Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

2020 ◽  
Vol 8 (1) ◽  
pp. 21-21
Author(s):  
Mani Mofidi ◽  
Ali Dashti ◽  
Mahdi Rezai ◽  
Niloufar Ghodrati ◽  
Hoorolnesa Ameli ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Musculoskeletal Pain ◽  
Normal Saline ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Vital Signs ◽  
Categorical Variables ◽  
Intravenous Morphine ◽  
Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

scholarly journals Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome

2021 ◽  
Author(s):  
Samuel Baek ◽  
Seok Kim ◽  
Myung Ho Shin ◽  
Tae Min Kim ◽  
Seoung-Joon Lee ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Efficacy ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Neck Disability Index ◽  
Vital Signs ◽  
Treatment Technique ◽  
The Novel ◽  
Numerical Rating ◽  
Neck Disability

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.

Evaluation of pain management in medical transfer of trauma patients by air

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 776-783
Author(s):  
Isabelle H. Miles ◽  
Russell D. MacDonald ◽  
Sean W. Moore ◽  
James Ducharme ◽  
Christian Vaillancourt
Keyword(s):  
Pain Management ◽  
Adverse Events ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Trauma Centre ◽  
Air Transport ◽  
Future Research ◽  
Trauma Patients ◽  
Numerical Rating ◽  
Standard Deviation Range

ABSTRACTObjectivesWith regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.MethodsWe conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency. Patients were included if they were ≥18 years old and underwent air transport to a trauma centre, and excluded if they were Glasgow Coma Scale score <14, intubated, or accompanied by a physician or nurse. Demographics, injury description, and transportation parameters were recorded. Outcomes included pain assessment via 11-point numerical rating scale, patterns of analgesia administration, and analgesia-related adverse events. Results were reported as mean ± standard deviation, [range], (percentage).ResultsWe included 372 patients: 47.0 years old; 262 males; 361 blunt injuries. Transport duration was 82.4 ± 46.3 minutes. In 232 (62.4%) patients who received analgesia, baseline numerical rating scale was 5.9 ± 2.5. Fentanyl was most commonly administered at 44.3 [25–60] mcg. Numerical rating scale after first analgesia dose decreased by 1.1 [-2–7]. Thereafter, 171 (73.7%) patients received 2.4 [1-18] additional doses. While 44 (23.4%) patients had no change in numerical rating scale after first analgesia dose, subsequent doses resulted in no change in numerical rating scale in over 65% of patients. There were 43 adverse events recorded, with nausea the most commonly reported (39.5%).ConclusionsInitial and subsequent dose(s) of analgesic had minimal effect on pain as assessed via numerical rating scale, likely due in part to inadequate dosing. Future research is required to determine and address the barriers to proper analgesia.

scholarly journals The effects of a novel pilates exercise prescription method on people with non-specific unilateral musculoskeletal pain: a randomised pilot trial

2016 ◽  
Vol 25 (4) ◽  
pp. 201-206
Author(s):  
Augustine Joshua Devasahayam ◽  
Doreen Ren Yan Ho ◽  
Elsa Yee Sum Leung ◽  
Ming Rong Goh ◽  
Patricia Koh
Keyword(s):  
Musculoskeletal Pain ◽  
Rating Scale ◽  
Exercise Prescription ◽  
Numerical Rating Scale ◽  
Pilot Trial ◽  
Neuromuscular Control ◽  
Secondary Outcome ◽  
Patient Specific ◽  
Control Group ◽  
Numerical Rating

Background: Pain alters the neuromuscular activation and results in altered movement adaptations. A new exercise prescription method proposes that we can restore the neuromuscular control by rehabilitating the deficient neural drive through Pilates exercises. This is done by identifying the postural control deficits using single-leg tests such as hopping, half squats and heel raises. The aim of this study was to find out if this method of prescribing exercises results in clinically relevant outcomes. Methods: Fifteen patients with chronic non-specific low back pain with unilateral musculoskeletal pain were recruited. Following consent, all patients were randomly assigned either to perform gym or Pilates-based individualised exercises once weekly for six weeks. The primary outcome was to measure the pain intensity using a 0–10 numerical rating scale. The secondary outcome measures were: the global perceived effect scale (GPE; 0–10), the patient-specific functional scale (PSFS; the patient-generated measure of disability) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; the condition-specific measure of disability). Results: There were statistically significant differences noted after intervention within the control group in the numerical rating scale ( P=0.041), GPE ( P=0.024), PSFS ( P=0.039) and within the experimental group in the WOMAC ( P=0.008), GPE ( P=0.007) and PSFS ( P=0.007). However, as there were clinically significant baseline differences, the within-group difference could be due to regression to the mean. There were no statistically significant results between the two groups after intervention. Conclusion: This new prescription method for Pilates-based exercises may improve disability and global perception of recovery. However, the outcomes are not different from a regular gym-based exercise programme.

