scholarly journals Opioid free pain management in ambulatory hemorrhoidectomy reduces pain

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
F Haak ◽  
L Merlo ◽  
B Dursunoglu ◽  
M von Flüe ◽  
D Steinemann
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Urinary Retention ◽  
Rating Scale ◽  
Outpatient Surgery ◽  
Postoperative Nausea And Vomiting ◽  
Early Discharge ◽  
Numeric Rating Scale ◽  
Significant Difference ◽  
The Impact

Abstract Objective Outpatient hemorrhoid surgery is a topic of growing importance with a need of modifications to pain management to enable early discharge. Opioid free anesthesia and analgesia (OFAA) has the goal to reduce postoperative pain as well as to improve discharge circumstances. The impact of OFAA on patients receiving ambulatory hemorrhoidectomy is investigated. Methods A retrospective cohort study on ambulatory hemorrhoidectomy between 2018 and 2020 was performed and patients that did and did not receive OFAA were compared. In the OFAA group patients received spinal anesthesia with Takipril and hyperbaric technique. Additionally Metamizole 500mg i.v. and Paracetamol 1g i.v. was used. In the non-OFAA group opioids were administered intravenously (fentanyl or remifentanyl) and sublingual (buprenorphin). Primary endpoint was pain measured according to a numeric rating scale (NRS) one hour postoperatively. Secondary endpoints were pain 24 hours postoperative, duration of hospital stay, urinary retention, postoperative nausea and vomiting (PONV), overall morbidity, and re-admission. Wilcoxon Rank-Sum test was performed to search for differences between the outcomes. Results 117 patients were included in the analysis. 41 percent of the patients were female. The mean age was 54±14 years. 40 patients did not receive opioids perioperatively (OFAA group) and 77 did (non-OFAA group). The non-OFAA group received a mean dose of 23.3±17.9 mg morphine equivalent. Median NRS score one hour postoperatively was 0 (interquartile range 0-1) for OFAA and 2 (0-4) for non-OFAA (p = 0.01). The median NRS score 24 hours postoperatively was 1 (0-2) for OFAA and 1 (0-3) for non-OFAA (p = 0.40). There were 3 patients (7.5%) with urinary retention in OFAA and 5 patients (6.5%) in non-OFAA(p = 0.84).No patient had PONV in OFAA and 5 (6.5%) in non-OFAA (p = 0.10). The overall morbidity was 5 (12.5%) in OFAA and 16 (20.8%) in non-OFAA (p = 0.27). There were two readmissions (5%) in OFAA and 6 (7.8%) in non-OFAA (p = 0.58). Conclusion There is a significant difference in pain one hour postoperatively between OFAA and non-OFAA with a clear benefit of not administering opioids. Opioids may trigger pelvic floor spasms and disimprove postoperative pain. In the context of outpatient surgery, we recommend an opioid free operation to reduce postoperative pain and improve discharge prerequisites.

scholarly journals Pain Level of Postoperative Orthopedic Patients at Dr. Soetomo General Hospital

2019 ◽  
Vol 1 (1) ◽  
pp. 19
Author(s):  
David Wicaksono ◽  
Lilik Herawati ◽  
Herdy Sulistyono
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Medical Personnel ◽  
Numeric Rating Scale ◽  
Individual Factors ◽  
Pain Level ◽  
Post Surgery ◽  
Significant Difference

Introduction: Postoperative pain is the most undesirable consequence of the surgery. If it is not managed properly, it can lead to a long healing. However, assessment and treatment of postoperative pain in surgical wards still have not received attention. Differences in patient’s pain level after surgery and after being transferred to the surgical ward is very important in monitoring the effectiveness postoperative pain management. Objective: This study was conducted to determine the overview of pain level experienced by patients following orthopedic surgery and to know the individual factors that can affect the patient's pain level. Method and Material: This research was observational analytic with 43 orthopedic postoperative patients as a sample. The Patients’ pain level were measured by the Numeric Rating Scale (NRS) at one hour after surgery and 24 hours after surgery. Result and Discussion: The Pain level one hour after surgery varied between pain level 0 as much as 53% to pain level 8 as much as 4.7%. The results of measurements of pain 24 hours after surgery only 23.3% of the patients who did not complain of pain, and there was a patient who experienced pain level 10. The results of the statistical calculation, the difference between the level of pain one hour and 24 hours post-surgery obtained value of p=0.037 (p<0.05). Conclusion: There was a significant difference between the pain level at one hour and 24 hours post-surgery. It might be due to the process of peripheral and central sensitization in patients with delayed pain management. It also may be influenced by individual factors as well as medical personnel.

