The three main types of surgery were general surgery with 31.8%, gynecologic surgery with 12.9%, and orthopedic surgery with 12.7%. The mean lowest level of pain felt by the patients included in the study in the first 24 hours was 3.90 ± 2.94, and the mean highest level of pain was 6.38 ± 4.45. CONCLUSIONS Postoperative pain is a subjective phenomenon and may be affected by factors such as type of surgery, previous experience of surgery, duration of surgery, the length of the surgical incision, the type of anesthesia, the quality of postoperative care, individual characteristics and experiences, and fear anxiety; thus, the experience of pain may vary from person to person.
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Affiliation(s)
- Gülay Yazıcı
- Ankara Yıldırım Beyazıt University, Health Sciences Faculty, Nursing Department, Ankara, Turkey.
| | - Kübra Yılmaz
- Ankara Yıldırım Beyazıt University, Health Sciences Faculty, Nursing Department, Ankara, Turkey
| | - Hülya Bulut
- Gazi University, Health Sciences Faculty, Nursing Department, Ankara, Turkey
| | - Halim Ömer Kaşıkçı
- Erenköy Mental and Nervous Diseases Training and Research Hospital, İstanbul, Turkey
| | - Tunçay Palteki
- Biruni University, Health Sciences Faculty, Emergency Aid and Disaster Management, İstanbul, Turkey
| | | | - Kemal Memişoğlu
- İstanbul Provincial Health Directorate, Provincial Health Director, İstanbul, Turkey
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Tiruneh A, Tamire T, Kibret S. The magnitude and associated factors of post-operative pain at Debre Tabor compressive specialized hospital, Debre Tabor Ethiopia, 2018. SAGE Open Med 2021; 9:20503121211014730. [PMID: 34035912 PMCID: PMC8132093 DOI: 10.1177/20503121211014730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/07/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: Post-operative pain is a form of acute pain following surgical intervention. And it is due to skin incision, tissue dissection, manipulation, and traction during the surgical procedure. The magnitude may reach up to 85.5% globally. Age, gender, duration of surgery, and length of skin incision were the common factors for post-operative pain. This study aims to assess the magnitude and associated factors of post-operative pain among surgical patients. Methods: Institutional-based cross-sectional study design was used. The study was conducted on a total of 159 surgical patients aged 8 years and above. The data were collected using chart review and recording the status of post-operative pain by the result of the Numeric Rating Scale at 1, 6, 12, 24, and 72 h of the post-operative period. Descriptive statistics, bivariate, and multivariable logistic regression were used. An adjusted odds ratio with a 95% confidence interval was used to determine the association. A p-value of less than 0.05 was used to declare statistical significance. Results: The majority (58.5%) of the study participants were females. The percentage of moderate to severe post-operative pain (Numeric Rating Scale: 4 and above) was between 37.7% within 1 h and 76.7% at 6 h of post-operative period. On multivariable logistic regression being female gender, preoperative pain and large skin incision were significantly associated with post-operative pain. Conclusions: Post-operative pain is still high which needs the attention of health professionals working on surgical patients and considering factors associated with post-operative pain.
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Affiliation(s)
- Abebe Tiruneh
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadese Tamire
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Simegnew Kibret
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Shah DD, Sorathia ZH. Tramadol/Diclofenac Fixed-Dose Combination: A Review of Its Use in Severe Acute Pain. Pain Ther 2020; 9:113-128. [PMID: 32062853 PMCID: PMC7203365 DOI: 10.1007/s40122-020-00155-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
Pain is a health issue affecting all populations, regardless of age, gender, economic status, race, or geography. Acute pain is the most common type of pain, with a complex aetiology. Inadequately managed acute pain adversely affects quality of life and imposes significant economic burden. The majority of the available pain-relieving drugs have monomodal mechanisms of analgesia, which necessitates combining drugs with non-redundant mechanisms of action in order to provide adequate pain relief and reduce the side effects from higher doses of individual drugs. In this regard, combining an oral opioid (such as codeine or tramadol) and a non-opioid (such as paracetamol or non-steroidal anti-inflammatory drug) offers a plausible option. Tramadol/diclofenac fixed-dose combination (FDC) is one such analgesic combination which has demonstrated promising clinical activity via its multimodal mechanisms of action. This review seeks to provide an up-to-date narrative on the current scientific literature regarding the pharmacological properties, clinical efficacy, and tolerability of tramadol/diclofenac FDC in the treatment of acute severe pain. A comprehensive, qualitative review of the literature was conducted using a structured search strategy in Medline/PubMed and additional Internet-based sources to identify relevant studies. Based on the available scientific literature, evidence of the efficacy and safety of tramadol/diclofenac FDC for treatment of patients with acute severe pain, including musculoskeletal pain, postoperative pain, and acute flare-up of osteoarthritis or rheumatoid arthritis, appears to be substantial. Although additional comparative studies would be required to definitively position tramadol/diclofenac FDC with respect to other analgesic combinations, the available data suggest that tramadol/diclofenac FDC is a valuable treatment option for patients with acute severe pain.
