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Sim GG, See AH, Quah LJJ. Patient-controlled analgesia for the management of adults with acute trauma in the emergency department: A systematic review and meta-analysis. J Trauma Acute Care Surg 2023; 95:959-968. [PMID: 37335181 DOI: 10.1097/ta.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Patient-controlled analgesia (PCA) has potential as a form of analgesia for trauma patients in the emergency department (ED). The objective of this review was to evaluate the effectiveness and safety of PCA for the management of adults with acute traumatic pain in the ED. The hypothesis was that PCA can effectively treat acute trauma pain in adults in the ED, with minimal adverse outcomes and better patient satisfaction compared with non-PCA modalities. METHODS MEDLINE (PubMed), Embase, SCOPUS, ClinicalTrials.gov , and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception date to December 13, 2022. Randomized controlled trials involving adults presenting to the ED with acute traumatic pain who received intravenous (IV) analgesia via PCA compared with other modalities were included. The Cochrane Risk of Bias tool and the Grading of Recommendation, Assessment, Development, and Evaluation approach were used to assess the quality of included studies. RESULTS A total of 1,368 publications were screened, with 3 studies involving 382 patients meeting the eligibility criteria. All three studies compared PCA IV morphine with clinician-titrated IV morphine boluses. For the primary outcome of pain relief, the pooled estimate was in favor of PCA with a standard mean difference of -0.36 (95% confidence interval, -0.87 to 0.16). There were mixed results concerning patient satisfaction. Adverse event rates were low overall. The evidence from all three studies was graded as low-quality because of a high risk of bias from lack of blinding. CONCLUSION This study did not demonstrate a significant improvement in pain relief or patient satisfaction using PCA for trauma in the ED. Clinicians wishing to use PCA to treat acute trauma pain in adult patients in the ED are advised to consider the available resources in their own practice settings and to implement protocols for monitoring and responding to potential adverse events. LEVEL OF EVIDENCE Systematic Review/Meta-Analyses; Level III.
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Affiliation(s)
- Guek Gwee Sim
- From the Department of Emergency Medicine (G.G.S.) and Department of Surgery (A.H.S.), Changi General Hospital; and Department of Emergency Medicine (L.J.J.Q.), Singapore General Hospital, Singapore, Singapore
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Erden S, Güler S, Tura İ, Başibüyük İF, Arslan UE. Evaluating patient outcomes in postoperative pain management according to the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R). Appl Nurs Res 2023; 73:151734. [PMID: 37722782 DOI: 10.1016/j.apnr.2023.151734] [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: 04/03/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND In the first 24 h after surgery, it is necessary to evaluate the patient responses to pain, analgesia and patient satisfaction to prevent complications related to the pain management process. AIM To evaluate patients' outcomes (pain qualities, side effects of the pain management, pain treatment satisfaction, non-pharmacological pain treatment methods, predictors of pain management satisfaction and percentage of pain relief) according to the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) in the first 24 h. DESIGN Cross-sectional study. METHODS The study sample was comprised of 700 patients, who were surgically treated at the surgical clinics of a university hospital and completed the first postoperative 24 h. The data was collected through the "Patient Information Form" and the "Turkish version of the revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R)". RESULTS The medians of the lowest and the worst postoperative pain severity level were 3.0 and 7.0, respectively. Patients experienced severe pain in 60 % of the first postoperative 24 h and reported that 70 % of their pain eventually decreased. A positive and significant correlation was found between pain interference, pain-affected mood/emotions, the severity of pain-related side effects, the least and worst pain severity levels and severe pain, and the percentage of time experienced with severe pain. CONCLUSIONS Most of the patients experienced severe pain, which restricted their daily life activities and led to negative emotions. Acute postoperative pain may negatively affect patient outcomes and delay postoperative recovery during the early period. Therefore, pain should be managed in the early period to prevent physical and psychological side effects.
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Affiliation(s)
- Sevilay Erden
- Cukurova University, Faculty of Health Sciences, Department of Surgical Nursing, Adana, Türkiye (RN, PhD).
| | - Sevil Güler
- Gazi University, Faculty of Nursing, Department of Surgical Nursing, Ankara, Türkiye (RN, PhD).
