scholarly journals Efficacy and Safety of Para Cervical Block in Manual Vacuum Aspiration (MVA) - in Low Resource Setting

2017 ◽  
Vol 31 (2) ◽  
pp. 70-74
Author(s):  
Nafisa Jesmin
Keyword(s):  
Visual Analog Scale ◽  
Severe Pain ◽  
Cervical Dilatation ◽  
Moderate Pain ◽  
Pain Sensation ◽  
Analog Scale ◽  
Low Resource ◽  
Vacuum Aspiration ◽  
Incomplete Abortion ◽  
Manual Vacuum Aspiration

Objective (s): To determine the safety and effectiveness of para-cervical block for cervical dilatation and uterine evacuation by MVA.Materials and methods: This descriptive (cross-sectional) study was conducted in a low resource set-up at Homna, Upzilla Health Complex Comilla between January 2016 and June 2016. Forty five patients of 1st trimester incomplete abortion of 12 weeks gestation were the target population for manual vacuum aspiration (MVA) for this study. All patients received para cervical block before MVA procedure. Three minutes after application of block, suction and evacuation of uterus was done. Perioperative oral analgesic (Ibuprofen) and anxiolytic (diazepam) were used 30 minutes before procedure in all patients. Before the procedure, all the women were asked to evaluate the level of pain on a visual analog scale ranged from 0-10. Thirty minutes after the procedure, the patient was asked to describe the pain that she had been feeling during MVA by using the same visual analog scale. Visual analog scale was described by: no pain (0 points), slight pain (1-3 points), moderate pain (4-6 points) and severe pain (7-10 points). Patients were followed up for 7 days and were evaluated for complications before leaving the facility and on the 7th day after procedure. A routine USG of lower abdomen was done on 7th post-evacuation day in all patients, which revealed completeness of the procedure. Informed consent was taken from all the patients.Results: All were first trimester incomplete abortion cases. MVA was performed with para cervical block. Para cervical block reduced pain sensation on cervical dilatation. According to VAS 30 (66.67%) patients had mild pain, 3(6.67%) patients had moderate pain and 12(26.67%) patients had no pain during the procedure. Six (13.33%) patients had mild pain and others had no pain after the procedure. There was no severe pain before or after the procedure. Thirty (75.56%) patients discharged before 4 hours and 11 (24.44%) patients discharged after 4 hours of the procedure. No patients had any complications like pervaginal bleeding, infection or retention of product. The cost was minimum and patient’s satisfaction was high.Conclusion: Paracevical block is effective in reducing pain sensation during MVA with a reasonable cost of the procedure.Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2) : 70-74

scholarly journals EFEK KOMBINASI PARASETAMOL DAN KODEIN SEBAGAI ANALGESIA PREEMPTIF PADA PASIEN DENGAN ORIF EKSTREMITAS BAWAH

2017 ◽  
Vol 13 (1) ◽  
pp. 97
Author(s):  
Sahurrahmanisa Sahurrahmanisa ◽  
Kenanga Marwan Sikumbang ◽  
Istiana Istiana
Keyword(s):  
Postoperative Pain ◽  
Visual Analog Scale ◽  
Severe Pain ◽  
Preemptive Analgesia ◽  
P Value ◽  
Moderate Pain ◽  
Analog Scale ◽  
Cross Sectional ◽  
Mild Pain ◽  
Consecutive Sampling