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Affiliation(s)
- Dilip D Shah
- Jewel Nursing Home, Plot No 89, Ns Road No 1, Andheri West, Mumbai, 400058, India.
| | - Zubair H Sorathia
- Medicare Hospital, Marol Naka Metro Station, Andheri East, Mumbai, 400059, India
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Wikström L, Nilsson M, Eriksson K. The association of patients' daily summarized self-rated "real-time" pain scores with physical recovery after major surgery - A repeated measurement design. Nurs Open 2020; 7:307-318. [PMID: 31871715 PMCID: PMC6917937 DOI: 10.1002/nop2.392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/26/2019] [Accepted: 09/08/2019] [Indexed: 11/29/2022] Open
Abstract
Aim To determine the associations of patients' documented self-rated pain with self-rated early postoperative physical recovery. Design Observational with repeated measures. Methods General and orthopaedic inpatients (N = 479) were during the period 2012-2015 screened for pain. Individual daily median pain scores at rest and during activity were based on 4-9 self-ratings on postoperative days 1 and 2, using the Numeric Rating Scale. Nine items reflecting physical recovery from the "Postoperative Recovery Profile" were used in a questionnaire. Results Associations between median pain scores on postoperative day 1 and physical recovery (fatigue, sleeping difficulties, bladder function, mobilization, muscle weakness and personal hygiene) the same day were found. Additionally, associations were found between median pain scores on day 1 and physical recovery (fatigue, sleeping difficulties, mobilization and muscle weakness) on day 2.
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Affiliation(s)
- Lotta Wikström
- School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Anaesthesia and Intensive CareRyhov County HospitalJönköpingSweden
| | | | - Kerstin Eriksson
- School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Anaesthesia and Intensive CareRyhov County HospitalJönköpingSweden
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Velazquez Cardona C, Rajah C, Mzoneli YN, Friedrichsdorf SJ, Campbell F, Cairns C, Rodseth RN. An audit of paediatric pain prevalence, intensity, and treatment at a South African tertiary hospital. Pain Rep 2019; 4:e789. [PMID: 31984294 PMCID: PMC6903419 DOI: 10.1097/pr9.0000000000000789] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/25/2019] [Accepted: 08/21/2019] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Pain in paediatric inpatients is common, underrecognised, and undertreated in resource-rich countries. Little is known about the status of paediatric pain prevention and treatment in low- and middle-income countries. OBJECTIVES This audit aimed to describe the prevalence and severity of pain in paediatric patients at a tertiary hospital in South Africa. METHOD A single-day prospective observational cross-sectional survey and medical chart review of paediatric inpatients at Grey's Hospital, Pietermaritzburg, South Africa. RESULTS Sixty-three children were included, and mean patient age was 9.7 years (SD 6.17). Most patients (87%) had pain during admission, with 29% reporting preexisting (possibly chronic) pain. At the time of the study, 25% had pain (median pain score 6/10). The worst pain reported was from needle procedures, including blood draws, injections, and venous cannulation (34%), followed by surgery (22%), acute illness/infection (18%), and other procedures (14%). Pharmacological treatments included WHO step 1 (paracetamol and ibuprofen) and step 2 (tramadol, tilidine, and morphine) analgesics. The most effective integrative interventions were distraction, swaddling, and caregiver participation. Although a pain narrative was present in the majority of charts, only 16% had documented pain intensity scores. CONCLUSION The prevalence of pain in hospitalised children in a large South African Hospital was high and pain assessment inadequately documented. There is an urgent need for pain education and development of guidelines and protocols, to achieve better pain outcomes for children. This audit will be repeated as part of a quality-improvement initiative.
