scholarly journals Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

2015 ◽  
Vol 97 (5) ◽  
pp. 364-368 ◽  
Author(s):  
A Chaudhry ◽  
S Hallam ◽  
A Chambers ◽  
AK Sahu ◽  
S Govindarajulu ◽  
...  

Introduction Postoperative pain after breast surgery is one of the major factors contributing to delay in mobilisation and prolonged hospital stay. A retrospective analysis was performed of patients undergoing skin sparing mastectomy and insertion of a subpectoral implant. The aim was to determine whether the use of an elastomeric local anaesthetic pump improved pain control and length of stay. Methods Twenty-five consecutive patients undergoing the above procedure were sited with an elastomeric local anaesthetic infusion pump intraoperatively, in addition to standard regular and pro re nata analgesia. The control group comprised 25 patients undergoing the same procedure in the same year who received standard analgesia alone. Visual analogue scale scores were recorded for the duration of inpatient stay, as was any further analgesic requirement. Results The median age was 51 years (range: 26–75 years) in the intervention group and 50 years (range: 28–70 years) in the control group. The mean visual analogue scale score was 0.28 (standard deviation [SD]: 0.61) at 24 hours for the intervention group and 1.84 (SD: 0.37) for the control group (p<0.0001). The mean length of stay was 1.8 days (SD: 0.71 days) for the intervention group and 2.28 days (SD: 0.94 days) for the control group (p=0.15). There were no complications involving catheter placement, leakage or toxicity relating to use of the local anaesthetic. Conclusions There was significantly reduced pain with the use of the local anaesthetic infusion pump. The elastomeric pump is a step towards enhanced patient recovery after breast surgery in the case of skin sparing mastectomy and subpectoral tissue expander reconstruction.

2018 ◽  
Vol 6 (9) ◽  
pp. 1606-1610 ◽  
Author(s):  
Hossein Sattari ◽  
Morteza Hashemian ◽  
Mohammad Reza Lashkarizadeh ◽  
Hamid Jalalifard

BACKGROUND: Nowadays pain control is one of the most important challenges for physicians, surgeons and anesthesiologists. New drugs and procedures to control pain have always been a major topic for researches. AIM: In this study, we evaluated the effects of preoperative pregabalin administration on relieving postoperative pain after thoracotomy surgery. MATERIALS AND METHODS: This study is a randomised, double-blind clinical trial, performed on 60 patients who underwent thoracotomy at Afzalipour hospital in Kerman, Iran. They were divided into case and control groups. Two hours before surgery an oral capsule of 300 mg pregabalin or placebo was given to patients. All patients similarly underwent general anaesthesia. Pain, nausea and vomiting were evaluated based on the visual analogue scale (VAS) and frequency. This study was verified and obtained the ethics committee code of K/92/489 from Kerman University of Medical Sciences. RESULTS: The average age of the pregabalin group was 39.7 ± 5.8 years and the control group 41.3 ± 6.1 years. The average pain score after regaining consciousness was 6.1 ± 0.2 in the case group and 7.9 ± 0.1 in the control group, and there was a significant difference between the 2 groups (p-value = 0.002). In the control group, 2 patients and the intervention group 3 patients, experienced nausea and vomiting. There was a significant difference between the overall average pethidine consumption and the average visual analogue scale in both groups. CONCLUSION: Pregabalin administration before thoracotomy is effective to reduce postoperative pain in patients. More research is needed to determine the optimal dose of pregabalin for preoperative administration.


2021 ◽  
Vol 103-B (6) ◽  
pp. 1155-1159
Author(s):  
Khodamorad Jamshidi ◽  
Farshad Zandrahimi ◽  
Abolfazl Bagherifard ◽  
Fatemeh Mohammadi ◽  
Alireza Mirzaei

