scholarly journals Evaluation of Contralateral Oblique and Lateral Views for Mid-Thoracic Epidural Access: A Prospective Observational Study

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. E51-E59
Keyword(s):  
Observational Study ◽  
Epidural Space ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Lateral View ◽  
Pain Clinic ◽  
Thoracic Region ◽  
Oblique View ◽  
Thoracic Epidural ◽  
Measured Angle

BACKGROUND: The mid-thoracic region has been known to be the most difficult area when accessing epidural space despite using fluoroscopy. Contralateral oblique (CLO) view has been considered for use; however, it has not been evaluated in the mid-thoracic region. OBJECTIVE: To evaluate the CLO view for mid-thoracic epidural access (TEA). STUDY DESIGN: A prospective observational study. SETTING: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. METHODS: A total of 30 patients participated in this study. After securing the mid-thoracic (T4–8) epidural space, fluoroscopic images were obtained. The needle tip location relative to the ventral interlaminar line (VILL), and the needle tip and laminar visualization were measured and analyzed on the CLO views at 40, 50, 60 degrees, and measured angle, and the lateral view. RESULTS: The needle tip was clearly visualized in all CLO views, compared with the lateral view (100% vs. 36.7%, P < 0.001). The visualization of the laminar margin and the needle tip location on (or just anterior to) VILL using the CLO measured angle were significantly clearer compared with those in the CLO view at 40 and 50 degrees and the lateral view (laminar margin: 40˚, 56.7% vs. 3.3%, P < 0.001; 50˚, 56.7% vs. 26.7%, P = 0.012; 90˚, 56.7% vs. 26.7%, P = 0.035; needle tip location: 40˚, 96.7% vs. 26.7%, P < 0.001; 50˚, 96.7% vs. 63.3%, P = 0.002; 90˚, 96.7% vs. 66.7%, P = 0.012). There was no difference in these values between the CLO view at 60 degrees and CLO measured angle. LIMITATIONS: Subjective and ambiguous criteria of evaluation may induce bias despite final measured values based on the consensus of an independent investigator. CONCLUSION: A CLO view at 60 degrees and CLO measured angle view can provide clearer visualization and more consistent needle tip location than the lateral and other CLO angle views for mid-TEA. A CLO view at 60 degrees and CLO measured angle views could be used to identify the needle location and achieve success in mid-TEA. KEY WORD: Chronic pain, contralateral oblique view, fluoroscopy, lateral view, mid-thoracic, pain management, epidural analgesia, ventral interlaminar line

Objective postoperative pain assessment using incentive spirometry values: a prospective observational study

2021 ◽  
Vol 11 (3) ◽  
pp. 315-324
Author(s):  
Matthew J Hallman ◽  
Nancy Dorinsky ◽  
Yueting Wang ◽  
Quefeng Li ◽  
Robert Isaak ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Observational Study ◽  
Pain Control ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Surrogate Data ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Subjective Pain ◽  
Incentive Spirometry

Aim: Determine if incentive spirometry (IS) values correlate with postoperative pain control. Design: Prospective observational study. Setting & participants: A total of 100 patients undergoing major abdominal procedures at the University of North Carolina Medical Center. Interventions: Patients studied as a single cohort. All patients received thoracic epidural analgesia preoperatively. Outcome: Preoperative and daily postoperative numeric pain scores, subjective pain description and IS values were collected for all patients. Results: There was a strong correlation with IS values relative to baseline for both the numeric pain scores (p < 0.0001), postoperative day (p < 0.0001) and the subjective pain score (p < 0.0007). Conclusion: IS values are an objective surrogate data point for pain control after surgery, particularly when followed over time and compared with a preoperative baseline value.

scholarly journals Pain during Cast Wedging of Forearm Shaft and Distal Forearm Fractures in Children Aged 3 to 12 Years—A Prospective, Observational Study