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Affiliation(s)
- Caridad Velazquez Cardona
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Grey's Hospital Pain Services Commitee, Pietermaritzburg, South Africa
| | - Chantal Rajah
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Youley Nosisi Mzoneli
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stefan Joerg Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Fiona Campbell
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Carel Cairns
- Department of Anaesthesia and Pain Management, Grey's Hospital, Pietermaritzburg, South Africa
- Grey's Hospital Pain Services Commitee, Pietermaritzburg, South Africa
| | - Reitze Nils Rodseth
- Perioperative Research Group, Department of Anaesthesia, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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11
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Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain. Br J Anaesth 2019; 123:e328-e332. [PMID: 30916030 DOI: 10.1016/j.bja.2018.10.066] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context. METHODS After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0-10) were obtained every 5 min for 15 min. RESULTS The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0-3 and 4-10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI. CONCLUSIONS An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-to-severe pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age. CLINICAL TRIAL REGISTRATION ACTRN12617001475336.
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Liu YB, Yu CC, Wu CC, Lin CD, Chueh SC, Tsai YC. Feasibility and safety of elective laparoscopic total extraperitoneal preperitoneal groin hernia repair in the elderly: a propensity score-matched comparison. Clin Interv Aging 2018; 13:195-200. [PMID: 29440879 PMCID: PMC5798546 DOI: 10.2147/cia.s148608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Several studies of hernia registries have revealed that elderly patients have higher perioperative complication rates compared with younger patients. However, the incidence of hernia increases with the aging process. To evaluate the feasibility and safety of laparoscopic hernia repair in elderly patients (≥75 years), we conducted a prospective case-matched control study to compare perioperative outcomes between patients older and younger than 75 years. Methods Between September 2008 and July 2015, 572 consecutive patients undergoing endoscopic hernia repair were included in this prospective study. This case-matched control study was matched based on sex, American Society of Anesthesiologists score, and body mass index between patients younger and ≥75 years. The propensity-score matching of two groups was carried out on a 1:1 basis. Perioperative data were prospectively recorded for all patients including demographic data, operation time, length of hospital stay, narcotic dose, and complications. Results In the final analysis, 54 patients who were <75 years were extracted to match the 54 patients ≥75 years. These two groups had similar baseline characteristics excluding age. They also had similar perioperative outcomes in hernia recurrence, metachronous contralateral hernia occurrence, complication rate and chronic pain. The patients ≥75 years of age had lower requirements for analgesics than those who were <75 years of age (p=0.047). Conclusion This is the first comparative cohort study investigating the impact of aging in an Asian hernia population. Laparoscopic inguinal hernia repair is feasible and safe for older patients, with comparable perioperative outcomes to patients <75 years.
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Affiliation(s)
- Ying-Buh Liu
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chih-Chin Yu
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan
| | - Chia-Da Lin
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan
| | - Shih-Chieh Chueh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,Cleveland Clinic, Glickman Urologic and Kidney Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Yao-Chou Tsai
- Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,Department of Urology, Tzu Chi University, Medical College, Hualien, Taiwan
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Eriksson K, Wikström L, Fridlund B, Årestedt K, Broström A. Association of pain ratings with the prediction of early physical recovery after general and orthopaedic surgery-A quantitative study with repeated measures. J Adv Nurs 2017; 73:2664-2675. [DOI: 10.1111/jan.13331] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Kerstin Eriksson
- Research School of Health and Welfare; Jönköping University; Jönköping Sweden
- Department of Anaesthesia and Intensive Care; Ryhov County Hospital; Jönköping Sweden
| | - Lotta Wikström
- Research School of Health and Welfare; Jönköping University; Jönköping Sweden
- Department of Anaesthesia and Intensive Care; Ryhov County Hospital; Jönköping Sweden
| | - Bengt Fridlund
- Research School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Kristofer Årestedt
- School of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- Department of Medical and Health Sciences; Division of Nursing Science; Linköping University; Linköping Sweden
- The Research Unit; Kalmar County Hospital; Kalmar Sweden
| | - Anders Broström
- Research School of Health and Welfare; Jönköping University; Jönköping Sweden
- Department of Clinical Neurophysiology; University Hospital; Linköping Sweden