Aim There is insufficient evidence to support bony reconstruction of the pubis after a type III internal hemipelvectomy (resection of all or part of the pubis). In this study, we compared surgical complications, postoperative pain, and functional outcome in a series of patients who had undergone a type III internal hemipelvectomy with or without bony reconstruction. Methods In a retrospective cohort study, 32 patients who had undergone a type III hemipelvectomy with or without allograft reconstruction (n = 15 and n = 17, respectively) were reviewed. The mean follow-up was 6.7 years (SD 3.8) for patients in the reconstruction group and 6.1 years (SD 4.0) for patients in the non-reconstruction group. Functional outcome was evaluated using the Musculoskeletal Tumor Society (MSTS) scoring system and the level of postoperative pain with a visual analogue scale (VAS). Results The mean MSTS score of the patients was significantly better in patients after reconstruction (26 (SD 1.7) vs 22.7 (SD 2.0); p < 0.001). The mean visual analogue scale score for pain was significantly less in the reconstruction group (2.1 (SD 2) vs 4.2 (SD 2.2); p = 0.016). One infection occurred in each group. Bladder herniation occurred in three patients (17.6%) in the non-reconstruction group but none in the reconstruction group. Five patients (29.4%) in the non-reconstruction group and one (7%) in the reconstruction group had a limp. Graft displacement occurred in two patients in the reconstruction group. Conclusion We recommend reconstruction of the bony defect after a type III hemipelvectomy: it gives a better functional result, less postoperative pain, and fewer late surgical complications. Cite this article: Bone Joint J 2021;103-B(6):1155–1159.


2020 ◽  
pp. 147-150

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.


2013 ◽  
Vol 127 (4) ◽  
pp. 383-391 ◽  
Author(s):  
A M A El-Fattah ◽  
E Ramzy

AbstractIntroduction:This double-blind, controlled, parallel-group study was designed to determine the efficacy of pre-emptive triple analgesia for paediatric post-tonsillectomy pain management.Materials and methods:One hundred and thirty-five children were randomised into two groups: pre-emptive triple analgesia (n = 55) and control (n = 80). Pain was assessed using a visual analogue scale (in hospital) and the Parent's Postoperative Pain Measure (at home), and scores recorded.Results:Visual analogue scale scores on awakening and for 6 hours post-surgery were significantly better in the study group than the control group (p < 0.05). The Parent's Postoperative Pain Measure scores of control group children were significantly higher within the first 3 post-operative days (p = 0.000), with a greater percentage of children experiencing significant pain and requiring more analgesia.Conclusion:The proposed multimodal, pre-emptive analgesia protocol for paediatric post-tonsillectomy pain results in less post-operative pain, both in hospital or at home.


2020 ◽  
Vol 7 (2) ◽  
pp. 409-414
Author(s):  
Arip Susianto ◽  
Hikmi Muharromah Pratiwi ◽  
Evi Komala Simamora

Latar belakang: Standar prosedur penanganan pada pasien paska bedah di RSUP Dr Kariadi belum cukup efektif untuk mengurangi nyeri tenggorok paska operasi dengan pamasangan endotrakeal tube pada General Anesthesia (GA). Penggunaan tablet hisap terbukti mampu menurunkan nyeri tenggorok, akan tetapi bukti penelitian masih terbatas. Penelitian ini untuk menguji keefektivitasan pemberian tablet hisap dan relaksasi napas dalam untuk mengurangi derajat nyeri tenggorok paska operasi. Metode: Penelitian dilakukan dengan desain quasi experimental pre-posttest pada 11 Juli – 30 Oktober 2019. Subyek penelitian berjumlah 60 pasien paska operasi dengan general anesthesia yang dikelompokan menjadi 30 kelompok intervensi dan 30 kelompok kontrol. Nyeri tenggorok paska operasi diukur dengan menggunakan Visual Analogue Scale (VAS) pada 6 jam paska operasi dan dievaluasi tiap 12 jam selama 48 jam. Hasil: Perbedaan rerata skor VAS antara kelompok kontrol dan kelompok intervensi secara signifikan terjadi pada penilaian nyeri 36 jam paska operasi (t = -3,70, p = 0,002) dan 48 jam paska operasi ( t = -4,28, p = 0,000). Skor VAS pada kelompok intervensi lebih rendah secara signifikan dibandingan dengan skor VAS pada kelompok kontrol. Simpulan: Pemberian tablet hisap dan relaksasi napas dalam secara signifikan menurunkan tingkat nyeri tenggorak paska operasi. Pemberian tablet hisap dapat dijadikan sebagai intervensi alternatif untuk penangangan pasien dengan komplikasi nyeri tenggorok paska operasi. Key words: Nyeri tenggorok, Endotracheal Tube, Tablet hisap, Relaksasi napas dalam, Visual Analogue Scale (VAS)   Background: The standard procedures of post operative patients at RSUP Dr Kariadi Semarang was ineffective to reduce post operative sore throat with Endotracheal Tube insertion in General Anesthesia. Lozenges was proven may reduce sore throat while the evidences were still limited. Methods: The research design was quasi experimental pre-post test on 11 july - 30 october 2019. The study subjects were 60 post operative patients with General Anesthesia grouped into 30 intervention grups and 30 control groups. Post operative sore throat was measured using Visual Analogue Scale (VAS) at 6 hours after surgery then evaluated every 12 hours for 48 hours. Results: Mean difference VAS score between intervention group and control group significantly in the assessment of pain 36 hours (t = -3,70, p = 0,002) and 48 hours ( t = -4,28, p = 0,000) post operatively. VAS score in intervention group was significantly lower than VAS score in control group. Conclusion: Lozenges and deep breath relaxation reduce significantly post operative sore throat. Lozenges could be used as an alternative intervention to treat patients with post operative sore throat. Keywords: Sore Throat, Endotracheal Tube, Lozenges, Deep Breath Relaxation, Visual Analogue Scale.


