Pulse co-oximetry perfusion index as a tool for acute postoperative pain assessment and its correlation to visual analogue pain score

2015 ◽  
Vol 2 (3) ◽  
pp. 62 ◽  
Author(s):  
NashwaNabil Mohamed ◽  
SabahAbdel Raouf Mohamed ◽  
Doaa Rashwan
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Pain Assessment ◽  
Perfusion Index ◽  
Acute Postoperative Pain ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain

Intravenous Magnesium – Lidocaine - Ketorolac Cocktail for Postoperative Opioid Resistant Pain: A Case Series of Novel Rescue Therapy

2020 ◽  
Vol 15 ◽  
Author(s):  
Christian Zanza ◽  
Yaroslava Longhitano ◽  
Edwin Lin ◽  
Jerry Luo ◽  
Marco Artico ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Score ◽  
Rescue Therapy ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
Intravenous Magnesium ◽  
Severe Postoperative Pain ◽  
Opioid Induced Hyperalgesia ◽  
Antinociceptive Tolerance

Background: Severe postoperative pain is principally managed by opioids. While effective, opioids do not provide adequate relief in many patients and cause many side effects including antinociceptive tolerance and opioid-induced hyperalgesia. To evaluate if a combination of intravenous Magnesium, Lidocaine, Ketorolac (MLK cocktail) is a useful rescue therapy through synergistic pharmacological mechanisms for acute pain relief. We present the intravenous combination of magnesium, lidocaine, and ketorolac (MLK cocktail) as a possible rescue for opioid insensitive severe postoperative pain. Materials and Methods: The principal settings were the post-operative care unit (PACU) and the surgical ward. We retrospectively analyzed the electronic medical record and anesthesia documents of 14 patients experiencing severe postoperative pain, >7/10 visual-analogue pain score (VAS), despite receiving at least 8 mg of intravenous morphine milligram equivalents (MME) after arrival in the LAC+USC Medical Center PACU between September 2012 and January 2013. The data reviewed included patients’ demographics, disease etiology, surgical procedure, opioids received perioperatively, and visual-analogue pain scores before and after each analgesic received, and after the MLK cocktail. The a priori primary outcome and a posteriori secondary outcome of this study is mean visual-analogue pain score and morphine milligram equivalent dose administered per hour, respectively. The main tool evaluated has been VAS score. Results: In patients who failed to respond to opioid analgesics, administration of the MLK cocktail improved the VAS pain scores immediately from 9.4 ± 1.0 to 3.6 ± 3.5. The MLK cocktail also decreased the MME doses/hour in the immediate 12 hours postoperative period from 12.4 ± 5.6 to 1.1 ± 0.9. Conclusions: In patients experiencing opioid-resistant severe postoperative pain, the magnesium, lidocaine, and ketorolac combination may be an effective non opioid rescue therapy. Additionally, magnesium, lidocaine, and ketorolac may be utilized in cases complicated by either antinociceptive tolerance or opioid-induced hyperalgesia, and can restore opioid responsiveness.

scholarly journals Artrodese posterolateral vs artrodese circunferencial no tratamento da espondilolistese degenerativa: avaliação clínica e impacto do IMC nos resultados

2013 ◽  
Vol 12 (3) ◽  
pp. 204-208
Author(s):  
Filipe Rodrigues Duarte ◽  
António Manuel Santos Nogueira de Sousa ◽  
Frederico José Antunes Raposo ◽  
Luís Filipe Almeida Valente ◽  
António Moura Gonçalves ◽  
...  
Keyword(s):  
Pain Score ◽  
Oswestry Disability Index ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain

OBJETIVO: O tratamento cirúrgico da espondilolistese degenerativa (ED) apresenta vantagens quando comparado com o tratamento conservador. As técnicas cirúrgicas evoluíram no sentido de optimizar a fixação vertebral após descompressão, com o intuito de aumentar a taxa de artrodese. A fixação pedicular associada à fusão intersomática permite aumentar a área de contacto ósseo e assim a taxa de fusão, mas serão os resultados clínicos e funcionais superiores? MÉTODOS: Estudo retrospectivo incluindo 51 indivíduos (idade média de 61,2 anos) submetidos a artrodese posterolateral (APL) (19) e artrodese circunferencial (360º) (32) de 1996 até 2009 com acompanhamento médio de 5,8 anos (2 a 14 anos). Incluídas apenas descompressões de um nível. Avaliação clínica (VAS - Visual Analogue Pain Score), satisfação global e avaliação funcional (Oswestry disability Index modificado). Cálculo do IMC (índice de massa corporal) - avaliação clínica e funcional IMC ≥30 vs IMC <30. Estudo estatístico com SPSS®. RESULTADOS: Os resultados mostram franca melhoria clínica e funcional no tratamento cirúrgico da espondilolistese degenerativa, independentemente das técnicas estudadas. A taxa de satisfação é igualmente elevada. No confronto entre as duas técnicas de fixação não houve diferenças estatisticamente significativas. Relativamente ao IMC, os pacientes não obesos tiveram melhores resultados clínicos (p<0,05), não havendo diferenças relativas à função entre os dois grupos. CONCLUSÃO: A descompressão seguida de instrumentação vertebral é um tratamento eficaz para os pacientes com espondilolistese degenerativa. A técnica de artrodese utilizada não influencia os resultados clínicos e funcionais