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Tighe PJ, King CD, Zou B, Fillingim RB. Time to Onset of Sustained Postoperative Pain Relief (SuPPR): Evaluation of a New Systems-level Metric for Acute Pain Management. Clin J Pain 2016; 32:371-9. [PMID: 26247416 DOI: 10.1097/ajp.0000000000000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Prior work on postoperative pain trajectories has examined pain score changes over time using daily averages of pain scores. However, little is known about the time required until patients consistently report minimal postoperative pain. MATERIALS AND METHODS We conducted a retrospective cohort study of surgical case data from 7293 adult patients to examine the impact of age, sex, and the type of surgery on the time to sustained postoperative pain relief (SuPPR). We defined SuPPR as the time required until a patient reports the first of multiple (2, 3, 4, or 5 sequential measurements; eg, SuPPR-2, SuPPR-3), uninterrupted, mild pain scores (≤4/10). RESULTS Overall, SuPPR times ranged from 3 minutes for SuPPR-2 and 9 minutes for SuPPR-5 to 160.1 hours for SuPPR-2 and 183.1 hours for SuPPR-5. For the SuPPR-2 outcome, the median time to event was 10.9 hours (interquartile range, 3 to 26.1 h) after surgery. For the SuPPR-5 outcomes, the median time to event was 31.5 hours (interquartile range, 17.8 to 54.2 h) after surgery. The peak median difference between 2 sequential SuPPR definitions was between SuPPR-3 and SuPPR-2 at 9 hours, with subsequent decreases to 6.5 hours between SuPPR-4 and SuPPR-3, and 5.2 hours between SuPPR-5 and SuPPR-4. There were statistically different differences across SuPPR-2 through SuPPR-5 definitions by age, sex, and type of surgery. DISCUSSION Although additional analyses are necessary, SuPPR may represent a novel method for evaluating acute pain service performance.
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Affiliation(s)
- Patrick J Tighe
- *Pain Research and Intervention Center of Excellence (PRICE), University of Florida Departments of †Anesthesiology ‡Biostatistics, University of Florida College of Medicine, Gainesville, FL
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Singh PK, Saikia P, Lahakar M. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study. Indian J Anaesth 2016; 60:737-743. [PMID: 27761037 PMCID: PMC5064698 DOI: 10.4103/0019-5049.191686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P < 0.000) compared to the fifth post-operative hour. The number of patients with complete analgesia decreased on the third post-operative day (P = 0.001 compared to fifth post-operative day). The Spearman correlation coefficient between pain score on the third post-operative day and level of satisfaction with nurse's response, doctor's response to pain and the overall pain management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management.
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Affiliation(s)
- Prashant Kumar Singh
- Department of Pharmacology, Medwin Hospital and Research Centre, Varanasi, Uttar Pradesh, Affiliated with Devi Ahilya Vishwavidyalaya, Indore, Madhya Pradesh, India
| | - Priyam Saikia
- Department of Anaesthesiology and Critical Care, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Mangala Lahakar
- Department of Pharmacology, Gauhati Medical College and Hospital, Guwahati, Assam, India; Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Guwahati, Assam, India
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Abstract
This article provides an overview of current methods used in acute pain management and explains why effective analgesia is crucial in the early postoperative period. It describes the pharmacology of both common and specialist analgesics, as well as explaining the role and uses of regional and neuraxial analgesia, for the non-anaesthetist.
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Affiliation(s)
| | - Su Cheen Ng
- Specialist Registrar in Anaesthesia and Pain Medicine
| | | | - Roman Cregg
- Consultant in Pain Medicine and Anaesthesia in the Pain Management Centre, National Hospital for Neurology and Neurosurgery and UCL Hospitals, London WC1N 3BG
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17
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Vahabi S, Abaszadeh A, Yari F, Yousefi N. Postoperative pain, nausea and vomiting among pre- and postmenopausal women undergoing cystocele and rectocele repair surgery. Korean J Anesthesiol 2015; 68:581-5. [PMID: 26634082 PMCID: PMC4667144 DOI: 10.4097/kjae.2015.68.6.581] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/21/2014] [Accepted: 12/31/2014] [Indexed: 12/22/2022] Open
Abstract
Background Postoperative nausea and vomiting (PONV) and postoperative pain are among the most common side-effects of surgery. Many factors, such as a change in the level of sex hormones, are reported to affect these complications. This study aimed to evaluate the probable effects of the menopause on PONV and postoperative pain. Methods Prospective study, in which a total number of 144 female patients undergoing cystocele or rectocele repair surgery under standardized spinal anesthesia were included. Patients were divided into two equally sized sample groups of pre- and postmenopausal women (n = 72). The occurrence of PONV, the severity of pain as assessed by visual analog scale (VAS) pain score, and the quantity of morphine and metoclopramide required were recorded at 2, 4, 6, 12, 18 and 24 h after surgery. Results The mean VAS pain score and the mean quantity of morphine required was higher among premenopausal women (P = 0.006). Moreover, these patients required more morphine for their pain management during the first 24 h after surgery compared to postmenopausal women (P < 0.0001). No difference was observed between the two groups regarding the incidence of PONV (P = 0.09 and P = 1.00 for nausea and vomiting, respectively) and the mean amount of metoclopramide required (P = 0.38). Conclusions Premenopausal women are more likely to suffer from postoperative pain after cystocele and rectocele repair surgery. Further studies regarding the measurement of hormonal changes among surgical patients in both pre- and postmenopausal women are recommended to evaluate the effects on PONV and postoperative pain.
