A comparative study of intravenous lignocaine, dexamethasone and combination of lignocaine-dexamethasone in attenuating propofol induced pain

Background: General anesthesia is preferred during surgeries to reduce the pain stimuli in patients and to increase the precision of surgical procedure. Propofol is amongst the most widely used general anesthetic agent with limitation of induced pain during administration. Current study was conducted to compare the effect of intravenous pre-administration of various drugs in attenuating propofol induced pain. Methods: A comparative observational study was conducted on patients of either sex and aged between 18-60 years. Patients were divided in three groups, who received intravenous lignocaine, dexamethasone and combination of lignocaine-dexamethasone respectively to attenuate propofol induced pain. Different variables like HR, SBP, DBP, MAP, RR SpO2 and any adverse events were monitored in all the patients. Results: The 46.66% and 53.33% patients who received lignocaine and dexamethasone alone perceived propofol induced mild to moderate pain; while only 23.33% patients who received lignocaine and dexamethasone in combination perceived mild propofol induced pain. The propofol induced pain event was persistent in only 2 out of 30 patients after a time lapse of 30 seconds for the group receiving lignocaine and dexamethasone in combination. Whereas, the pain event was present even after time lapse of 30 seconds in 08 and 07 out of 30 patients of groups receiving lignocaine and dexamethasone alone.Conclusions: Pre-administration of lignocaine and dexamethasone in combination attenuated the propofol induced pain more significantly in comparison to single administration of mentioned drugs. No significant adverse events except perianal irritation were observed in some patients who received combination of lignocaine and dexamethasone intravenously.

The Effect of Relaxation Techniques and Distraction Techniques on Reducing Pain Scale in Postoperative Patients at UKI Hospital East Jakarta in 2020

The purpose of this study was to determine the effect of relaxation techniques and distraction techniques on reducing pain scale in postoperative patients at UKI Hospital in 2020. This study used a cross sectional study approach which aims to determine the effect of relaxation and distraction techniques on postoperative patients at UKI Hospital. Cross sectional is a method for approaching respondents (point time approach) which is carried out at one time. the independent variable is relaxation technique and the dependent variable distraction is the decrease in pain scale in postoperative patients. The results of the study concluded that there were differences in the results of the pain scale between the pre-test and post-test with the Relaxation technique in postoperative patients. Most of the respondents had moderate pain scale results as many as 77% of postoperative patients, the group after intervention with Relaxation showed that most respondents had mild pain scale results as many as 86% of postoperative patients. There is a difference in the results of the pain scale between the pre-test and post-test with the Distraction technique in postoperative patients. Most of the respondents had controlled severe pain scale results as many as 88% of patients, the group after the distraction intervention showed that most of the respondents had moderate pain scale results as many as 79% of patients.

A STUDY TO ASSESS THE EFFECTIVENESS OF HELFER SKIN TAP TECHNIQUE ON THE LEVEL OF PAIN REDUCTION DURING INTRA MUSCULAR INJECTION AMONG ORTHOPAEDIC PATIENT OF PANDIT DEEN DAYAL UPADHYAYA (CORONATION) GOVERNMENT HOSPITAL DEHRADUN UTTARAKHAND