scholarly journals Effectiveness of Ketoprofen Suppositoria as Preemptive Analgesia for Postoperative Pain in Patients Undergoing Elective Surgery with General Anesthesia

2020 ◽  
Vol 2 (1) ◽  
pp. 20
Author(s):  
Lupi Lestari ◽  
Elizeus Hanindito ◽  
Arie Utariani
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Numeric Rating Scale ◽  
Preemptive Analgesia ◽  
Acute Postoperative Pain ◽  
Numeric Rating

Introduction: Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk deep vein thrombosis, fast recovery, and reduced cost of care. Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period, has the potential to be more effective than a similar analgesic treatment initiated after surgery. As a part of multimodal analgesia, the use of NSAIDs should always be considered for acute postoperative pain management. NSAIDs can be used preoperatively as a part of the preemptive regimen and for postoperative pain control to increase the efficacy of opioids and reduce its side effects. Material and Method: This research was experimental research with a case-control design of the study. The samples separated into two groups, the first group got ketoprofen suppository before the induction, and the second group didn’t get the ketoprofen suppository The intensity of pain measured with the Numeric Rating Scale (NRS) or Wong-Baker Faces Pain Scale was the variable studied at different postoperative times (30 min, 60 min, 120 min, 2-6 hours, 6-12 hours). The total amount of rescue analgesics (fentanyl) and side effects were other variables of this study. Result and Discussion: The result is ketoprofen suppository as preemptive analgesia administrations can reduce postoperative pain. Numeric Rating Scale was significantly lower in the ketoprofen group compared to the control group (p < 0,05) at 30 min, 60 min, 230 min, 2-6 hours, 6-12 hours. The number of postoperative analgesics needed in the recovery room was significant differences among both groups (p < 0,05). Conclusion: Preemptive analgesia in patients who underwent an operation with general anesthesia with ketoprofen suppository was effectively in blocking noxious stimuli and central sensitization, with subsequent prevention of acute postoperative pain.

scholarly journals A Consult Is Just a Page Away: A Prospective Observational Study on the Impact of Jinxing on Call Karma in Neurosurgery

2017 ◽  
Vol 44 (4) ◽  
pp. 420-423
Author(s):  
Holger Joswig ◽  
Lauren Zarnett ◽  
David A. Steven ◽  
Martin N. Stienen
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Rating Scale ◽  
Study Groups ◽  
Numeric Rating Scale ◽  
Personal Beliefs ◽  
Significant Difference ◽  
Level Of Experience ◽  
The Impact ◽  
Numeric Rating

AbstractObjective: Our aim was to assess the impact of jinxing on “call karma” in neurosurgery. Methods: We conducted a prospective observational study on 15 residents on call for the neurosurgery service, recording the total number of admissions, consults, deaths encountered, surgeries performed, hours of sleep and subjective call rating on a numeric rating scale (NRS) of 0-10 in terms of general awfulness. Results: Some 204 on-call nightshifts were analyzed, of which 61 (29.9%) were jinxed and 143 (70.1%) were nonjinxed. Jinxes seemed to occur in clusters. The baseline parameters (experience, type of call coverage and superstition level) of the study groups were well balanced. A trend toward more surgeries was observed during jinxed nights, where residents slept significantly less (mean 147.8±96.2 vs. 180.9±106.1 min, p=0.037) and rated their on-call experience worse on the NRS (4.4±2.2 vs. 3.5±2.0, p=0.011), while there was no significant difference in number of admissions, consults or deaths. Conclusions: The act of jinxing ought to be avoided in the neurosurgical setting, as it might be potentially harmful to resident call karma, irrespective of level of experience, resources and personal beliefs.