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Affiliation(s)
- Sepideh Vahabi
- Department of Anesthesiology and Critical Care, Lorestan University of Medical Science, Khoramabad, Iran
| | - Abolfazl Abaszadeh
- Department of Anesthesiology and Critical Care, Lorestan University of Medical Science, Khoramabad, Iran
| | - Fatemeh Yari
- Department of Anesthesiology and Critical Care, Lorestan University of Medical Science, Khoramabad, Iran
| | - Nazanin Yousefi
- Department of Anesthesiology and Critical Care, Lorestan University of Medical Science, Khoramabad, Iran
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Bameshki A, Peivandi Yazdi A, Sheybani S, Rezaei Boroujerdi H, Taghavi Gilani M. The Assessment of Addition of Either Intravenous Paracetamol or Diclofenac Suppositories to Patient-Controlled Morphine Analgesia for Postgastrectomy Pain Control. Anesth Pain Med 2015; 5:e29688. [PMID: 26587407 PMCID: PMC4644315 DOI: 10.5812/aapm.29688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 06/19/2015] [Accepted: 07/07/2015] [Indexed: 12/27/2022] Open
Abstract
Background: Major surgical procedures, such as gastrectomy, result in extensive postoperative pain, which can lead to increased morbidity, discomfort and dissatisfaction among the patients. Objectives: The aim of this study was to evaluate the effect of adding diclofenac suppositories or intravenous paracetamol, on morphine consumption and on the quality of postgastrectomy pain control. Patients and Methods: This randomized double blinded clinical trial was carried out in 90 patients with gastric cancer, who were candidates for gastrectomy, which were divided into three similar groups. The patients were transferred to an intensive care unit after the operation and received patient-controlled analgesia (PCA) with morphine, morphine PCA plus intravenous paracetamol 1 g, every 6 hours, and morphine PCA plus diclofenac suppositories, 100 mg every 8 hours. The patients were evaluated for up to 24 hours after the operation for the severity of pain, alertness, and opioid complications. Results: There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001). In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups. Conclusions: In this study, intravenous paracetamol or diclofenac suppositories, administered for postgastrectomy pain control, decreased morphine consumption by almost 32% and also improved alertness. Nevertheless, the amount of opioids did not affect the incidence of complications.
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Affiliation(s)
- Alireza Bameshki
- Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arash Peivandi Yazdi
- Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Sheybani
- Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hengameh Rezaei Boroujerdi
- Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehryar Taghavi Gilani
- Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding author: Mehryar Taghavi Gilani, Cardiac Anesthesia Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Tel/Fax: +98-5118525209, E-mail:
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Couceiro TCDM, Lima LC, Burle LMC, Valença MM. Lidocaína intravenosa no tratamento da dor pós‐mastectomia: ensaio clínico aleatório encoberto placebo controlado. Braz J Anesthesiol 2015; 65:207-12. [DOI: 10.1016/j.bjan.2014.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/19/2014] [Indexed: 10/24/2022] Open
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Shinagawa A, Melhem FE, de Campos AC, Dias Cicarelli D, Frerichs E. Predictores de dolor y tiempo de internación prolongado tras cirugía ortognática: estudio de cohorte retrospectivo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rca.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Couceiro TCDM, Lima LC, Burle LMC, Valença MM. Intravenous lidocaine for postmastectomy pain treatment: randomized, blind, placebo controlled clinical trial. Braz J Anesthesiol 2015; 65:207-12. [PMID: 25925033 DOI: 10.1016/j.bjane.2014.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Postoperative pain treatment in mastectomy remains a major challenge despite the multimodal approach. The aim of this study was to investigate the analgesic effect of intravenous lidocaine in patients undergoing mastectomy, as well as the postoperative consumption of opioids. METHODS After approval by the Human Research Ethics Committee of the Instituto de Medicina Integral Prof. Fernando Figueira in Recife, Pernambuco, a randomized, blind, controlled trial was conducted with intravenous lidocaine at a dose of 3mg/kg infused over 1h in 45 women undergoing mastectomy under general anesthesia. One patient from placebo group was. RESULTS Groups were similar in age, body mass index, type of surgery, and postoperative need for opioids. Two of 22 patients in lidocaine group and three of 22 patients in placebo group requested opioid (p=0.50). Pain on awakening was identified in 4/22 of lidocaine group and 5/22 of placebo group (p=0.50); in the post-anesthetic recovery room in 14/22 and 12/22 (p=0.37) of lidocaine and placebo groups, respectively. Pain evaluation 24h after surgery showed that 2/22 and 3/22 patients (p=0.50) of lidocaine and placebo groups, respectively, complained of pain. CONCLUSION Intravenous lidocaine at a dose of 3mg/kg administered over a period of an hour during mastectomy did not promote additional analgesia compared to placebo in the first 24h, and has not decreased opioid consumption. However, a beneficial effect of intravenous lidocaine in selected and/or other therapeutic regimens patients cannot be ruled out.