Pain is an unpleasant sensory and emotional feeling accompanying existing or impending tissue damages or reference to such damage.According to WHO annual report more than 16 billion IM injections are administered throughout the word. Aim: This study is intended to determine the effectiveness of Helfer skin tap technique on the level of pain reduction during IM injection among orthopedic patient of PanditDeenDayalUpadhaya (Coronation)Government Hospital, Dehradun Uttarakhand. Methodology: An experimental approach with cross-over design was adopted for the study. The study samples were orthopedic patients who receiving IM diclofenac injection. There were 50 subjects that fulfill the inclusion and exclusion criteria are divided into two experimental groups (25 samples in each groups) by simple random sampling technique. The pain level was assessed by universal numerical pain rating scale .The pain level with the administration of intramuscular injection by Helfer skin tap technique was compared with a pain level with conventional Technique. Result:The result shows that in experimental group I majority of sample 52%perceived mild pain with Helfer skin tap technique whereas with majority of samples 64% perceived moderate pain with conventional technique. The mean pain score with Helfer skin tap technique was 3.88 was less than conventional technique 5.32.The obtained t value was 3.80 was significant at p<0.05 level of significance.Inexperimental group II majority of sample 64% perceived mild pain with Helfer skin tap technique whereas with majority of samples 68% perceived moderate pain with conventional technique. The mean pain score with Helfer skin tap technique was 3.52 was less than conventional technique 5.16.The obtained t value was 5.479 was significant at p<0.05 level of significance In period I the mean pain score using Helfer skin tap technique in experimental group I 3.88 was less than mean pain score of conventional technique in experimental group II 5.15.the obtained t value was found statistically significant at p<0.05 level. In period II the mean pain score using Helfer skin tap technique 3.52 was less than the mean pain scores of conventional technique 5.32.the obtained t value 4.5 was statistically significant at p<0.05 level of significance. There was no significant association found between level of pain during intramuscular injection with selected demographic variables. The overall result shows that Helfer skin tap technique was helpful in reducing the level of pain during intramuscular injection among orthopedic patients.

Changes in Plasma Beta-Endorphin Levels in Stage III–IV Nasopharyngeal Carcinoma Patients Post World Health Organization 3-Step Analgesic Ladder Therapy

Introduction Nasopharyngeal carcinoma (NPC) is the most common malignancy in the field of otorhinolaryngology, and chronic pain is identical with this malignancy. Pain therapy according to World Health Organization (WHO) recommendations is WHO 3-step analgesic ladder. Pain is subjective and related to the function of beta-endorphin hormone. Objective Analyzing the relationship between the degree of pain and plasma endorphin levels in stage III–IV NPC patients before and after the administration of WHO 3-step analgesic ladder. Materials and Methods The study design used pretest and posttest without control design. Participants were given WHO 3-step analgesic ladder therapy for 3 days. The participants then rated the pain scale using the visual analog scale (VAS) and plasma beta-endorphin levels in venous blood. The statistical test used the dependent t-test, Wilcoxon test, and Spearman test with p < 0.05, confidence interval: 95%. Results There were 14 stage-III NPC patients with moderate pain (78.57%) and 31 stage-IV NPC participants had moderate pain (83.87%; p = 0.071). The VAS value in the moderate pain group before and after therapy was 82.22 and 66.67%, respectively (p < 0.001). The values of plasma beta-endorphin levels before and after therapy were 74.89 ± 69.12 and 72.49 ± 75.53 pg/mL, respectively (p = 0.647). Plasma beta-endorphin levels were −19.20 ± 37.72 pg/mL (mild pain), −4.76 ± 35.30 pg/mL (moderate pain), and −21.67 ± 6.27 pg/mL (severe pain; p = 0.717). Conclusion Pain levels in advanced NPC patients have decreased after the therapy, but plasma beta-endorphin levels have no significant difference.

A Study to Evaluate the Effectiveness of Aloe Vera Gel on Pain Perception among Patients with Osteoarthritis at Selected Communities in Kanyakumari District