| | - İlknur Tura
- Cukurova University, Faculty of Health Sciences, Department of Surgical Nursing, Adana, Türkiye (RN, MsN)
| | | | - Umut Ece Arslan
- Hacettepe University, Public Health Institute, Public Health Department, Ankara, Türkiye (RN, PhD)
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Li S, Xiong H, Jia Y, Li Z, Chen Y, Zhong L, Liu F, Qu S, Du Z, Wang Y, Huang S, Zhao Y, Liu J, Jiang L. Oxycodone vs. tramadol in postoperative parent-controlled intravenous analgesia in children: a prospective, randomized, double-blinded, multiple-center clinical trial. BMC Anesthesiol 2023; 23:152. [PMID: 37138225 PMCID: PMC10155412 DOI: 10.1186/s12871-023-02054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Management of acute postoperative pain is one of the major challenges in pediatric patients. Oral oxycodone has shown good pain relief in postoperative pain relief in children, but no studies have investigated intravenous oxycodone in this context. OBJECTIVE whether oxycodone PCIA can provide adequate and safe postoperative pain relief, in comparison to tramadol as reference opioid drug. DESIGN a randomized, double-blind, parallel, multi-center clinical trial. SETTING five university medical centers and three teaching hospitals in China. PARTICIPANTS patients aged 3-month-old to 6-year-old undergoing elective surgery under general anesthesia. INTERVENTION patients were randomly allocated to either tramadol (n = 109) or oxycodone (n = 89) as main postoperative opioid analgesic. Tramadol or oxycodone were administered with a loading dose at the end of surgery (1 or 0.1 mg.kg-1, respectively), then with a parent-controlled intravenous device with fixed bolus doses only (0.5 or 0.05 mg.kg-1, respectively), and a 10-min lockout time. OUTCOMES the primary outcome was adequate postoperative pain relief, defined as a face, legs, activity, cry, and consolability (FLACC) score < 4/10 in the post-anesthesia care unit (PACU), with no need for an alternative rescue analgesia. FLACC was measured 10 min after extubation then every 10 min until discharge from PACU. Analgesia was currently conducted with the boluses of either tramadol or oxycodone if FLACC was ≥ 3, up to three bolus doses, after what rescue alternative analgesia was administered. RESULTS tramadol and oxycodone provided a similar level of adequate postoperative pain relief in PACU and in the wards. No significant differences were either noted for the raw FLACC scores, the bolus dose demand in PACU, the time between the first bolus dose and discharge from PACU, analgesic drug consumption, bolus times required in the wards, function activity score, or the parents' satisfaction. The main observed side effects in both groups were nausea and vomiting, with no difference between groups. However, patients in the oxycodone group showed less sedation levels and had a shorter stay in the PACU, compared with the tramadol group. CONCLUSIONS an adequate postoperative analgesia can be achieved with intravenous oxycodone, this with less side effects than tramadol. It can therefore be a choice for postoperative pain relief in pediatric patients. TRIAL REGISTRATION The study was registered at www.chictr.org.cn (Registration number: ChiCTR1800016372; date of first registration: 28/05/2018; updated date:06/01/2023).
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Affiliation(s)
- Siyuan Li
- The Anesthesia & Comfort Health Center, Xi'an International Medical Center Hospital, Xi'an Shaanxxi, 710100, China
- Department of Anesthesiology, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Hongfei Xiong
- The Anesthesia & Comfort Health Center, Xi'an International Medical Center Hospital, Xi'an Shaanxxi, 710100, China
- Department of Anesthesiology, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, 710004, Shaanxi, China
| | - Yingping Jia
- Department of Anesthesiology, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450007, China
| | - Zhengchen Li
- Department of Anesthesiology, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450007, China
| | - Yexi Chen
- Department of Anesthesiology, Children's Hospital Affiliated of Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, 450007, China
| | - Liang Zhong
- Department of Anesthesiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430015, China
| | - Feng Liu
- Department of Anesthesiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430015, China
| | - Shuangquan Qu
- Department of Anesthesiology, Hunan Children's Hospital, Changsha, 410007, China
| | - Zhen Du
- Department of Anesthesiology, Hunan Children's Hospital, Changsha, 410007, China
| | - Yuxia Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Suxia Huang
- Department of Anesthesiology, Zhumadian Central Hospital, Zhumadian, 463000, China
| | - Yonghui Zhao
- Department of Anesthesiology, Zhumadian Central Hospital, Zhumadian, 463000, China
| | - Jing Liu
- The Second Affiliated Hospital of Xi'an Medical College, Xi'an, 710038, China
| | - Lihua Jiang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Dang H, Stafseth SK. Documentation for Assessing Pain in Postoperative Pain Management Pre- and Post-intervention. J Perianesth Nurs 2023; 38:88-95. [PMID: 35970659 DOI: 10.1016/j.jopan.2022.05.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Although Norwegian law requires the documentation of patients' care processes, including pain assessment, research has shown that the quality of postoperative documentation for assessing pain does not meet an acceptable standard and requires improvement. The purpose of this study was to investigate whether an educational intervention can increase nurses' documentation of postoperative pain assessments, alter patients' opioid consumption, and ensure that patients have at least one documented Numeric Rating Scale (NRS) ≤3 at rest before being discharged. A secondary aim was to investigate whether the nurses' education and experience influenced their pain assessments. DESIGN An observational study with a pre-post intervention. METHODS The study following a pre-post design involved documenting pain assessments of 304 patients undergoing cancer surgeries in a postoperative unit at the Norwegian Radium Hospital, Oslo University Hospital. In an educational intervention, two 45-minutes teaching sessions within two weeks, addressed validated pain assessment tools and the documentation of pain assessment. Descriptive frequency analysis and partial correlation with Pearson's r - value were used, with P < .05 indicating significance. FINDINGS Postintervention, pain assessments in general increased significantly from a mean of two times per patient to three times. Overall, the use of assessment tool Critical -Care Pain Observation Tool increased from 6.1% to 25.8%, opioid consumption increased in mean from 3.34 to 4.79 in milligram and the documentation at discharge increased from 81.4% to 91.4%. The documentation of nurses with more than 10 years' experience in the unit especially improved from 17.5% to 31.7%. CONCLUSIONS Educational intervention and reminders about basic systematic pain assessment and the evaluation of pain measures improved nurses' documentation of postoperative pain management and documentation at discharge. The findings underscore the importance of regularly ensuring the quality of patients' treatment by systematically documenting nurses' clinical tasks and the outcome of patients' care.