scholarly journals Acute Pain Assessment Inadequacy in the Emergency Department: Patients’ Perspective

2022 ◽  
Vol 9 ◽  
pp. 237437352110496
Author(s):  
Jenni Hämäläinen ◽  
Tarja Kvist ◽  
Päivi Kankkunen
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Acute Pain ◽  
Pain Assessment ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Numerical Rating ◽  
Emergency Department Patients ◽  
Pain At Rest ◽  
Patients Perspective

For many patients, acute pain is a common cause to seek treatment in an Emergency Department (ED). An inadequate assessment could cause inappropriate pain management. The aim of this study was to describe and explain patients’ perceptions of acute pain assessment in the Emergency Department. The data were collected from ED patients (n = 114). Patients reported that nurses were asking about intensity of pain at rest, but only 52% during movement. According to the patients, the most common tools to assess acute pain were the verbal rating scale (VRS; 54% of patients), numerical rating scale (NRS; 28% of patients), and visual analogue scale (VAS; 9.7% of patients). Over twenty per cent of patients stated that ED nurses did not ask about the intensity of pain after analgesic administration. Twenty-four per cent of the patients were not pleased with nursing pain assessment in the ED. The assessment of acute pain is still inadequate in the ED. Therefore, ED nurses need to be more attentive to systematic acute pain management of patients in the ED.

MISMATCH IN BODY–CHAIR DIMENSIONS AND THE ASSOCIATED MUSCULOSKELETAL PAIN AMONG SELECTED UNDERGRADUATE STUDENTS IN GHANA

2013 ◽  
Vol 16 (03) ◽  
pp. 1350016
Author(s):  
Ajediran I. Bello ◽  
Abigail S. Sepenu
Keyword(s):  
Musculoskeletal Pain ◽  
Undergraduate Students ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Lecture Hall ◽  
Seat Height ◽  
Lower Back ◽  
Numerical Rating ◽  
Rating Scale Data ◽  
University Of Ghana

Purpose: To assess the misfit in body–chair dimensions with regard to the occurrence of musculoskeletal pain among undergraduates. Methods: Selected undergraduate students of School of Allied Health Sciences University of Ghana, participated in this study. The popliteal height, buttock-popliteal length and the hip breadth of the students were measured in sitting using retractable tape measure. The corresponding seat height, seat depth and seat width of three fixed-style lecture hall chairs were similarly measured and the average scores were determined. Mismatch or fit in body–chair dimension were calculated through a standard rule. The associated musculoskeletal pain as reported by the participants was assessed using numerical rating scale. Data were analyzed with percentage, mean, standard deviation and Krukas–Wallis test at p < 0.05. Results: A total of 126 students with mean age 22 ± 01 years were recruited. The mean popliteal height, buttock-popliteal length and hip breadth of the students were 40.8(4.5), 46.8(4.6) and 35.3(3.3) cm, respectively while the corresponding average chair dimensions for seat height, seat depth and seat width were 52.0, 51.0 and 53.0 cm, respectively. Appreciable number of the students mismatched the lecture hall chair at the three levels of study. About 114 (90.5%) of the students attributed their pain to the study chairs in which 40 (31.7%) and 38 (30.2%) were in their fourth and second years of study, respectively. Lower back pain was the most prevalent (38.6%) among the sampled students. Conclusion: The large proportion of the incompatibility indicated that the school chairs were not designed based on anthropometric dimensions, thus giving insight into the source of the pain.

scholarly journals Prospective analysis of post-operative pain management in elective laparotomies in a tertiary care centre

2021 ◽  
Author(s):  
Nithya T. ◽  
S. Rajagopalan
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Open Cholecystectomy ◽  
Care Center ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Tertiary Care Centre ◽  
Numerical Rating ◽  
Management Method