Aim: to evaluate the effectiveness of Aloe Vera gel on pain perception among patients with osteoarthritis in selected communities at Kanyakumari district. Objectives: (i) To assess and compare the pre-test and post-test level of pain perception among patients with osteoarthritis in experimental and control group. (ii) To evaluate the effectiveness of Aloe Vera gel on level of pain perception among patients with osteoarthritis in experimental group. (iii) To find out the association between the post-test level of pain perception among patients with osteoarthritis in experimental group and control group with the selected demographic variables. A Quasi experimental, non-equivalent, pre test and post test control group design was adopted. The convenience sampling technique was used to select 30 samples for experimental group and 30 samples for control group. OARSI (osteoarthritis research society international) questionnaire was used to assess the osteoarthritic pain. Aloe Vera gel was applied locally on painful areas for 28 consequent days and post test was conducted on 28th day by using OARSI questionnaire. The data were gathered and analyzed by descriptive and inferential statistical method. The findings revealed that during pre test 20(67%) of them had moderate pain, 10(33%) of them had mild pain. During post test 19(63%) of them were in mild pain, 11(37%) of them were in moderate pain. The mean score on level of pain perception among patients with osteoarthritis was 33.3 in pre test and 22 in post test. The estimated t’ value was 8.99* which is significant at p < 0.05. It shows that local application of Aloe Vera gel was effective in reducing the level of pain perception among osteoarthritis pain. Hence the research hypothesis H1 is retained. This study statistically proved the pain reducing effect of Aloe Vera gel on Osteoarthritic patients at 5% significant level. The researcher concluded that Aloe Vera gel application is a non pharmacological, cost effective and very practicable measure to reduce the level of pain perception among patients with osteoarthritis. Keywords: Aloe Vera gel, Pain perception, Osteoarthritis.

Hubungan Rasionalitas Penggunaan Obat Nyeri Terhadap Tingkat Nyeri Pada Lansia Dengan Osteoarthritis Di Panti Pelayanan Sosial Lanjut Usia Bisma Upakara Pemalang Tahun 2021

Osteoarthritis is a degenerative joint disease characterized by cartilage damage and often occurs in the elderly. Diseases that are often found in the community. Management of osteoarthritis is aimed at controlling or relieving pain. Inappropriate drug selection can cause the drug to be ineffective, exacerbate a disease, and cause unwanted effects. This study aims to determine the relationship between the rationality of the use of pain medication on the level of pain in the elderly with osteoarthritis. The research design is a descriptive correlative study with a cross sectional approach. The sampling technique used was total sampling with a total of 43 respondents. Data collection tools using a questionnaire and statistical tests using the Kolmogorov Smirnov test. The results of the study found that the percentage related to rationality of rational pain medication (69.8%) was irrational (30.2%) and at the level of pain experienced mild pain (18.6%), moderate pain (67.4%), and moderate pain. weight (14.0%). Statistical test results obtained p value of 0.042 (<0.05) Ho is rejected, which means that there is a significant relationship between the rationality of pain medication use and pain levels in the elderly with osteoarthritis at the Bisma Upakara Elderly Social Service Institution, Pemalang. . The results of this study recommend for health workers to provide or improve health education related to the rationality of using pain medication.Keywords: Pain, Osteoarthritis, Rationality AbstrakOsteoarthritis adalah penyakit radang sendi degeneratif dengan di tandai dengan adanya kerusakan kartilago dan sering terjadi pada lansia .Penyakit yang sering dijumpai pada masyarakat. Penatalaksanaan osteoarthritis ditujukan pada pengendalian atau menghilangkan nyeri. Pemilihan obat yang tidak tepat dapat menyebabkan obat menjadi tidak berkhasiat, memperparah suatu penyakit, dan menimbulkan efek yang tidak diinginkan.Penelitian ini bertujuan untuk mengetahui hubungan rasionalitas penggunaan obat nyeri terhadap tingkat nyeri pada lansia dengan osteoarthritis. Desain penelitian studi deskriptif korelatif dengan pendekatancross sectional. Teknik pengambilan sampel menggunakan total samplingdengan jumlah 43 responden. Alat pengumpulan data menggunakan kuesioner dan uji statistik menggunakan uji Kolmogorov Smirnov. Hasil dari penelitiandidapatkan persentase terkait rasionalitas obat nyeri yang rasional (69,8%) tidak rasional (30,2%) dan pada tingkat nyeri yang mengalami nyeri ringan (18,6%), nyeri sedang (67,4%), dan nyeri berat (14,0%).hasil uji statistik didapatkan p value sebesar 0,042 (< 0,05) yang berarti ada hubungan yang signifikan rasionalitas penggunaan obat nyeri terhadap tingkat nyeri pada lansia dengan osteoarthritis di Panti Pelayanan Sosial Lanjut Usia Bisma Upakara Pemalang. Hasil peneltian ini merekomendasikan bagi tenaga kesehatan untuk memberikan atau meningkatkan pendidikan kesehatan terkait dengan rasionalitas penggunaan obat nyeri. Kata kunci : Nyeri; Osteoarthritis; Rasionalitas