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Affiliation(s)
- Huong Dang
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; MEVU Department, Lovisenberg Diaconal University College, Oslo, Norway.
| | - Siv K Stafseth
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; MEVU Department, Lovisenberg Diaconal University College, Oslo, Norway
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Zhang J, Ma Q, Li W, Li X, Chen X. S-Ketamine attenuates inflammatory effect and modulates the immune response in patients undergoing modified radical mastectomy: A prospective randomized controlled trial. Front Pharmacol 2023; 14:1128924. [PMID: 36873990 PMCID: PMC9977820 DOI: 10.3389/fphar.2023.1128924] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
Objective: This study aimed to investigate the impact of varying dosages of S-ketamine on perioperative immune-inflammatory responses in patients undergoing modified radical mastectomy (MRM). Methods: This is a prospective, randomized, controlled trial. A total of 136 patients with American Society of Anesthesiologists status I/II scheduled for MRM were enrolled and randomly assigned into groups to receive the control (C) or one of three different doses [0.25 (L-Sk), 0.5 (M-Sk), or 0.75 (H-Sk) mg/kg] of S-ketamine. The primary outcomes were the cellular immune function and inflammatory factors before anesthesia and at the end of (T1) and 24 h (T2) after the surgery. Secondary outcomes included the visual analog scale (VAS) score, opioid consumption, rate of remedial analgesia, adverse events, and patient satisfaction. Results: The percentage and absolute counts of CD3+ and CD4+ cells in groups L-Sk, M-Sk, and H-Sk were higher than those of group C at T1 and T2. Moreover, a pairwise comparison revealed that the percentage in group H-Sk was higher than those in the L-Sk and M-Sk groups (p < 0.05). The ratio of CD4+/CD8+ was lower in group C at T1 and T2 than those in groups M-Sk and H-Sk (p < 0.05). There was no significant difference in the percentage and absolute counts of natural killer (NK) cells and B lymphocytes among the four groups. However, compared with group C, the concentrations of white blood cells (WBC), neutrophils (NEUT), hypersensitive C-reactive protein (hs-CRP), the neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) at T1 and T2 in three different doses of S-ketamine groups were significantly low, and the lymphocytes were significantly high. The ratio of SIRI and NLR at T2 in group M-Sk was lower than that in group L-Sk (p < 0.05). Additionally, a significant decrease in VAS score, opioid consumption, rates of remedial analgesia, and adverse events was observed in the M-Sk and H-Sk groups. Conclusion: Collectively, our study demonstrates that S-ketamine could reduce opioid consumption, decrease postoperative pain intensity, exert a systemic anti-inflammatory effect, and attenuate immunosuppression in patients undergoing MRM. Moreover, we found that the effects of S-ketamine are related to the dose used, with significant differences observed in 0.5 or 0.75 mg/kg of S-ketamine. Clinical Trial Registration: chictr.org.cn, identifier ChiCTR2200057226.
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Affiliation(s)
- Junxia Zhang
- The Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Qian Ma
- The Clinical Medical College of Ningxia Medical University, Yinchuan, Ningxia, China.,Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Wenbin Li
- Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiaohui Li
- Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xuexin Chen
- Department of Anesthesiology, Cancer Hospital, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Al Sadah ZM, Alfaraj NH, AlAlwan NE, Al Dhaif LH, Khidr AM, Fallatah SM. Assessment of patients' satisfaction with the postanesthesia care unit service at University Hospital in Al Khobar, KSA. J Taibah Univ Med Sci 2022; 18:217-224. [PMID: 36817216 PMCID: PMC9926208 DOI: 10.1016/j.jtumed.2022.09.012] [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: 05/27/2022] [Revised: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives The quality of health care is individually and subjectively reflected through patients' level of satisfaction, as well as the optimality and effectiveness of the provided postoperative pain management. The provision of postanesthesia care unit (PACU) service in hospitals has led to overall positive outcomes, in addition to the enhancement of patients' satisfaction with the provided pain management service. This study assessed patients' level of satisfaction with PACU service at a university hospital and discussed different factors that might have contributed to the level of satisfaction. Methods A prospective cross-sectional study was carried out among patients after being discharged from PACU. The study took place at King Fahad Hospital of the University in Al Khobar, KSA between November 2021 and February 2022. The data were collected using a three-section predesigned questionnaire. Results Two hundred patients were included in this study. Nearly all patients (95.5%) were satisfied with the provided pain management service. Almost all patients (99.5%) indicated that the PACU staff was courteous and professional during the entire pain management service. More patients complained about pain before using analgesia and this difference was statistically significant (Z = 8.642; p < 0.001). The satisfaction rate was significantly higher in the older age group (>45 years) (Z = 2.114; p = 0.035), in patients with American Society of Anesthesiology (ASA) 3 physical status (H = 13.130; p = 0.001), and those with a previous surgical history (Z = 2.139; p = 0.032). Conclusion This study concluded that the level of patients' satisfaction with PACU service was high, and established a statistically significant association with age, ASA score, and previous surgical history. Healthcare providers should consider patient education and effective communication to increase patients' satisfaction level and improve the overall quality of care.
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Key Words
- ASA, American Society of Anesthesiology
- Analgesia
- Anesthesia
- BMI, Body Mass Index
- GA, General anesthesia
- ICU, Intensive care unit
- IRB, Institutional Review Board (IRB)
- IV, Intravenous
- KFHU, King Fahad Hospital of the University
- OR, Operating room
- PACU, Postanesthesia care unit
- Patient satisfaction
- Postanesthesia care unit
- Preoperative education
- SCRELC, Standing Committee for Research Ethics on Living Creatures
- SPSS, Statistical Packages for Software Sciences
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Affiliation(s)
- Zhra M. Al Sadah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA,Corresponding address: Zhra Muneer Al Sadah, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA.
| | - Noor H. Alfaraj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Noor E. AlAlwan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Lamees H. Al Dhaif
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Alaa M. Khidr
- Department of Anesthesia, King Fahad Hospital of the University, Al Khobar, KSA
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Patient satisfaction with post-operative pain management and associated factors among surgical patients at Tikur Anbessa Specialized Hospital: Cross-sectional study. Ann Med Surg (Lond) 2022; 79:104087. [PMID: 35860062 PMCID: PMC9289483 DOI: 10.1016/j.amsu.2022.104087] [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: 05/01/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Objective Method Result Conclusion Patient satisfaction with postoperative pain management was suboptimal. ASA status, pain, analgesic techniques & management were significantly associated. Patient satisfaction also associated with empathy, patient education, & communication.