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 229
Author(s):  
Florian Freislederer ◽  
Tobias Berberich ◽  
Thomas O. Erb ◽  
Johannes Mayr
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Forearm Fracture ◽  
Lateral View ◽  
Oxygen Mixture ◽  
Forearm Fractures ◽  
Vas Score ◽  
Fractures In Children ◽  
Before And After ◽  
Multicenter Prospective Observational Study

Background: Although fracture displacement in children is easily treated by cast wedging, no data on pain associated with the procedure are available. We hypothesized that there is no clinically relevant difference in pain before and after cast wedging in children between 3 and 12 years of age. Patients and Methods: This international, multicenter, prospective, observational study included 68 children (39 male, 29 female) aged 3 to 12 years (median age 8 years) with forearm fractures. Cast wedging was performed 5 to 10 days after the injury. Before starting the procedure, we administered a single oral dose of sodium metamizole (10 mg/kg body weight), and the children inhaled a nitrous oxide/oxygen mixture (50%/50%) during the wedging procedure. Pain was rated on a visual analog scale (VAS) 5 to 10 min before incision of the cast as well as 3 to 5 min and 30 min (maximum remembered pain) after inhalation stop. The degree of bending was judged either by the surgeon or was determined on the basis of first signs of pain expressed by the patient. We assessed the effectiveness of the procedure by obtaining X-ray images in two planes after 3 to 9 days. Results: Among the 68 patients, median VAS score before cast wedging was 0. This increased to a score of 1 (p = 0.015) at 3 to 5 min after the procedure. Median VAS score for the maximum remembered pain measured after 30 min was 0. Median differences in angulation between proximal and distal bone fragments before and after the intervention were 0° (p < 0.0001) in the a.p. view and 8.4° (p < 0.0001) in the lateral view. Conclusion: Cast wedging improved the position of forearm fracture fragments at the expense of minimal short-term pain.

scholarly journals Drug-related problems and its determinant among hospitalized neonates with sepsis at Jimma University Medical Center, Ethiopia: a prospective observational study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mengist Awoke ◽  
Tsegaye Melaku ◽  
Mohammed Beshir
Keyword(s):  
Drug Therapy ◽  
Observational Study ◽  
Neonatal Intensive Care ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Clinical Pharmacy Service ◽  
Drug Related Problems ◽  
Combined Use ◽  
Jimma University ◽  
Neonatal Population

Abstract Background Neonatal populations are quite susceptible to drug-related problems (DRPs) because of clinical heterogeneity and clinical practice trends. However, studies reporting DRPs in the neonatal population are quite limited. Objective This study aimed to assess the magnitude and types of DRPs and determinant factors among neonates admitted with neonatal sepsis at the Neonatal Intensive Care Unit (NICU) of the Jimma University Medical Center (JUMC), Ethiopia. Methods A hospital-based prospective observational study was conducted involving 201 neonates with sepsis admitted to the NICU from May to August 30, 2018. DRPs were classified using Cipolle’s classification method. Statistical Package for Social Science Version 22 was employed for data analysis. Logistical regression was carried out to determine the determinants of DRPs. A p-value < 0.05 was considered to be statistically significant. Results Of 201 neonates with sepsis included in this study, 125 (62.2%) were males and the median age of the neonate was 5 days. The mean (±standard deviation) number of medications taking during their hospital stay was 2.6 ± 0.7. DRPs were identified in 98 neonates, at a rate of 48.8% (95% CI, 41.7–55.9). Dose too high (42, 35.8%) and need additional drug therapy (40, 34.1%) were the commonly identified DRPs. Taking antibiotics plus other medications (Adjusted Odds Ratio (AOR) =5.2, 95%CI [1.2–22.0], p = 0.02) was a determinant factor for the occurrence of DRPs. Conclusion The burdens of DRPs occurrence were high in hospitalized neonates with sepsis. The most common DRPs identified were dose too high and need additional drug therapy. Combined use of other medicines with antibiotics was a predictor of DRP occurrence. The innovative way to tackle the occurrence of DRPs, such as the incorporation of clinical pharmacy service provider into the neonatal care team, which will prevent, detect and/or minimize the occurrence of DRPs, is highly recommended.

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