scholarly journals Opioid-free anesthesia versus opioid-inclusive anesthesia for breast cancer surgery: a retrospective study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Pia Di Benedetto ◽  
Massimiliano Pelli ◽  
Chiara Loffredo ◽  
Rosaria La Regina ◽  
Federico Policastro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Retrospective Study ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Postoperative Nausea And Vomiting ◽  
Numeric Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Anesthetic Technique

Abstract Background Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects. In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV). Results A total of 89 patients submitted to quadrantectomy were included and divided into an OFA group (38 patients) and an OIA group (51 patients) according to the received anesthetic technique. Analgesia in the OIA group was based on an intraoperative infusion of remifentanil, and analgesia in the OFA consisted of an intraoperative infusion of ketamine and magnesium sulfate. Postoperative pain in both groups was managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Postoperative pain, assessed with the numeric rating scale (NRS), requirements for additional analgesics, the incidence of PONV, and patient satisfaction evaluated using a QoR-40 questionnaire were compared between the two groups. Levels of pain at 30 min and 6, 12, and 24 h after surgery; number of paracetamol rescue doses; and the incidence of PONV were lower in the OFA group (p <0.05). Patient satisfaction was comparable in the two groups. Conclusions A combination of ketamine, magnesium, and clonidine could be more effective than opioid-based analgesia in reducing postoperative pain and lowering PONV occurrence after quadrantectomy for breast cancer.

scholarly journals Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Phuong Hoang Vu ◽  
Duc Viet Tran ◽  
Yen Thi Le ◽  
Ha Thi Thu Do ◽  
Sao Thi Vu ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Registered Nurses ◽  
Management Practices ◽  
Rating Scale ◽  
Management Practice ◽  
Postoperative Pain Management ◽  
Numeric Rating Scale ◽  
Assessment Tools ◽  
Urban Hospital

This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.

scholarly journals Implementation and Evaluation of the Peg Pain Assessment Scale in a Primary Care Setting

2020 ◽  
Author(s):  
Nancy Harritos
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Pain Assessment ◽  
Care Setting ◽  
Primary Care Setting ◽  
Rating Scale ◽  
Assessment Tool ◽  
Improve Patient Care ◽  
Numeric Rating Scale ◽  
The Impact

Inadequate pain assessment is a significant problem and a key barrier to appropriate pain management. This project evaluates the feasibility, effectiveness, and impact of using the PEG scale, a 3-item pain assessment tool in place of the unidimensional Numeric Rating Scale to assess chronic pain in a primary care setting. A multidimensional pain assessment tool that evaluates not only the severity of pain, but also the impact of pain on quality and functioning could improve patient care and pain management.

scholarly journals Impact on Quality of Life of Patients Treated by Different File Systems for Root Canal Treatment

2021 ◽  
Author(s):  
L.S. Priyanka ◽  
Lakshmi Nidhi Rao ◽  
Aditya Shetty ◽  
Mithra N. Hegde ◽  
Chitharanjan Shetty
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Postoperative Pain ◽  
Root Canal ◽  
File Systems ◽  
Study Groups ◽  
Significant Difference ◽  
Related Quality ◽  
The Impact

Abstract Introduction The outcomes of oral health conditions and therapy for those conditions are described by the term “oral health-related quality of life.” Oral health-related quality of life is recognized by the World Health Organization as an important part of the Global Oral Health Program. The study aims to compare the impact of three root canal preparation systems on patients’ quality of life and correlate postoperative pain with the impact on the quality of life. Materials and Methods A survey was performed in which 90 patients were randomly assigned to three groups based on the root canal preparation system: (1) ProTaper Gold (Dentsply, Tulsa Dental Specialties, Tulsa, Oklahoma, United States), (2) Neoendo flex (Neoendo, India),and (3) Hyflex EDM/CM (Coltene Whaledent) that included 30 participants in each group. Data collection included the implementation of a demographic data questionnaire, Oral Health Impact Profile 14 (quality of life), and visual analogue scale(pain). The questionnaire was given after root canal treatment in the first 24 hours. The data obtained were statistically analyzed. Results No significant differences were found in the quality of life among study groups. Group 1 demonstrated a highly significant difference in the postoperative pain with p value of 2.67. Conclusion Within the limitations of the present study, Protaper Gold showed a highly significant difference in postoperative pain when compared with other file systems. No significant differences were found in the quality of life among the study groups.