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Affiliation(s)
| | - Luciana Cavalcanti Lima
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil; Faculdade Pernambucana de Saúde (FBS), Recife, PE, Brazil
| | | | - Marcelo Moraes Valença
- Department of Neurology and Neurosurgery, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543020-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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de Mello LC, Rosatti SFC, Hortense P. Assessment of pain during rest and during activities in the postoperative period of cardiac surgery. Rev Lat Am Enfermagem 2014; 22:136-43. [PMID: 24553714 PMCID: PMC4292697 DOI: 10.1590/0104-1169.3115.2391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 09/23/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess the intensity and site of pain after Cardiac Surgery through sternotomy during rest and while performing five activities. METHOD descriptive study with a prospective cohort design. A total of 48 individuals participated in the study. A Multidimensional Scale for Pain Assessment was used. RESULTS postoperative pain from cardiac surgery was moderate during rest and decreased over time. Pain was also moderate during activities performed on the 1st and 2nd postoperative days and decreased from the 3rd postoperative day, with the exception of coughing, which diminished only on the 6th postoperative day. Coughing, turning over, deep breathing and rest are presented in decreased order of intensity. The region of the sternum was the most frequently reported site of pain. CONCLUSION the assessment of pain in the individuals who underwent cardiac surgery during rest and during activities is extremely important to adapt management and avoid postoperative complications and delayed surgical recovery.
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Affiliation(s)
| | - Silvio Fernando Castro Rosatti
- Doctoral student, Universidade Federal de São Carlos, São Carlos,
SP, Brazil. Physician, Irmandade da Santa Casa de Misericórdia de São Carlos, São
Carlos, SP, Brazil
| | - Priscilla Hortense
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade
Federal de São Carlos, São Carlos, SP, Brazil
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Ribeiro SBF, Pinto JCP, Ribeiro JB, Felix MMS, Barroso SM, Oliveira LFD, Felix AA, Nascimento VDG, Ribeiro MFF, Sousa FAEF. Pain management at inpatient wards of a university hospital. Rev Bras Anestesiol 2013; 62:599-611. [PMID: 22999394 DOI: 10.1016/s0034-7094(12)70160-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 11/19/2011] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This is an exploratory, descriptive and transversal study aiming to determine the prevalence, characterization, location, and measurement and discuss pharmacological analgesic measures for acute pain management in five inpatient wards of a university hospital. METHOD We enrolled 856 subjects in the study, of whom 272 were in pain at the time. Information related to pain was obtained using a bedside structured interview. Numeric pain scale and body diagram were used. RESULTS Analgesia was assessed through medical records. The overall prevalence of pain was 31.8%, with severe pain in 44.2% and mean of 6.6 on numeric pain scale. The main reason was trauma and the most common site the abdomen. The most widely used analgesic was dipyrone (76.1%) with/without combination. Strong opioid was prescribed to 4.4%. For 27.5% there was no improvement. CONCLUSION We conclude that pain is highly prevalent, poorly evaluated, undertreated, with inappropriate use of analgesics.
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Affiliation(s)
- Sonia B Felix Ribeiro
- Department of Internal Medicine, Pain Clinic, Universidade Federal do Triângulo Mineiro, Brazil.
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