Author(s):  
Egidius Umbu Ndeta

Background : The severity of postoperative pain depends on the individual's physiological and psychological assumptions, the established tolerance for pain, the location of the incision, the nature of the procedure, the depth of surgical trauma and the type of anesthetic agent and how the agent is administered. Apart from pharmacological action, pain can also be treated with music. Music is an expression of one's soul and one's communication language. Music can sometimes make people cry, laugh, even music can heal sick people. Sape 'or also known as sampe is a musical instrument or instrument originating from the Dayak Kenyah and Kayan tribes. This traditional musical instrument is starting to become worldwide and favored by the international community, the sound of the sape 'is soft and easy to animate.Research Purposes : The effect of traditional music SAPE' therapy on postoperative pain reduction at Santo Vincentius Hospital  Singkawang city.Research Methods : Experimental research with pre and post test control group design. The sample selection used consecutive sampling method. The number of samples was 14 respondents after laparotomy surgery (7 samples from the intervention group and 7 samples from the control group). Data analyzed by using Paired Sample t Test.Result : Respondents were female, namely as many as 85.7%, aged 26-35 years, namely as many as 50.3% and had no experience of surgery, namely as many as 35.7%. The mean score for the pre intervention group was 7.29, while the average for the post intervention group was 5.29. The average of the music therapy intervention group with sape 'was 2,000, while the mean for the control group was 0.429. The average difference between the two groups was 1,571. The  statistic results of Paired Sample t Test with  p 2-tailed was significant of 0.002.Conclusion : There is an effect of traditional sape music therapy on reducing the pain scale of post surgery at RSU Santo Vincentius Singkawang.