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BORAN ÖF, GÜNAY O, GÜNAY AE, BORAN M, BİLAL B, BAKACAK M, YAZAR FM, DOLU H, BOZAN MB, BİRADLİ H. Factors affecting perioperative patient satisfaction with regional anesthesia: A patient-centered survey study. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1136625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To determine the demographic and clinical characteristics that affect patient satisfaction with regional anesthesia.
Methods: This study was conducted at Kahramanmaras Sutcu Imam University Hospital between June-July 2019. The patients were included on a voluntary basis and all had undergone obstetrics, urology, orthopedics, or general surgery, and met the following inclusion criteria: (1) age >18 years, (2) received regional anesthesia, (3) ASA-PS score of ≤ 3, and (4) no cognitive problem that would prevent self-expression. A Personal Information Form and the Evaluation of the Experience of Regional Anesthesia Questionnaire were applied to 402 patients at 48 hours after surgery performed under regional anesthesia in a university hospital in Turkey.
Results: The EVAN-LR total scores were 71.2±15.6 in obstetrics patients, followed by 54.9±24.9 in orthopedic patients, 26.6±24.4 in urology patients and 15.9±7.2 in general surgery patients (p
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Affiliation(s)
| | | | | | - Maruf BORAN
- Amasya University, Faculty of Medicine, Internal Medicine Intensive Care Unit
| | - Bora BİLAL
- KAHRAMANMARAS SUTCU IMAM UNIVERSITY, SCHOOL OF MEDICINE
| | - Murat BAKACAK
- KAHRAMANMARAS SUTCU IMAM UNIVERSITY, SCHOOL OF MEDICINE
| | | | - Hasan DOLU
- Dr.Ersin Aslan Research and Education Hospital, Department of Anesthesiology and Reanimation
| | | | - Hilal BİRADLİ
- KAHRAMANMARAS SUTCU IMAM UNIVERSITY, SCHOOL OF MEDICINE
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Wu Y, Kang Y, Li Y, Fu B. Impact of Ultrasound-Guided Deep Serratus Anterior Plane Block Combined With Dexmedetomidine as an Adjuvant to Ropivacaine Inpatient Quality of Recovery Scores Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial. Front Oncol 2022; 12:858030. [PMID: 35433468 PMCID: PMC9008730 DOI: 10.3389/fonc.2022.858030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 01/22/2023] Open
Abstract
BackgroundBreast cancer has overtaken lung cancer as the most commonly diagnosed malignancy and is the leading cause of cancer-related death in women. Surgery is the only possible cure for breast cancer, and the incidence of acute postoperative pain (APP) is high in breast surgery. Previous reports suggested that ultrasound-guided deep serratus anterior plane block (dSAPB) provided effective blockade to relieve pain after modified radical mastectomy for breast cancer. In fact, despite the long-acting local anesthetic agents used, the patient’s pain cannot completely be eliminated due to the short duration of anesthesia. Dexmedetomidine as an adjunct to local anesthetics can prolong peripheral nerve block duration. However, no study has investigated the role of dSAPB with dexmedetomidine in the quality of recovery scores undergoing modified radical mastectomy. Thus, this study was conducted aiming at this aspect.Material and MethodsThis single-center, double-blind, randomized clinical trial was conducted at Bethune International Peace Hospital. A total of 88 participants of elective modified radical mastectomy were enrolled from May and November 2021. Ultrasound-guided dSAPB combined with 30 ml of 0.375% ropivacaine or 30 ml of 0.375% ropivacaine with dexmedetomidine (1 μg/kg) was administrated before anesthesia at the fourth to fifth ribs of the axillary midline. The primary outcome was quality of recovery, measured 24 h postoperatively using the QoR-15. Secondary outcomes were the Visual Analogue Scale (VAS) scores at rest and movement at 1, 6, 12, 24, and 48 h after surgery, 48 h sufentanil consumption postoperatively, the incidence of postoperative nausea and vomiting (PONV), length of post-anesthesia care unit (PACU) stay, dizziness, delirium, SAPB-related adverse events, and patient’s satisfaction with pain management.ResultsAmong the 88 participants, 8 did not meet the inclusion criteria; the other 80 were randomized to receive dSAPB combined with ropivacaine (Group R, N=40) and dSAPB combined with ropivacaine plus DEX (Group RD, N=40), of which a total of 7 (4 in Group R and 3 in Group RD) were excluded due to protocol deviation. Eventually,73 participants (36 in Group R and 37 in Group RD) were included for final analysis, with age (SD, years, 54.08[6.28] vs. 54.62[7.44], p=0.740), body mass index (BMI) (SD, 27.96[1.67] vs. 27.57[2.38], p=0.428), and median preoperative global QoR-15 score (interquartile range (IQR), 127[123.25–131] vs. 126[121–130], p=0.662). The median postoperative global QoR-15 score (IQR, 107[103–112] vs. 109.5[107–114], p=0.016), VAS score at rest at 12th hour (IQR, 1[1–2] vs. 1[1–2], p=0.033), VAS score in movement at 12th hour (IQR, 2[1–3] vs. 2[1–3], p=0.014) and at 24th hour (IQR, 3[2–3] vs. 3[2–3], p=0.040), and median sufentanil rescues consumption (IQR, 14[12–17 vs. 14[12–15], p=0.022] of Group RD were significantly lower than those of the Group R. Patient satisfaction score (SD, 8.28[0.70] vs. 8.62[0.59], p=0.024) of Group RD were significantly higher than those of the Group R.ConclusionThe ultrasound-guided dSAPB combined with dexmedetomidine plus ropivacaine may improve the QoR-15 in patients undergoing modified radical mastectomy and indicates that it may be a useful intervention to aid recovery following breast cancer surgery. Furthermore, participants in the ropivacaine with DEX group met the superior pain relief in the early postoperative period, reduced postoperative cumulative opioid consumption, increased patient satisfaction, and no increase in the incidence of complications.