Abstract: Postoperative pain is a complex pain response which often occurred in post-operative patient. Effective pain management is conducted by giving preemptive analgesia, preventive analgesia and multimodal. The purpose of this study was to analyze the effect combination of paracetamol 325 mg and codeine 10 mg in a patient with ORIF inferior extremity. This was an observational analytic study with a cross sectional method and 32 respondents were included by consecutive sampling method. The result of this study, in group with the combination of paracetamol and codeine there are 4 respondents (25.0%) of mild pain, 12 respondents (75.0%) of moderate pain, and there’s none had severe pain, and the group without combination therapy there’s no mild pain, 7 respondents (43.8%) of moderate pain, and 9 respondents (56.2%) of severe pain. The statistic analyses with Kolmogorov Smirnov p-value <0.05, it can be concluded that in this study a combination of paracetamol and codeine are effective as a preemptive analgesia. Keywords: postoperative pain, preemptive analgesia, visual analog scale (VAS), paracetamol, codeine Abstrak: Nyeri pasca bedah merupakan respon nyeri yang sering dirasakan pasien setelah pembedahan dengan respon yang kompleks. Penanganan nyeri yang efektif dilakukan dengan pemberian analgesia preemptif, analgesia preventif, dan analgesia multimodal. Tujuan penelitian ini untuk menganalisi efek kombinasi parasetamol 325 mg dan kodein 10 mg sebagai analgesia preemptif pada pasien dengan ORIF ekstremitas bawah. Penelitian ini menggunakan rancangan observasional analitik cross sectional dengan teknik consecutive sampling didapatkan 32 sampel. Hasil penelitian, pada kelompok yang diberikan kombinasi parasetamol dan kodein sebanyak 4(25.0%) nyeri ringan, 12 (75.0%) nyeri sedang dan tidak didapatkan nyeri berat, sedangkan pada kelompok yang tidak diberikan kombinasi parasetamol dan kodein tidak ditemukan nyeri ringan, sebanyak 7 (43.8%) nyeri sedang dan 9 (56.2%) nyeri berat. Analisa statistik menggunakan Komogorov Smirnov didapatkan perbedaan yang signifikan antara kedua kelompok dengan nilai p value < 0,05 sehingga dapat disimpulkan pada penelitian ini kombinasi parasetamol dan kodein dapat digunakan sebagai analgesia preemptif. Kata-kata kunci: nyeri paska bedah, analgesia preemptif, visual analog scale (VAS) , parasetamol, kodein.

scholarly journals Use of Misoprostol in the Management of Early Pregnancy Loss

2014 ◽  
Vol 7 (2) ◽  
pp. 9-13
Author(s):  
G Gurung ◽  
A Rana ◽  
J Baral
Keyword(s):  
Early Pregnancy ◽  
Severe Pain ◽  
University Teaching ◽  
Missed Abortion ◽  
Excessive Bleeding ◽  
Vacuum Aspiration ◽  
Incomplete Abortion ◽  
Manual Vacuum Aspiration ◽  
Blighted Ovum

Aims: To evaluate the effectiveness of Misoprostol administered vaginally to assist complete evacuation in early pregnancy losses (incomplete abortion, missed abortion and blighted ovum). Methods: It is a descriptive study conducted in the Department of Ob/Gyn and Emergency Department Tribhuvan University Teaching hospital. All women with clinical/USG diagnosis of incomplete abortion, missed abortion and blighted ovum ≤12 weeks POG either from last menstrual period (LMP) or USG were inserted tab. misoprostol 800 mcg in the posterior fornix. Same dose was repeated when the evacuation was incomplete on day 3 of follow-up. Manual vacuum aspiration (MVA) was offered on day 14 if evacuation was incomplete or any complications like excessive bleeding/severe pain occurred during this period. Results: A hundred and thirty three women with incomplete/missed/blighted ovum were reported, of which 112 (84.3%) were analyzed as 21(15.7%) lost to follow up. Among the 112, 51 (45.5%) were incomplete abortion, 34(30.3%) blighted and 27 (24.1%) missed abortion. Complete evacuation was achieved in 98/112 (87.5%) cases [73 (65%) cases with single dose & 25(22.3%) with double doses]. Evacuation was failed in 14(12.5%) cases [incomplete abortion 6 (42%), blighted 7 (50%) & missed abortion 1 (7.1%)]. Failure for complete evacuation (n=14) related to gestational age: 10-12 weeks 9/14(64%), 7-9 weeks 5 (35%) and none in the ≤6 weeks. Although the plan was to evacuate on day 14 of follow-up for incomplete evacuation which was applicable only in 11(78.5%) cases, 3(21.5%) cases were surgically (MVA) treated beforehand (2 for excessive bleeding, 1 for severe pain). No severe complications and side effects requiring treatment were observed. Conclusions: Vaginal Misoprostol is proved to be effective and safe in cases of incomplete abortion, missed abortion and blighted ovum. In the cases that failed to achieve complete evacuation by medical means using misoprostol were subjected to surgical manual vacuum aspiration (MVA) on day 14 of follow-up. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11133   Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 9-13