2019 ◽  
Vol 3 (1) ◽  
pp. 21
Author(s):  
Jeanny Rantung

Abstrak   Nyeri neuropati adalah salah satu komplikasi kronik yang dapat dialami penyandang Diabetes Mellitus (DM) yang dapat menyebabkan gangguan fisik, sosial dan spiritual. Terapi musik adalah alah satu upaya yang dapat diberikan perawat untuk mengontrol nyeri selain terapi farmakologis yang diberikan oleh tim medis. Tujuan: menerapkan intervensi keperawatan nonfarmakologi dengan menggunakan terapi musik dalam mengurangi nyeri neuropati pada pasien DM. Metode: penelitian ini adalah penerapan Evidance Based Nursing (EBN) dengan melibatkan 10 orang responden yang dibagi menjadi kelompok intervensi terapi musik dan kelompok control, yang diperoleh dengan teknik accidental sampling. Intensitas nyeri diukur dengan menggunakan Visual Analogue Scale (VAS) yang dilakukan sebelum terapi musik diberikan, pada menit ke-30 dan menit ke-60. Hasil: responden yang mendapat terapi musik mengalami penurunan intensitas nyeri, dari nyeri sedang menjadi nyeri ringan, dan pada kelompok kontrol mengalami penurunan intensitas nyeri tapi masih dalam kategori nyeri sedang. Diskusi: Terapi musik merupakan intervensi keperawatan yang dapat menjadi pilihan terapi atau pengobatan terhadap nyeri neuropati pada penyandang diabetes sehingga menjadi pelengkap terhadap upaya medis yang sudah dilakukan.   Kata kunci: Nyeri, Neuropati, Terapi Musik   Abstract   Neuropathic pain is one of the chronic complications of diabetes mellitus (DM) that causes physical, social and spiritual disorders. Music therapy is one of the efforts that nurses can provide to control pain in addition to the pharmacological therapy provided by the medical team. Objective: to apply nonfarmacological nursing intervention by using music therapy to reduce neuropathic pain in type 2 DM patients. Method: the study was an aplication of Evidance Based Nursing (EBN) with 10 respondents involved who were divided into music therapy intervention group and control group, which were obtained by accidental sampling technigue. Pain intensity was measured using the Visual Analogue Scale (VAS) which was performed before music therapy was given, in the 30th minute and 60th minute. Results: respondents who received music therapy experienced a decrease in pain intensity, from moderate to mild pain, and the control group experienced a decrease in pain intensity but still in the moderate pain category. Discussion: Music therapy is a nursing intervention that can be an option of therapy or treatment for neuropathic pain among person with diabetes, so that it becomes a complement to the medical efforts that have been made.   Key words: Pain, Neuropathy, Music therapy


2020 ◽  
Vol 16 ◽  
Author(s):  
Caroline Yavari ◽  
Seyedeh Zahra Masoumi ◽  
Farideh Kazemi ◽  
Mansoureh Refaei ◽  
Abolghasem Yaghoobi

Background:: Childbirth is an important experience in the woman's life; and its quality has short- and long-term effects on them. Objective:: The present study aimed to determine the effect of positive mental imagery on the labor pain tolerance in primiparous women referred to Atieh teaching-medical center in Hamadan. Methods:: The present clinical trial study (IRCT20120215009014N242) was conducted on 90 primiparous mothers referred to Atieh Hospital of Hamadan in interventional (n= 45) and control (n= 45) groups. Data collection tools included demographic information forms, Behavioral pain scale, Visual analogue scale (VAS), and the birth registration checklist that were responded by both groups through interviews and observation during labor. The intervention group participated in 4 weekly counseling sessions in groups of 5 to 7 participants, but the control group received only routine care. Finally, the obtained data from above questionnaires was analyzed using SPSS 21 and analysis of covariance (ANCOVA), Independent t-test and chi-square test and the significance level of tests was considered to be at the level of 5%. Results:: The research results indicated that the mean age of control and intervention groups was 25.98±4.82 and 25.32± 4.85 respectively. The mean scores of Visual analogue scale (VAS) and the Behavioral Pain Scale significantly decreased compared to the control group (P <0.001). The mean scores of behavioral changes in the intervention group were 1.77 ± 0.68, 2.39± 0.54 and 3.09±0.60 in 4-5 cm, 6-7 cm and 8-10 cm dilatations respectively. That was statistically significant decrease compared to the control group (P=0.005). Conclusion:: Positive mental imagery counseling reduced the visual analogue intensity and behavioral pain intensity in primiparous women. It seems that continuing education and counseling during pregnancy and empowering mothers to control themselves and learn mental imagery techniques and practice during pregnancy and childbirth can help mothers to more relax and alleviate the labor painintensity.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 100.3-100
Author(s):  
Y. Wang ◽  
X. Liu ◽  
Y. Shi ◽  
X. Ji ◽  
W. Wang ◽  
...  