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Germossa GN, Sjetne IS, Småstuen MC, Hellesø R. Patient Satisfaction With a Nurse-Led Pain Management Program: A Quasi-Experimental Study in Ethiopia. SAGE Open Nurs 2022; 8:23779608221141237. [DOI: 10.1177/23779608221141237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Patient satisfaction is one of the important indicators of quality care. Objective To examine patient ratings of pain management satisfaction before and after introducing a nurse-led management program. Methods A quasi-experimental design with three cross-sectional surveys between October 1, 2016 and June 15, 2017. A total of 845 patients admitted to the four inpatient departments (medicine, surgery, maternity, and gynecology) of Jimma University Medical Centre were invited to participate in the study. A questionnaire adapted from the American Pain Society Patient Outcome Questionnaire, Pain Treatment Satisfaction Scale, and related literature was used for the survey. Data were analyzed using the chi-square test (categorical variables), t-tests for continuous variables, and robust regression to determine the effect of nurse-led management program on patient satisfaction. For all tests, p-values <.05 were considered statistically significant. Results Of the 845 patients invited, 782 (92.5%) participated in the surveys—Survey 1: N = 256; Survey 2: N = 259; Survey 3: N = 267. The proportion of patients who perceived that staff responded within 30 min increased from 67.8% in Survey 1 to 71.1% in Survey 2 and 74.2% in Survey 3. On a scale of 1 to 5 (1 = strongly dissatisfied and 5 = strongly satisfied), the overall mean patient satisfaction with pain management was 3.61 (SD 0.80) in Survey 1, 3.81 (SD 0.86) in Survey 2, and 4.10 (SD 0.64) in Survey 3. Moreover, the patients scored significantly higher on all satisfaction items in Survey 2 (B ranged between 0.12 and 0.41) and Survey 3 (B ranged between 0.24 and 0.74) compared to Survey 1. Conclusion The patients’ ratings of their satisfaction and staff nurse responsiveness following the nurse-led pain management program have increased compared to the levels before the intervention. However, further studies, including those with a control group, are warranted to confirm the results.
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Affiliation(s)
- Gugsa Nemera Germossa
- School of Nursing, Jimma University Institute of Health Sciences, Jimma University, Jimma, Ethiopia
- Department of Nursing Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Ragnhild Hellesø
- Department of Nursing Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Tano PF, Apiribu F, Tano EK, Boamah Mensah AB, Dzomeku VM, Boateng I. Predicting factors that determine patients' satisfaction with post-operative pain management following abdominal surgeries at Komfo Anokye Teaching Hospital, Kumasi, Ghana. PLoS One 2021; 16:e0251979. [PMID: 34033660 PMCID: PMC8148314 DOI: 10.1371/journal.pone.0251979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/06/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Poorly controlled postoperative pain has been known to be characterized by longer post-operative care, longer hospital stays with increased readmission rates, and decreased patient satisfaction. Post-operative pain has been continuously addressed in the past three (3) to four (4) decades and has been shown that 20 to 80% of post-operative patients suffer ineffective pain management. Objective The study was aimed at assessing the factors that may predict the satisfaction of patients with early postoperative pain management following abdominal surgeries at the Komfo Anokye Teaching Hospital, Kumasi. Methodology A descriptive cross-sectional study was conducted among patients who had undergone abdominal surgeries between October 2019 and December 2019 at the Komfo Anokye Teaching Hospital. Structured questionnaires based on the IPO-Q were used to obtain responses from the patients. Descriptive and Inferential statistical analysis were employed in analyzing the data obtained from the respondents of the study. Results 138 patients were involved in this study. The mean age of patients in the study was 45.81 (±16.81) years. A higher percentage, 58.7% of the patients were males. 39.1% had completed their tertiary level of education. The majority (50.7%) of the patients had had persistent pain for more than three (3) months. The satisfaction of the patients with the post-operative pain management received was generally high among a significant majority of the patients. Meanwhile, among the factors that influence the satisfaction of the patients with the post-operative pain management received, type of analgesia and pain relief methods (Pearson Coefficient = 0.523, p-value <0.05), patient’s ability to request more pain relief, (Pearson Coefficient = 0.29, p-value <0.05), patient’s access to information about their pain treatment options from the Nurses (Pearson coefficient = -0.22, p<0.05), were the only predictors of satisfaction in patients. Conclusion This study found out that patients were generally satisfied with the post-operative pain management offered by their healthcare providers although the degree of satisfaction depended largely on the type of analgesia and pain relief methods, the ability to request for more pain relief, and access to information on pain treatment.