Literature Review : Gambaran Tingkat Nyeri Pada Remaja yang Menstruasi

The period of growth in adolescents is characterized by physical and psychological changes. Girls will experience menstruation and the impact that often occurs is dysmenorrhea (menstrual pain). Dysmenorrhea causes mood disorders in adolescents which will reduce learning motivation. In early adolescents who need adaption, their mental is needed to be ready for the changes which physically and psychologically related to dysmenorrhea. His study aimed to determine the level of pain in adolescents who menstruate. He method used in this research was descriptive with a litetarute review approach. The articles were published in 2011-2021 on Garba Garuda or PubMed. The result obtained according to the inclusion and exclusion criteria were then analyzed using the JBI (Joanna Briggs Institute) instrument. The result of study of the 5 articles with a total of 1,807 respondents showed that the level of menstrual pain was 27,6% mild pain, 37,2% moderate pain, and 35,2% severe pain. The number of adolescents who have moderate pain levels is more that those with mild and severe pain levelsKeywords: adolescents, dysmenorrhea, menstrual pain AbstrakMasa pertumbuhan pada anak remaja ditandai dengan perubahan fisik dan psikologis. Pada anak perempuan akan mengalami menstruasi dan dampak yang sering terjadi yaitu dismenorea (nyeri haid). Dismenorea menyebabkan gangguan mood pada remaja yang akan menurunkan motivasi belajar. Pada remaja awal yang membutuhkan adaptasi sehingga perlu kesiapan mental mengenai perubahan yang dialami secara fisik dan psikologis terkait dismenorea. Penelitian bertujuan untuk mengetahui gambaran tingkat nyeri pada remaja yang menstruasi. Metode yang digunakan pada penelitian ini adalah deskriptif dengan pendekatan literature review, pencarian artikel pada rentang waktu 10 tahun yaitu dari 2011-2021 melalui penelusuran didapatkan 4 artikel melalui Garba Garuda dan 1 artikel melalui PubMed. Hasil pencarian sesuai dengan kriteria inklusi dan eksklusi kemudian dianalisa menggunakan instrument JBI (Joanna Briggs Institute), kemudian diolah menggunakan uji Chi-Square dan tidak memenuhi syarat sehingga dilanjutkan menggunakan uji Mann-Whitney. Hasil penelitian dari ke-5 artikel dengan total responden 1.807 menunjukkan bahwa tingkat nyeri haid yaitu 27,6% nyeri ringan, 37,2% nyeri sedang, dan 35,2% nyeri berat. Dari ke-5 artikel yang telah dianalisa menunjukkan bahwa remaja putri yang berada pada tingkat nyeri sedang lebih banyak dibanding dengan tingkat nyeri ringan dan beratKata kunci: dismenore, nyeri menstruasi, remaja

Which NSAID to choose for treatment of pain syndrome in polymorbid patients?

A polymorbid patient is a patient with several diseases occurring simultaneously at different stages and phases of their development. Patients with polymorbid pathology have a statistically significant almost 2.5 times higher risk (odds ratio [OR] = 2.41; p = 0.01) of pain syndrome and other diseases (for example, depression, arterial hypertension, etc.), which will contribute to the progression of polymorbidity. Individuals with chronic pain have a significantly increased risk of all causes’ death (hazard ratio [HR] = 1.95; 95 % confidence interval [CI]: 1.26–3.03) and cardiovascular causes (RR = 2.72; 95 % CI: 1.41–5.26) compared to patients without chronic pain. Therefore, in order to improve the prognosis and quality of life of the patient, both acute and chronic pain must be treated with non-pharmacological (exercise therapy, taping, virtual reality, etc.) and pharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for mild to moderate pain. The rational choice of NSAIDs in polymorbid patients can be difficult due to the presence of pathologies that limit their use or conditions that are risk factors of complications of drug therapy. In this article, the author present approaches to choosing the optimal NSAID in polymorbid patients, and justify efficacy and safety of administration of original meloxicam in these individuals (Movalis®, Boehringer Ingelheim International).