Frequency and nature of pain in patients undergoing neurorehabilitation

2020 ◽  
pp. 026921552095678
Author(s):  
Alicja Timm ◽  
Stefan Knecht ◽  
Matthias Florian ◽  
Heidrun Pickenbrock ◽  
Bettina Studer ◽  
...  
Keyword(s):  
Treatment Period ◽  
Daily Living ◽  
Severe Pain ◽  
Pain Medication ◽  
Daily Activities ◽  
Inpatient Stay ◽  
Moderate Pain ◽  
Group Level ◽  
Analog Scale ◽  
Pain Scores

Objective: This prospective study investigated the extent to which patients undergoing neurorehabilitation reported pain, how this pain developed during inpatient stay and whether patients were treated accordingly (using pain medication). Methods: The extent of pain, performance in daily activities, with a focus on possible impairment from pain, and pain medication were assessed at the beginning and the end of neurorehabilitation treatment. Overall 584 patients, with various neurological diagnoses, such as stroke, intracerebral hemorrhage, polyneuropathy, etc. were classified into four groups based on whether they reported having “no pain,” “mild pain,” “moderate pain,” or “severe pain.” All patients received conventional neurorehabilitation therapy in the Mauritius Hospital, Germany. Results: A total of 149 patients had clinically relevant pain at the beginning of their inpatient stay, at a group level this did not change significantly during the treatment period. At the end of inpatient stay, a slight increase was noted in patients reporting pain. Overall 164 patients suffered from moderate or severe pain, operationalized of pain scores >3 on the visual analog scale. A total of 145 patients who had pain at the end of inpatient stay, did not receive pain medication. There was a weak negative association between pain at baseline and activities of daily living at the end of the treatment period, such that, patients with higher pain levels tended to showed lower Barthel Index scores at the end. Conclusion: In our study, about one-third of patients suffered from clinically relevant pain during neurorehabilitation treatment and most of them did not receive any pain medication.

An Audit of Pain Control Pathways following Video-Assisted Thoracoscopic Surgery

2011 ◽  
Vol 6 (4) ◽  
pp. 248-252 ◽  
Author(s):  
Espeed Khoshbin ◽  
Ali N. Al-Jilaihawi ◽  
Nicholas B. Scott ◽  
Dhruva Prakash ◽  
Alan J. B. Kirk
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Visual Analog Scale ◽  
Severe Pain ◽  
Thoracoscopic Surgery ◽  
Analog Scale ◽  
Pain Scores ◽  
Audit Commission ◽  
Video Assisted Thoracoscopic Surgery ◽  
Daily Pain

Objective To compare different modes of pain management following video-assisted thoracoscopic surgery (VATS) to our national standard. Methods This is an audit based on patient's experiences. One hundred consecutive patients who underwent VATS with or without pleurodesis were managed by one of the following pain relief pathways: (A) thoracic paravertebral block + morphine patient-controlled analgesia (PCA), (B) percutaneous thoracic paravertebral catheter +/– morphine PCA, (C) thoracic epidural +/– morphine PCA, (D) morphine PCA alone, and (E) intravenous or subcutaneous morphine as required. Pain score was documented up to four times per day for each patient. The incidence of severe pain was defined as visual analog scale ≥7. The results were compared with the standard set by the audit commission for postoperative pain relief in the UK. The mean daily pain scores were calculated retrospectively for all patients. Results There were no statistically significant differences in mean daily pain scores irrespective of having a pleurodesis. The percentage of patients experiencing severe pain was 34% [mean visual analog scale = 8 (standard deviation = 1.0)]. This was almost seven times the standard. Among these pathways, B had the least percentage incidence of severe pain (16.7%) followed by A (25.0%) D (33.3%), C (35.7%), and E (52.4%). Conclusions We are not compliant with the standards set by the audit commission. Pain management in theater recovery needs to be targeted. In the light of these results, we recommend the use of percutaneous thoracic paravertebral catheter +/– morphine PCA for postoperative VATS pain relief.

scholarly journals MANUAL VACUUM ASPIRATION (MVA)

2016 ◽  
Vol 23 (11) ◽  
pp. 1349-1353
Author(s):  
Muhammad Usman Anjum ◽  
Surriya Yasmin ◽  
Qamoos Razzaq
Keyword(s):  
Access To Health Care ◽  
Pregnancy Loss ◽  
Health Care Facilities ◽  
Vacuum Aspiration ◽  
Incomplete Abortion ◽  
Trimester Pregnancy ◽  
Products Of Conception ◽  
Number Of Patients ◽  
Manual Vacuum Aspiration ◽  
Anembryonic Pregnancy