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Affiliation(s)
- Priscilla Felicia Tano
- Department of Nursing, Faculty of Allied Health Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- * E-mail:
| | - Felix Apiribu
- Department of Nursing, Faculty of Allied Health Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Adwoa Bemah Boamah Mensah
- Department of Nursing, Faculty of Allied Health Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Veronica Millicent Dzomeku
- Department of Nursing, Faculty of Allied Health Science, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Boateng
- Department of Physiology, University of Cape Coast, Cape Coast, Ghana
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Foust Winton RE, Draucker CB, Von Ah D. Pain Management Experiences Among Hospitalized Postcraniotomy Brain Tumor Patients. Cancer Nurs 2021; 44:E170-E180. [PMID: 32657900 PMCID: PMC7794082 DOI: 10.1097/ncc.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Brain tumors account for the majority of central nervous system tumors, and most are removed by craniotomies. Many postcraniotomy patients experience moderate or severe pain after surgery, but patient perspectives on their experiences with pain management in the hospital have not been well described. OBJECTIVE The aim of this study was to describe how patients who have undergone a craniotomy for brain tumor removal experience pain management while hospitalized. METHODS Qualitative descriptive methods using semistructured interviews were conducted with patients on a neurological step-down unit in an urban teaching hospital in the Midwest United States. Interviews focused on how patients experienced postcraniotomy pain and how it was managed. Narratives were analyzed with standard content analytic procedures. RESULTS Twenty-seven participants (median age, 58.5 years; interquartile range, 26-41 years; range, 21-83 years) were interviewed. The majority were white (n = 25) and female (n = 15) and had an anterior craniotomy (n = 25) with sedation (n = 17). Their pain experiences varied on 2 dimensions: salience of pain during recovery and complexity of pain management. Based on these dimensions, 3 distinct types of pain management experiences were identified: (1) pain-as-nonsalient, routine pain management experience; (2) pain-as-salient, routine pain management experience; and (3) pain-as-salient, complex pain management experience. CONCLUSIONS Many postcraniotomy patients experience their pain as tolerable and/or pain management as satisfying and effective; others experience pain and pain management as challenging. IMPLICATIONS FOR PRACTICE Clinicians should be attuned to needs of patients with complex pain management experiences and should incorporate good patient/clinician communication.
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Affiliation(s)
- Rebecca E Foust Winton
- Author Affiliation: Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis
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Mitra S, Jain K, Singh J, Jindal S, Saxena P, Singh M, Saroa R, Ahuja V, Kang J, Garg S. Does an acute pain service improve the perception of postoperative pain management in patients undergoing lower limb surgery? A prospective controlled non-randomized study. J Anaesthesiol Clin Pharmacol 2020; 36:187-194. [PMID: 33013033 PMCID: PMC7480304 DOI: 10.4103/joacp.joacp_104_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/11/2019] [Indexed: 11/05/2022] Open
Abstract
Background and Aim: An acute pain service (APS) has been running in our institute since April 2013 and is managed by the Department of Anesthesia and Intensive Care. However, it is not clear to what extent the patients feel benefited from the APS. The aim of the study was to compare the perception of postoperative pain management in patients receiving care under APS with those receiving routine postoperative pain relief following lower limb surgery. Material and Methods: This was a prospective, hospital-based, controlled non-randomized study. American Society of Anesthesiologists (ASA) grades I–III patients with age 18–75 years undergoing lower limb orthopedic surgery were prospectively recruited into APS (index group) or routine postoperative care (control group) (n = 55 each). Postoperatively, American Pain Society Patient Outcome Questionnaire-Revised (APS-POQ-R) and Short Form (SF-12) were used to evaluate the outcome of postoperative pain management at 24 h and health-related quality of life after 4 weeks respectively. Results: Both groups were comparable in terms of demographic data. Patients in the index group had statistically significant better perception of care than the control group. Index group scored significantly higher than control group on median patient satisfaction score (9; interquartile range [IQR] [7–10] vs. 5 [3–6]; P < 0.001). In index group, there was significant reduction of worst pain in first 24 h along with decreased frequency of severe pain. Conclusion: Implementation of acute pain service plays an important role in improving the quality of postoperative pain relief, perception of care, and patient satisfaction.
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Affiliation(s)
- Sukanya Mitra
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Kompal Jain
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jasveer Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Swati Jindal
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Puja Saxena
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Manpreet Singh
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Richa Saroa
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Vanita Ahuja
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Jannat Kang
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Sudhir Garg
- Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India
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The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials. Anesthesiol Res Pract 2020; 2020:6974321. [PMID: 32280341 PMCID: PMC7140144 DOI: 10.1155/2020/6974321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/06/2020] [Accepted: 02/26/2020] [Indexed: 12/28/2022] Open
Abstract
Methods We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration's tool. Results Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P < 0.001. Conclusions The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.