Background:Clinical practice guidelines recommend that exercise is an essential component in the self-management of Ankylosing Spondylitis (AS). Attending supervised interventions requiring periodic medical center visits can be burdensome and patients may decline participation, whereas, effective home-based exercise interventions that do not need regular medical center visits are likely to be more accessible and acceptable for patients with AS. Recently, increasing evidences have been accumulated that the wearable devices could facilitate patients with inflammatory arthritis by giving exercise instructions and improving self-efficacy. Therefore, patients with AS may benefit from an effective technology-assisted home-based exercise intervention.Objectives:To investigate the efficacy of a comprehensive technology-assisted home-based exercise intervention on disease activity in patients with AS.Methods:This study was a 16-week assessor-blinded, randomized, waiting-list controlled trial (ChiCTR1900024244). Patients with AS were randomly allocated to the home-based exercise intervention group and the waiting-list control group. A 16-week comprehensive exercise program consisting of a moderate intensity (64%-76% HRmax) aerobic training for 30min on 5 days/week and a functional training for 60min on 3 days/week was given to patients in the intervention group immediately after randomization, with 1.5h training sessions for two consecutive days by a study physical therapist at baseline and Week 8. The aerobic exercise intensity was controlled by a Mio FUSE Wristband with a smartphone application. The functional training consisted of the posture training, range of motion exercises, strength training, stability training and stretching exercises. Patients in control group received standard care during the 16-week follow-up and started to receive the exercise program at Week 16. The primary outcome was ASDAS at Week 16. The secondary outcomes were BASDAI, BASFI, BASMI, ASAS HI, peak oxygen uptake, body composition and muscle endurance tests. The mean difference between groups in change from baseline was analyzed with the analysis of covariance.Results:A total of 54 patients with AS were enrolled (26 in intervention group and 28 in control group) and 46 (85.2%) patients completed the 16-week follow-up. The mean difference of ASDAS between groups in change from baseline to 16-week follow-up was −0.2 (95% CI, −0.4 to 0.003, P = 0.032), and the mean change from baseline was -0.4 (95% CI, -0.5 to -0.2) in the intervention group vs -0.1 (95% CI, -0.3 to 0.01) in the control group, respectively. Significant between-group differences were found between groups for BASDAI (−0.5 [95% CI, −0.9 to −0.2], P = 0.004), BASMI (−0.7 [95% CI, −1.1 to −0.4], P <0.001), BASFI (−0.3 [95% CI, −0.6 to 0.01], P=0.035), peak oxygen uptake (2.7 [95% CI, 0.02 to 5.3] ml/kg/min, P=0.048) and extensor endurance test (17.8 [95% CI, 0.5 to 35.2]s, P=0.044) at Week 16. Between-group differences were detected in ASAS HI (−0.9 [95% CI, −1.7 to −0.1], P=0.030), body fat percentage (−1.0 [95% CI, −2.0 to −0.01] %, P=0.048) and visceral adipose tissue (−4.9 [95% CI, −8.5 to −1.4] cm2, P=0.008) at Week 8, but not at Week 16. No significant between-group differences were detected in the total lean mass, time up and go test and the flexor endurance test during the follow-up.Conclusion:Comprehensive technology-assisted home-based exercise has been shown to have beneficial effects on disease activity, physical function, spinal mobility, aerobic capacity, and body composition as well as in improving fatigue and morning stiffness of patients with AS.References:[1]van der Heijde D, Ramiro S, Landewé R, et al. Ann Rheum Dis 2017;76:978–991.Disclosure of Interests:None declared


2020 ◽  
pp. 105477382098336
Author(s):  
Ceyda Su Gündüz ◽  
Nurcan Çalişkan

This non-randomized control group intervention study was conducted to determine the effect of preoperative video based pain training on postoperative pain and analgesic use in patients undergoing total knee arthroplasty. During the study, the patients in the control ( n = 40) received routine care and the patients in the intervention group ( n = 40) received video based pain training. İt was determined that the mean postoperative pain scores of the intervention group were significantly lower and their pain management was better compared to the control group ( p < .05). The intervention group was found to use significantly less paracetamol on operation day compared to the control group ( p < .05). The intervention group was determined to benefit from non-pharmacological methods more than the control group did ( p < .05). Providing video based pain training to patients undergoing total knee arthroplasty is recommended since it reduces postoperative pain levels and increases the use of non-pharmacological pain control methods.


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