Objectives: To determine the safety and effectiveness of manual vacuumaspiration (MVA) in treating first trimester pregnancy loss. Place & duration of study: Departmentof Gynecology, Shahina Jamil Teaching Hospital, Abbottabad, Pakistan, from September2013 to December 2014. Study design: Descriptive cross-sectional study. Materials andmethods: All the patients who were less than 12 weeks of gestation and diagnosed with missedabortion, incomplete abortion, having retained products of conception after normal deliveryand anembryonic pregnancy were included in the study. Diagnosis was made on the basis ofhistory, physical examination and ultrasonography. Urine pregnancy test and β-HCG were donein selected patients. Last menstrual period and USG were used to determine the gestationalage. Manual vacuum aspiration was carried out under Para cervical block using “Ipas EasyGrip” cannula with a 60ml syringe attached to it to create a negative pressure. Completenessof the procedure was determined and products of conception were sent for histopathologicalexamination. Results: There were 165 patients enrolled in this study. All study subjects weremarried. Mean age of the patients was 27.60± 4.86 years. Fifty patients had a previous historyof abortion. Mean parity was 2.98± 2.22 and mean gestational age was 8.23±1.6 weeks.The maximum number of patients, 80%, belonged to age group of 20-30 years. There were37 patients who were presented with first pregnancy. The number of multigravida and grandmultigravida patients were equal, 64 cases in each group. The main reason for undergoingMVA in our study subjects was missed and incomplete abortion followed by retained productsof conception and anembryonic pregnancy. Conclusion: MVA is a preferred mode of treatingfirst trimester pregnancy loss as it is a simple, safe and cost-effective procedure. MVA should beused preferentially in rural areas where there is a limited access to health care facilities, powerout-breaks are common and advanced medical equipment is not available.

scholarly journals Diminished mechanosensitivity and chemosensitivity in patients with achalasia

2003 ◽  
Vol 285 (6) ◽  
pp. G1198-G1203 ◽  
Author(s):  
Stephen Brackbill ◽  
Guoxiang Shi ◽  
Ikuo Hirano
Keyword(s):  
Visual Analog Scale ◽  
Esophageal Motility ◽  
Healthy Subjects ◽  
Motor Dysfunction ◽  
Visceral Sensation ◽  
Pain Sensation ◽  
Analog Scale ◽  
Pain Thresholds ◽  
Esophageal Body ◽  
Acid Perfusion

The pathogenesis of achalasia involves the degeneration of enteric and autonomic nervous systems with resultant effects on esophageal motility. The neural degeneration could affect visceral sensation in achalasia. The aim of this study was to examine mechanosensitivity and chemosensitivity in patients with achalasia. Perceptual responses to esophageal distension and acid perfusion were assessed in nine achalasia patients and nine healthy subjects. Mechanosensitivity was evaluated using a barostat with a double-random staircase distension protocol. Responses were graded as follows: 0, no sensation; 1, initial sensation; 2, mild discomfort; 3, moderate discomfort; and 4, pain. Chemosensitivity was graded along a visual analog scale after perfusion of saline and 0.1 N HCl. Barostat pressure-volume relationships were used to report esophageal body compliance. Barostat pressures for initial sensation and mild discomfort were not significantly different for patients and controls. The pressures for moderate discomfort (37.9 ± 3.5 vs. 25.7 ± 2.4 mmHg; P < 0.05) and pain (47.8 ± 2.3 vs. 32.2 ± 3.5 mmHg; P = 0.002) were significantly higher in achalasics than controls. Seven of the eight achalasia patients never reached pain thresholds at the maximum distension pressure (50 mmHg). Sensation to acid perfusion was significantly lower in achalasics compared with controls (2.2 ± 1.2 vs. 6.7 ± 1.7 cm; P < 0.05). Compliance was significantly increased in patients with achalasia compared with controls. We conclude that both mechanosensitivity and chemosensitivity are significantly diminished in achalasia patients compared with controls. Also, initial sensation and pain sensation are differentially affected in achalasics. These findings suggest that neuropathic defects in achalasia may manifest themselves in visceral sensory and motor dysfunction.

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