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Baek W, Jang Y, Park CG, Moon M. Factors Influencing Satisfaction with Patient-Controlled Analgesia Among Postoperative Patients Using a Generalized Ordinal Logistic Regression Model. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:73-81. [PMID: 32165329 DOI: 10.1016/j.anr.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to identify the factors affecting the satisfaction with patient-controlled analgesia (PCA) of patients using a generalized ordinal logistic regression model and to evaluate the difference in results of the ordinal regression from those of binary regression. METHODS The study design involved secondary analysis of electronic medical records from a single tertiary care hospital in Seoul, Korea. It included 2,409 patients treated with PCA for postoperative pain management after open or laparoscopic abdominal surgery. Binary logistic regression and generalized ordinal logistic regression were used to identify factors affecting satisfaction. RESULTS Binary logistic regression analysis showed that there was insufficient information for analysis. Generalized ordinal logistic regression revealed that sex, age, pain, PCA usage, and side-effects were common factors affecting PCA satisfaction. However, the effect of some factors affecting PCA satisfaction differed with the level of satisfaction. In open surgery patients, the effect of pain at 6 hours after surgery was significantly greater in the group with lower satisfaction. While, in the laparoscopic surgery patients, the effect of pain at 6-24 hours after surgery was significantly greater in the group with lower satisfaction. CONCLUSION Generalized logistic regression may be an appropriate statistical method for analyzing ordinal data. Degree of postoperative pain and assessment interval are the most important factors associated with PCA satisfaction. Because the factors affecting PCA satisfaction were different for the two types of abdominal surgeries, customizing PCA to individual patients may potentially improve pain management and consequently increase PCA satisfaction.
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Affiliation(s)
- Wonhee Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mir Moon
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
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Vu HTT, Mai HT, Nguyen HTT, Nguyen TTH, Nguyen TX, Nguyen TN, Pham T, Nguyen LTM, Vu GT, Pham HQ, Phan HT, Tran BX, Latkin CA, Ho CSH, Ho RCM, Nguyen AT. Older Patient Satisfaction with Chronic Pain Management in the National Geriatric Hospital in Vietnam. Patient Prefer Adherence 2020; 14:1801-1809. [PMID: 33116425 PMCID: PMC7547775 DOI: 10.2147/ppa.s265873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/22/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The high prevalence of chronic pain and difficulties in pain management in older people are challenging for healthcare providers globally. Patient satisfaction regarding pain management is one of the measures to assess efficacy of pain control as well as healthcare services. Thus, our study aimed to evaluate the older patients' satisfaction with pain management and its associated factors in Vietnam. PATIENTS AND METHODS A cross-sectional study was conducted at National Geriatric Hospital, Hanoi, Vietnam from May to October 2018. Face-to-face interviews were conducted on 495 older patients with chronic pain by using a structured questionnaire. The Pain Treatment Satisfaction Scale (PTSS) was used to assess the level of satisfaction with pain management. A Tobit regression model was used to estimate factors associated with satisfaction toward pain management. RESULTS The mean total satisfaction score was 1.77 (SD= 0.22). Older patients were most satisfied with the aspect of side effects of pain relief medication (mean=0.66, SD=0.56). On the contrary, they were most dissatisfied with information provided about pain and its treatment and efficacy of pain relief medication. Outpatients were less satisfied with information provided, the impact of current medication and pain management in general compared to inpatients. The regression model showed that patients with severe pain tended to be more dissatisfied with pain management than those with no pain. CONCLUSION This study indicated that the general satisfaction with chronic pain management in older patients was quite good especially in the aspect of pain medication's side effects. However, dissatisfactory factors remained, including information provided about pain and efficacy of current pain medication. Intensive training regarding pain in geriatric care, health education communication for older people, and improved quality of medical services should be performed to ensure the quality of pain management, especially in the older population.
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Affiliation(s)
- Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Hue Thi Mai
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
- Correspondence: Huong Thi Thu Nguyen Scientific Research Department, National Geriatric Hospital, 1A Phuong Mai - Dong Da, Hanoi100000, VietnamTel +84 973056334 Email
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Thang Pham
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | | | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
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Vilīte B, Strīķe E, Rutka K, Leibuss R. Pain management in intensive care unit patients after cardiac surgery with sternotomy approach. Acta Med Litu 2019; 26:51-63. [PMID: 31281217 DOI: 10.6001/actamedica.v26i1.3956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Postoperative pain is a common problem among intensive care patients. Pain management includes pain assessment and documentation, patient care, and pharmacological treatment. Materials and methods The study used a prospective, cross-sectional design. Nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. Toronto Pain Management Inventory was used to assess nurses and the 2010 Revised American Pain Society Patient Outcome Questionnaire was used to assess the patients. A research protocol was used to document pharmacological treatment data and Visual Analog Scale (VAS) pain measurements. The pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients. Results Postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). Pain intensity had a tendency to decrease over time, from a mean VAS score of 4.66 two hours after extubation to a mean VAS score of 3.12 twelve hours after extubation. Mostly opioids (100%) and nonsteroidal anti-inflammatory drugs (NSAIDs, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. Patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses' pain knowledge was average (X = 60.6 ± 7.3%). Conclusions An individualized pain management plan requires pain documentation and ensures high patient satisfaction. Pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high.
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Affiliation(s)
- Baiba Vilīte
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Eva Strīķe
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Katrīna Rutka
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Roberts Leibuss
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
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Sillero Sillero A, Zabalegui A. Satisfaction of surgical patients with perioperative nursing care in a Spanish tertiary care hospital. SAGE Open Med 2018; 6:2050312118818304. [PMID: 30574305 PMCID: PMC6295759 DOI: 10.1177/2050312118818304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 11/19/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Although numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care. METHOD A descriptive cross-sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica-Oberst Patient Satisfaction Scale (LOPSS-12). RESULTS 150 patients (73 women, 49% and 77 men; 51%) completed the survey. The mean age was 63 years (standard deviation, 16 years). The mean overall satisfaction score on the La Monica-Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21). The scale showed adequate content validity (Lawshe's Content Validity Index was 0.76) and moderate reliability (Cronbach's alpha = 0.70). Two variables-patient sex and the presence of comorbidities-were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses "impatient," but also considered the nurses' advice to be "useful." Patients with hospital-acquired complications were more likely to perceive nurses to be "more interested in completing tasks than in listening," although they also felt that nurses worked "conscientiously." CONCLUSION Overall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica-Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.