Background: The study was conducted to record the drug used for postoperative pain in elective laparotomies and to determine the effectiveness of multimodal analgesics used.Methods: A prospective observational study for a period of 15 months from March 2019 to May 2020 in 140 patients who underwent elective laparotomies from the department of general surgery Rajarajeswari medical college and hospital (tertiary care center).Results: A total of 140 patients were included among which 58 (41.4%) were female and 82 (58.6%) were male patients. The 20 different types of surgeries were recorded. In our study the most common surgery performed was open appendectomy followed by open cholecystectomy. Most common mode of analgesia used was combined analgesia. Opioids, NSAIDS (non-steroidal anti-inflammatory drugs), epidural and transdermal patch was used. NRS (numerical rating scale) score was recorded for all 140 patients on postoperative days 1, 2 and 3.Conclusions: Combined analgesia was better mode of pain management method than a single analgesic. Due to different multimodal analgesics used in different institutions patients experienced different degrees of pain, hence we need a standard protocol for a best pain management method.

Intravenous Butorphanol, Meperidine, and Their Combination Relieve Pain and Distress in Women in Labor

2005 ◽  
Vol 102 (5) ◽  
pp. 1008-1013 ◽  
Author(s):  
Kenneth E. Nelson ◽  
James C. Eisenach
Keyword(s):  
Pain Relief ◽  
Pain Intensity ◽  
Drug Administration ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Therapeutic Benefit ◽  
Kappa Opioid Receptor ◽  
Numerical Rating ◽  
Effective Pain Relief ◽  
Descriptive Scale

Background Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia. Methods Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration. Results All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects. Conclusions These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit.

scholarly journals A PROSPECTIVE SURVEY OF APPROPRIATENESS OF PAIN PHARMACOTHERAPY MANAGEMENT IN POST-CESAREAN SECTION PATIENTS IN CIPTO MANGUNKUSUMO HOSPITAL

2019 ◽  
pp. 280-283 ◽  
Author(s):  
JOHAN ◽  
INSTIATY ◽  
NAFRIALDI ◽  
YUDITIYA PURWOSUNU
Keyword(s):  
Pain Management ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Management Index ◽  
Post Surgery ◽  
Emergency Cesarean ◽  
Experienced Pain ◽  
Chi Squared ◽  
Numerical Rating ◽  
Numerical Rating Scale Score

Objective: In this study, we sought to assess the pattern of analgesic usage, adequacy of pain management, side effects, and analgesic drug interactionsin the post-emergency cesarean surgery setting.Methods: This was a prospective observational study of 80 patients who underwent emergency cesarean surgery at the Obstetrics and GynecologyDepartment of the Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPN-CM) between July 2015 and January 2016. Adequacy of painmanagement during the first 3 post-operative days was assessed using Pain Management Index. Relation between pain intensity during activities andrest with patient characteristic was assessed using Chi-squared test and Fischer’s exact test.Results: Nineteen patients (8.7%) were prescribed two types of nonsteroid anti-inflammatory drugs concomitantly, and 41.8% received inappropriateanalgesics at a lower frequency. Most patients experienced pain with numerical rating scale score >3 in the first 24 h post-surgery: 59 patients(73.75%) experienced pain during activities and 7 patients (8.75%) during rest.Conclusion: Post-emergency cesarean surgery pain management at RSUPN-CM was not optimal. Most patients did not receive adequate painmanagement in the first 24 h post-surgery.

scholarly journals Performance of the Surgical Pleth Index and Analgesia Nociception Index in Healthy Volunteers and Parturients

2021 ◽  
Vol 12 ◽  
Author(s):  
Byung-Moon Choi ◽  
Hangsik Shin ◽  
Joo-Hyun Lee ◽  
Ji-Yeon Bang ◽  
Eun-Kyung Lee ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Normal Saline ◽  
Bone Pain ◽  
Rating Scale ◽  
Clinical Performance ◽  
Numerical Rating Scale ◽  
The Other ◽  
Surgical Patients ◽  
Numerical Rating ◽  
Intraoperative Pain