The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy

2015 ◽  
Vol 9 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Line Kjeldgaard Pedersen ◽  
Ole Rahbek ◽  
Lone Nikolajsen ◽  
Bjarne Møller-Madsen
Keyword(s):  
Cerebral Palsy ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Score ◽  
Pain Assessment ◽  
Reliability And Validity ◽  
Measurement Properties ◽  
Cosmin Checklist ◽  
Children With Cerebral Palsy

AbstractBackground and aimsPain in children with cerebral palsy (CP) is difficult to assess and is therefore not sufficiently recognized and treated. Children with severe cognitive impairments have an increased risk of neglected postoperative, procedural and chronic pain resulting in decreased quality of life. The r-FLACC (revised Face, Legs, Activity, Cry and Consol ability) pain score is an internationally acclaimed tool for assessing pain in children with CP because of its ease to use and its use of core pain behaviours. In addition the r-FLACC pain score may be superior to other pain assessment tools since it includes an open- ended descriptor for incorporation of individual pain behaviours. The COSMIN group has set up three quality domains, which describe the quality of Health-Related Patient-Reported Outcomes (HR-PROs). These are reliability (internal consistency, reliability and measurement error), validity (content validity, construct validity and criterion validity) and responsiveness. The r-FLACC score has only been assessed for reliability and validity in the original English version by the developers of the score. The aim of this study is to assess reliability and validity of the r-FLACC pain score for use in Danish children with CP.MethodsTwenty-seven children aged 3–15 years old with CP were included after orthopaedic surgery. Two methods for assessment of postoperative pain were used. Pain intensity was assessed by r-FLACC, with a 2 min standardized video recording of the child, and the Observational Visual Analogue Score (VAS-OBS) assessed by the parents. The COSMIN checklist was used as a guideline in the reliability and validity testing of the r-FLACC score.ResultsReliability was supported by three measurement properties. Internal consistency was excellent with a Cronbachs alpha of 0.9023 and 0.9758 (two raters). A factor analysis of the subgroups in the r-FLACC score showed unidimensionality. A test-retest showed excellent intra-rater reliability with an intraclass correlation (ICC) of 0.97530. Inter-rater reliability was acceptable with an ICC of 0.74576. Validity was supported by three measurement properties. Content validity was tested by the originators of the r-FLACC. Construct validity was supported by a significant increase in r-FLACC scores following surgery (n = 17; difference 2.23; p = 0.0397). Criterion validity was acceptable with Pearson’s correlation coefficients of 0.76 and 0.59 when comparing r-FLACC scores and VAS-OBS scores.Conclusions and implicationsThis study benefits from a systematical approach to the validation and reliability parameters by using the COSMIN checklist as a guideline. It is evident that the r-FLACC pain score maintains its psychometric properties after translation. In conclusion, the r-FLACC pain score is valid and reliable in assessing postoperative pain in children with CP not able to self-report pain. With the r-FLACC pain score clinicians have a valid tool for assessing postoperative pain, hence increasing the quality of pain management in children with CP. In addition the validated r-FLACC score has the potential for use in interventional research regarding pain management in this vulnerable group of patients. Future perspectives include validation of the r-FLACC score for procedural and chronic everyday pain and implementation into daily practice.