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Affiliation(s)
| | - Adelaida Zabalegui
- Department of Nursing Research and Education, Hospital Clinic of Barcelona, Barcelona, Spain
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Varndell W, Fry M, Elliott D. Quality and impact of nurse-initiated analgesia in the emergency department: A systematic review. Int Emerg Nurs 2018; 40:46-53. [PMID: 29885907 DOI: 10.1016/j.ienj.2018.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/27/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
AIM This paper reports a systematic literature review evaluating the impact and quality of pain management associated with nurse initiated analgesia in patients presenting to the emergency department (ED). BACKGROUND Pain is a major presenting complaint for individuals attending the ED. Timely access to effective analgesia continues to be a global concern in the ED setting; emergency nurses are optimally positioned to improve detection and management of pain. DESIGN Systematic review. DATABASES AND DATA TREATMENT Four databases - CINAHL, EMBASE, Medline, ProQuest - the Cochrane Library and the National Institute of Clinical Excellence were searched from date of inception to December 2017; with no language restrictions applied. Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published valid criteria. RESULTS Twelve articles met inclusion, comprising a wide range of analgesics and administration routes to manage mild to severe pain. Overall study quality was high; 7 studies included a form of comparison group. Patient outcome measures included time to analgesia (n = 12; 100%), change in pain score (n = 6; 50.0%); adverse events (n = 6; 50.0%); patient satisfaction (n = 5; 41.7%) and documenting pain assessment (n = 2; 16.7%). CONCLUSION Nurse-initiated analgesia was associated with safe, timely and effective pain relief.
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Affiliation(s)
- Wayne Varndell
- Clinical Nurse Consultant, Prince of Wales Hospital Emergency Department, Randwick, NSW 2031, Australia; Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia; Level 7 Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia.
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Abstract
Acute pain medicine services influence many different aspects of postoperative recovery and function. Here, we discuss the various stakeholders of an acute pain medicine service, review the direct and indirect impact on said stakeholders, review the shared and competing interests between acute pain medicine programs and various payer systems, and discuss how APM services can help service lines align with the interests of the recent CMS Innovations Comprehensive Care for Joint Replacement Model.
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Affiliation(s)
- Chancellor F Gray
- Division of Adult Arthroplasty and Joint Reconstruction, Department of Orthopaedics and Rehabilitation
| | - Cameron Smith
- Division of Acute Pain Medicine and Regional Anesthesia, Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL
| | - Yury Zasimovich
- Division of Acute Pain Medicine and Regional Anesthesia, Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL
| | - Patrick J Tighe
- Division of Acute Pain Medicine and Regional Anesthesia, Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL
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Abstract
Postoperative pain control is a highly studied topic because of its significant effect on costs, hospital course, and, most importantly, patient satisfaction. Opioid use has been the "status quo" of postoperative pain management but prolongs hospital stays and increases complications. Optimizing acute pain management in patients with orthopedic trauma is important and can translate into significant positive physiologic and financial outcomes. Although multiple viable examples of optimizing acute pain management in the literature demonstrate outcome improvements, implementation has not been widespread. Significant outcome success will depend more on systemwide implementation than a specific regimen for postoperative pain control.
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Min EK, Chong JU, Hwang HK, Pae SJ, Kang CM, Lee WJ. Negative oncologic impact of poor postoperative pain control in left-sided pancreatic cancer. World J Gastroenterol 2017; 23:676-686. [PMID: 28216975 PMCID: PMC5292342 DOI: 10.3748/wjg.v23.i4.676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/14/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the association between postoperative pain control and oncologic outcomes in resected pancreatic ductal adenocarcinoma (PDAC).
METHODS From January 2009 to December 2014, 221 patients were diagnosed with PDAC and underwent resection with curative intent. Retrospective review of the patients was performed based on electronic medical records system. One patient without records of numerical rating scale (NRS) pain intensity scores was excluded and eight patients who underwent total pancreatectomy were also excluded. NRS scores during 7 postoperative days following resection of PDAC were reviewed along with clinicopathologic characteristics. Patients were stratified into a good pain control group and a poor pain control group according to the difference in average pain intensity between the early (POD 1, 2, 3) and late (POD 5, 7) postoperative periods. Cox-proportional hazards multivariate analysis was performed to determine association between postoperative pain control and oncologic outcomes.
RESULTS A total of 212 patients were dichotomized into good pain control group (n = 162) and poor pain control group (n = 66). Median follow-up period was 17 mo. A negative impact of poor postoperative pain control on overall survival (OS) was observed in the group of patients receiving distal pancreatectomy (DP group; 42.0 mo vs 5.0 mo, P = 0.001). Poor postoperative pain control was also associated with poor disease-free survival (DFS) in the DP group (18.0 mo vs 8.0 mo, P = 0.001). Patients undergoing pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy (PD group) did not show associations between postoperative pain control and oncologic outcomes. Poor patients’ perceived pain control was revealed as an independent risk factor of both DFS (HR = 4.157; 95%CI: 1.938-8.915; P < 0.001) and OS (HR = 4.741; 95%CI: 2.214-10.153; P < 0.001) in resected left-sided pancreatic cancer.
CONCLUSION Adequate postoperative pain relief during the early postoperative period has important clinical implications for oncologic outcomes after resection of left-sided pancreatic cancer.
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