Various commercially available nociception devices have been developed to quantify intraoperative pain. The Surgical Pleth Index (SPI) and Analgesia Nociception Index (ANI) are among the analgesic indices that have been widely used for the evaluation of surgical patients. This study aimed to evaluate the clinical performance of the SPI and ANI in conscious healthy volunteers and parturients. Ten healthy volunteers and 10 parturients participated in this study. An algometer was used to induce bone pain in the volunteers until they rated their pain as five on the numerical rating scale (NRS); this procedure was repeated during the administration of remifentanil or normal saline. The study comprised two periods, and the volunteers were infused with different solutions in each period: normal saline during one period and remifentanil during the other in a randomized order. The parturients’ SPI and ANI data were collected for 2 min when they rated their pain levels as 0, 5, and 7 on the NRS, respectively. Both the SPI and ANI values differed significantly between NRS 0 and NRS 5 (P &lt; 0.001) in the volunteers, irrespective of the solution administered (remifentanil or normal saline). At NRS 5, the SPI showed similar values, irrespective of remifentanil administration, while the ANI showed significantly lower values on remifentanil administration (P = 0.028). The SPI and ANI values at NRS 5 and NRS 7 did not differ significantly in the parturients (P = 0.101 for SPI, P = 0.687 for ANI). Thus, the SPI and ANI were effective indices for detecting pain in healthy volunteers and parturients.

scholarly journals GAMBARAN SKALA NYERI PADA PASIEN PASCABEDAH CAESAR DENGAN PENGGUNAAN OBAT KETAMIN DOSIS RENDAH

e-CliniC ◽  
2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Richi M. Posumah ◽  
Harold F. Tambajong ◽  
Lucky T. Kumaat
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Caesarean Section ◽  
Low Dose ◽  
Rating Scale ◽  
Anaesthetic Agent ◽  
Numerical Rating Scale ◽  
Emotional Experience ◽  
Pain Scale ◽  
Numerical Rating

Abstract : Pain is an uncomfortable sensorical feeling and emotional experience that relate to the destruction of tissue actually or potentially. Pain management is an important thing for the postoperative patients. Postoperative pain causing the change of body hormones that eventually lead to pain, nausea and vomitting. Postoperative pain management is an important aspect and therefore the analgetic drugs will be administered to overcome the pain. Not only function as an anaesthetic agent, low dose ketamine also has an analgetic effect. This study was aimed to determine the pain scale of the caesarean section patients using low – dose ketamine. This is an descriptive prospective study and the samples were the postoperative caesarean section patients from Prof. DR. R.D Kandou Hospital, Bhayangkara Hospital and GMIM Pancaran Kasih Hospital in Manado from December 2015 – January 2016. Patient that has been finished the operation were administered low dose ketamine as bolus 0,1 mg/kg and continuous IV 0,1 mg/kg/hour for 6 hours then the pain were assessed by using the Numerical Rating Scale (NRS) and FACES Pain Scale (FPS) starts from two hours, four hours and six hours after the ketamine was administered. Conclusion : Low dose ketamine was able to lower postoperative pain on caesarean section patients.Keywords : Postoperative Pain, Pain Scale, Caesarean Section, Low – Dose KetamineAbstrak : Nyeri merupakan perasaan sensorik dan pengalaman emosional yang tidak nyaman dan berhubungan dengan kerusakan jaringan secara actual maupun potensial. Manajemen nyeri merupakan hal yang penting dalam penganganan pasien pascabedah. Nyeri yang disebabkan oleh pembedahan terjadi karena perubahan hormon – hormon dalam tubuh dan hasilnya berupa rasa nyeri, mual dan muntah. Manajemen nyeri pascabedah merupakan aspek penting maka diberikan obat analgetik untuk mengatasinya. Selain sebagai obat anestetik, obat ketamin dengan dosis rendah memiliki fungsi analgetik. Tujuan penelitian ini adalah untuk mengetahui gambaran skala nyeri pada pasien pascabedah caesar dengan menggunakan obat ketamin dosis rendah. Penelitian ini bersifat deskriptif prospektif dan sampel merupakan pasien pascabedah caesar diambil di RSUP. Prof. DR. R. D. Kandou Manado, RS Bhayangkara Mando dan RSU GMIM Pancaran Kasih Manado yang dilaksanakan pada bulan Desember 2015 – Januari 2016. Pasien setelah selesai operasi diberikan ketamin dosis rendah dengan dosis bolus 0,1 mg/kg dan infus kontinyu IV 0,1 mg/kg/jam selama 6 jam kemudian penilaian nyeri pasien menggunakan skala nyeri Numerical Rating Scale (NRS) dan FACES Pain Scale (FPS) pada jam II, jam IV dan jam VI setelah pemberian obat ketamin. Simpulan : Ketamin dengan dosis rendah mampu menurunkan nyeri pascabedah pada pasien bedah caesar.Kata Kunci : Nyeri Pascabedah, Skala Nyeri, Bedah Caesar, Ketamin Dosis Rendah

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