One visual analogue pain score is sufficient after laparoscopic cholecystectomy

2002 ◽  
Vol 89 (1) ◽  
pp. 114-115 ◽  
Author(s):  
W. Schwenk ◽  
J. W. Mall ◽  
J. Neudecker ◽  
J. M. Müller
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Score ◽  
Visual Analogue Pain Score ◽  
Visual Analogue Pain

Prostaglandin E2 production in synovial tissue and acute postoperative pain after knee arthroscopy

2010 ◽  
Vol 1 (3) ◽  
pp. 172-172
Author(s):  
Nina Solheim ◽  
Bente Halvorsen ◽  
Leiv Arne Rosseland ◽  
Audun Stubhaug
Keyword(s):  
Postoperative Pain ◽  
Prostaglandin E2 ◽  
Pain Intensity ◽  
Pain Score ◽  
Synovial Tissue ◽  
Inflammatory Mediators ◽  
Knee Arthroscopy ◽  
Local Inflammation ◽  
Acute Postoperative Pain ◽  
Perceived Pain

Abstract Postsurgical inflammation leads to sensitisation of “sleeping” nociceptors, which enhance pain perception and induce hyperalgesia. Prostaglandin E2 plays a central role in this process. Synovial microdialysis technique allows analyses of biological markers of local inflammation simultaneous with a close follow up of the patient’s pain experience. Tissue injury (or surgery) initiates liberation of inflammatory mediators and hyperalgesic substances. This project is translational and aims at exploring the relationship between perceived acute postoperative pain and inflammation. Microdialysis of synovial tissue and pain score after arthroscopy is of special interest to study since the natural pain course and the local inflammation can be observed in patients with no analgesic therapy. Methods This is a clinical observational study of local inflammatory mediators and perceived pain in patients undergoing knee arthroscopy in general anesthesia with propofol, remifentanil and fentanyl. Microdialysis of the synovial membrane was performed in all patients every 20 min for 140 min postoperatively (seven samples). At the same intervals PGE2 was measured and correlated with patients report of pain intensity on a 0–100mm visual analogue scale (VAS). Results Five patients (1 female, 4 male) who did not receive any non-steroidal antiinflammatory drugs or paracetamol were included. The pain intensity was 1–34mmVAS and the PGE2 levels were from 293 pg/ml to 5818 pg/ml. Maximum pain score (mean 23 and SD 12mm VAS) and PGE2 levels (mean 2026 pg/ml and SD 1380 pg/ml) occurred about 40 min after surgery. Correlation analysis shows a significant correlation (R = 0.48, p = 0.004). Conclusion This pilot study indicates a positive correlation between postoperatively perceived pain and local PGE2 concentration.

scholarly journals Evaluation of the Intraoperative Perfusion Index for Correlation with Acute Postoperative Pain in Patients Undergoing Laparoscopic Colorectal Cancer Surgery

2019 ◽  
Vol 8 (9) ◽  
pp. 1299
Author(s):  
Ji Hye Kwon ◽  
Hue Jung Park ◽  
Woo Seog Sim ◽  
Joo Hyun Park ◽  
Kang Ha Jung ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Pain ◽  
Diagnostic Value ◽  
Cancer Surgery ◽  
Perfusion Index ◽  
Acute Postoperative Pain ◽  
Colorectal Cancer Surgery ◽  
Clinical Issue ◽  
Index Change ◽  
Pain Scores

Despite technical advancements in the perioperative management of cancer surgery, postoperative pain remains a significant clinical issue. We examined the diagnostic value of the intraoperative perfusion index for predicting acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed data for 105 patients who had undergone laparoscopic colorectal cancer surgery. Patients with pain scores <7 and ≥7 on a 10-point scale upon arrival in the postoperative anesthesia care unit (PACU) were categorized into the N and P groups, respectively. The perfusion index value was extracted prior to intubation, at the start and end of surgery, and after extubation. To minimize individual variance in the absolute value of the perfusion index, we calculated the perfusion index change ratio. A total of 98 patients were examined. Among them, 50 (51.0%) and 48 (49.0%) patients reported pain scores of <7 and ≥7 upon arrival at the PACU, respectively. Fentanyl consumption during the intraoperative and PACU periods was significantly higher in Group P than in Group N (p < 0.001). The perfusion index change ratios did not significantly differ between the groups. The intraoperative perfusion index change ratios do not correlate with acute postoperative pain following laparoscopic colorectal cancer surgery.

Treatment with Buttress Plate Technique for Symptomatic Ulnar Styloid Base Nonunion

2021 ◽  
Author(s):  
Ömer Faruk Kümbüloğlu ◽  
Necmi Cam ◽  
Hacı Mustafa Özdemir
Keyword(s):  
Pain Score ◽  
Mean Value ◽  
Dash Score ◽  
Visual Analogue Pain Score ◽  
Ulnar Styloid ◽  
Level Of Evidence ◽  
Visual Analogue Pain ◽  
Plate Technique ◽  
Buttress Plate