Pre-experimental Study to Assess the Effectiveness of Warm Compress on Lumbar Region during First Stage of Labour among Primi Parturient Mothers in Labour Room of Selected Hospitals at Amravati

The goal of this study was to determine the intensity of pain experienced by primiparturient women during the first stage of labour. To see how beneficial a warm compress is on the lumbar area. To see if there's a link between labour discomfort and certain demographic factors. At the 0.05 level of significance, the post-test pain score will be lower than the pre-test pain score. The research method chosen was quantitative, and the study design was pre-experimental, pre-test, and post-test. Purposive sampling was used to collect data from 60 primiparturient moms in the early stages of labour. The research was carried out at Amravati's Dayasagar Hospital. A pre-test was done using a numerical pain scale to determine pain levels among primiparturient moms who met the inclusion criteria. In the initial stage of labour, a warm compress on the lumbar area is applied for 15 minutes every half hour for four hours. The numerical pain scale is used to measure post-test pain levels. In the current study, 53.3 percent of primigravida moms in the control group reported moderate pain (scoring 4-6) and 46.6 percent had severe pain in post-test 1. (score 7-10). 36.6 percent had moderate pain (scoring 4-6) and 63.3 percent had severe pain (7-10) in post-test 2, while 13.3 percent had moderate pain (4-6) and 86.6 percent had severe pain in post-test 3. (score 7-10). In post-test 1, 70% of the experimental group experienced moderate pain (scoring 4-6) and 30% had severe pain (score 7-10). In post-test 2, 66.6 percent of participants reported moderate pain, while 33.3 percent reported severe pain. In post-test 3, 56.6 percent of participants reported moderate pain, while 43.3 percent reported severe pain. As a result, it may be stated that using a warm compress to relieve pain was successful.

A Functional and Radiological Outcome Analysis of Hip Forage Procedure, done for Early Stages(Ficat and Arlet Grade 1 and 2A) of Avascular Necrosis of Head of Femur

Background: Avascular necrosis of the femoral head is a severe disease and causes osteoarthritis of the hip joint in young adults. Early diagnosis leads to better prognosis and therapeutic success. Aim: To study pain, radiological outcome & functional outcome post hip forage procedure in patients of avascular necrosis of head of femur (Ficat and Arlet grade 1 and grade 2A). Study Design: This was a prospective observational study. Place and Duration of Study: Conducted in the Department of Orthopaedics, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai over a period of 2 years from 2015 to 2017 Methodology: We included 50 patients (39 males, 11 females) with Avascular necrosis of unilateral or bilateral head of femur (Grade 1 and Grade 2A), clinical, radiological and functional(with the help of Harris hip score) examination was done at 6 months and 12 months follow up post operatively. Results: Out of the 50 patients, pre-peratively, 60% reported moderate pain, 20% mild pain and 20% severe pain. At follow-up, 36% patients reported slight pain, 26% mild pain, 26% moderate pain, 8% marked pain, and no pain was reported by 4% patients. Pre-operatively, no limp was seen in 34% patients, while 66% patient had a limp. At follow-up, 70% patient had a limp and no limp in 30% patients. Before surgery, support (cane use) was required by 6% patients, while at follow-up, support was noted by 12% patients. Preoperative mean Harris Hip Score was 63.6, while that at follow-up it was 74.74. Radiological worsening of the disease occurred only in 38% of the patients which suggests that disease progression was delayed in most patients(62%). 2% patients had a complication of foot drop. Conclusion: Avascular necrosis of femoral head is more common in young males. Core decompression by multiple drilling and/or core decompression with fibular strut grafting are equally effective in pre collapse stages (stage 1 and stage 2A) with better functional and radiological outcomes and hence these procedures can play a vital role in delaying the disease progression.