scholarly journals Pre-Hospital Pain Management in Children with Injuries: A Retrospective Cohort Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3056
Author(s):  
Ada Holak ◽  
Michał Czapla ◽  
Marzena Zielińska
Keyword(s):  
Pain Management ◽  
Pain Intensity ◽  
Pain Assessment ◽  
Rating Scales ◽  
Rating Scale ◽  
Low Frequency ◽  
Numeric Rating Scale ◽  
Health Concern ◽  
School Age Children ◽  
Medical Teams

Background: The all-too-frequent failure to rate pain intensity, resulting in the lack of or inadequacy of pain management, has long ceased to be an exclusive problem of the young patient, becoming a major public health concern. This study aimed to evaluate the methods used for reducing post-traumatic pain in children and the frequency of use of such methods. Additionally, the methods of pain assessment and the frequency of their application in this age group were analysed. Methods: A retrospective analysis of 2452 medical records of emergency medical teams dispatched to injured children aged 0–18 years in the area around Warsaw (Poland). Results: Of all injured children, 1% (20 out of 2432) had their pain intensity rated, and the only tool used for this assessment was the numeric rating scale (NRS). Children with burns most frequently received a single analgesic drug or cooling (56.2%), whereas the least frequently used method was multimodal treatment combining pharmacotherapy and cooling (13.5%). Toddlers constituted the largest percentage of patients who were provided with cooling (12%). Immobilisation was most commonly used in adolescents (29%) and school-age children (n = 186; 24%). Conclusions: Low frequency of pain assessment emphasises the need to provide better training in the use of various pain rating scales and protocols. What is more, non-pharmacological methods (cooling and immobilisation) used for reducing pain in injured children still remain underutilized.

scholarly journals Clinical benefits, referral practice and cost implications of an in-hospital pain service: results of a service evaluation in a London teaching hospital

2016 ◽  
Vol 11 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Maya Sussman ◽  
Elizabeth Goodier ◽  
Izabella Fabri ◽  
Jessica Borrowman ◽  
Sarah Thomas ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pain Management ◽  
Teaching Hospital ◽  
Rating Scale ◽  
Service Evaluation ◽  
Rank Test ◽  
Future Research ◽  
Binary Logistic Regression Analysis ◽  
Significant Difference ◽  
Referral Practice

Background: In-hospital pain services (IPS) are commonplace, but evidence of efficacy is inadequate, and patients’ pain management in any hospital ward remains problematic. This service evaluation aimed to measure the effect of a contemporary IPS, its appropriate use and cost-efficacy. Methods: Records of 249 adults reviewed by the IPS in an inner London Teaching Hospital over an 8-month period were analysed for demographic data, interventions, workload and change in pain intensity measured by numerical rating scale (NRS). Non-parametric tests were used to evaluate differences between initial and final NRS. Spearman’s rank correlation analysis was used to create a correlation matrix to evaluate associations between all identified independent variables with the change in NRS. All strongly correlated variables (ρ > 0.5) were subsequently included in a binary logistic regression analysis to identify predictors of pain resolution greater than 50% NRS and improvement rather than deterioration or no change in NRS. Finally, referral practice and cost of inappropriate referrals were estimated. Referrals were thought to be inappropriate when pain was not optimised by the referring team; they were identified using a set algorithm. Results: Initial median NRS and final median NRS were significantly different when a Wilcoxon signed-rank test was applied to the whole cohort; Z = –5.5 (p = 0.000). Subgroup analysis demonstrated no significant difference in the ‘mild’ pain group; z = –1.1 (p = 0.253). Regression analysis showed that for every unit increase in initial NRS, there was a 62% chance of general and a 33% chance of >50% improvement in final NRS. An estimated annual cost-saving potential of £1546 to £4558 was found in inappropriate referrals and patients experiencing no benefit from the service. Discussion: Results suggest that patients with moderate to severe pain benefit most from IPS input. Also pain management resources are often distributed inefficiently. Future research is required to develop algorithms for easy identification of potential treatment responders.

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