Abstract Background Surgical treatment options for symptomatic ulnar styloid base nonunion can be divided into two groups: styloid excision and styloid fixation methods. Styloid fixation is commonly performed using tension band wiring or distal ulna hook plate. However, these methods are more suitable for large styloids than small ones. For this reason, fixation of small styloids still remains a problem. Purpose To present the surgical details and results of patients operated using the buttress plate technique, due to the symptomatic ulnar styloid base nonunion. Patients and Methods In this study, 11 patients who underwent surgery for symptomatic ulnar styloid base nonunion using buttress plate technique were evaluated retrospectively. The patients were evaluated with the help of forearm and wrist range of motion, grip strength, disabilities of the arm, shoulder, and hand (DASH) score and visual analogue pain score. Results The mean follow-up period was 15 months (range: 13–21 months). Union was achieved in 10 patients. At the final follow-up, the forearm supination and pronation active range of motions were significantly higher than those in the preoperative period, the visual analogue pain score mean value was 0.7 (range: 0–5), and the DASH score mean value was 7 (range: 1–32). Conclusion We conclude that good results can be achieved with the buttress plate technique in patients with both large and small fragmented ulnar styloid base nonunions and no distal radioulnar joint instability. Level of Evidence This is a Level IV, therapeutic study.

scholarly journals Comparison of Intraoperative Nociception and Postoperative Acute Pain After Traditional or Minimally Invasive Ovariohysterectomy in Dogs

2021 ◽  
Vol 49 ◽  
Author(s):  
Bruno Watanabe Minto ◽  
Fabrícia Geovânia Fernandes Filgueira ◽  
Brenda Mendonça De Alcântara ◽  
Laís Fernanda Sargi ◽  
Tryssia Scalon Magalhães Moi ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Respiratory Rate ◽  
Acute Pain ◽  
Pain Assessment ◽  
Statistical Difference ◽  
Invasive Technique ◽  
Acute Postoperative Pain ◽  
End Tidal ◽  
Ovarian Pedicle

Background: Many variations of ovariohysterectomy techniques have been described, including the traditional one and minimally invasive procedures. Non-laparoscopic Snook hook technique is an alternative for performing minimally invasive ovariohysterectomy. Few studies have been carried out in order to assess pain in animals submitted to minimally invasive surgeries, especially involving one of the most performed surgical procedures in veterinary practice. The aim of this study was to evaluate surgical duration, intraoperative nociception and acute postoperative pain after traditional ovariohysterectomy or minimally invasive non-laparoscopic technique in dogs using Snook hook. The hypothesis is that non-laparoscopic minimally invasive ovariohysterectomy would be faster and less painful than the conventional technique.Material, Methods & Results: Thirty dogs were divided into Traditional Group (TG = 15) and Minimally Invasive Group (MIG = 15). Heart rate, respiratory rate, systolic blood pressure, body temperature, oxyhemoglobin saturation, end-tidal carbon dioxide concentration (ETCO2) and end-tidal isoflurane concentration were evaluated before the surgery to start (M0), during incision (M1), clamping of the first ovarian pedicle (M2), second ovarian pedicle (M3), uterine cervix (M4), abdominal suture (M5) and at the end of surgery (M6). The modified Glasgow Pain Scale was used for acute postoperative pain assessment and Visual Analogue Scale (VAS) was used to assess the sensitivity of surgical wound. The level of significance established for all statistical analyzes was 5%. Statistical differences were not observed between groups considering total surgical time and postoperative acute pain intensity (P > 0.05), in spite of MIG having shorter duration of surgery. There was no statistical difference between groups considering all intraoperative parameters except respiratory rate (TG < MIG; P < 0.05) and ETCO2 (MIG < TG; P < 0.05) at the moment of traction of the first ovarian pedicle (M2). Pain assessment by VAS showed statistical difference 24h after the end of surgery (TG < MIG) (P < 0.05). Discussion: Both procedures were similar regarding intraoperative nociception and acute postoperative pain. It is possible that the sensation of pain in both procedures was blocked by the effectiveness of analgesics, once they might cause an inhibition of painful behaviors limiting a possible difference in pain identification. Higher respiratory stress observed in MIG at M2 and higher pain score by VAS noted in MIG 24 h after the end of surgery can be justified by greater traction of ovarian pedicle, due to limited surgical access of minimally invasive technique. Minimally invasive ovariohysterectomy non-laparoscopic seems to be potentially faster, probably due to the smaller size of the abdominal incision, which takes less time to be closed. In the present study, both techniques were performed by an experienced surgeon, providing safe procedures, nevertheless it is important to emphasize that iatrogenic injury can be caused by surgeons not proficient in the Snook hook technique, considering the limited visualization of anatomical abdominal structures. Data obtained indicate that traditional ovariohysterectomy and non-laparoscopic Snook hook technique promote similar intraoperative nociception and acute postoperative pain, however minimally invasive procedure is potentially faster and with less surgical trauma.

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