Acute Pain最新文献

Background

The Faces Pain Scale-Revised (FPS-R) is commonly used for measuring pain intensity in paediatric and adult populations. When applied in a clinical setting, this scale may not always be used correctly as a patient self-report.

Methods

A sample of 99 nurses was selected at random from medical, surgical, critical care and aged care units over a 1-week snapshot period in 2002. This group of nurses was surveyed via open-ended questioning to assess their knowledge about applying the FPS-R, when measuring pain in adult patients who are able to communicate. Following the survey, a range of ongoing education strategies was implemented. Three years later, the survey was repeated using the same process (n = 101).

Results

In the initial survey, 52% of respondents gave a correct answer, stating that they would ask the patient to choose the face representing their level of pain. The second survey yielded a similar result with 55% of answers coded as correct by the investigators.

Conclusion

A substantial proportion of surveyed nurses were unable to describe the correct use of the FPS-R at either point of knowledge canvassing. In practice, it would appear that these nurses, if using the FPS-R, would not ask the patient about the intensity of their pain in situations when the patient is capable of a self-report. Implemented education strategies did not contribute to the correct application of FPS-R tool. Clinicians need to be aware of the possibility of misinterpreted application of self-reporting pain intensity measurement tools which employ a facial expression.

Background

Patients undergoing total knee arthroplasty usually receive a multimodal analgesic regimen including peripheral nerve blockade, but may still experience significant pain. This study examined whether preoperative gabapentin decreases acute postoperative pain and opioid consumption in this setting.

Methods

Retrospective chart review of single institution, hospital-based orthopaedic practice. Consecutive patients undergoing unilateral elective primary knee arthroplasty were evaluated for perioperative gabapentin use. Sixty-one consecutive patients received gabapentin; for each, an age- and gender-matched control was identified.

Results

Patients in both groups demonstrated similar demographics, all received lumbar plexus blockade. Catheters were removed on postoperative day 2 (95%). There were no differences in postoperative pain scores or opioid use between groups. Overall, median verbal pain scores (IQR) were 0(1), 0(3), 1(3) and 3(3) in the post-anaesthesia care unit and postoperative days 0, 1 and 2, respectively. Postoperative consumption of other analgesics was not different across groups. Patients in the gabapentin group received a single-injection sciatic nerve block less often than patients in the control group (77% vs. 94%, respectively; p < 0.05).

Conclusions

Patients undergoing unilateral total knee arthroplasty experience low pain scores utilizing a multimodal analgesic regimen including continuous lumbar plexus blockade independent of gabapentin use.

Background

Pain after uterine curettage has not been clearly evaluated. This study was designed to investigate the hypothesis that flurbiprofen axetil used prior to curettage on abortion could decrease 50% pain from uterine contraction.

Methods

Ninety seven ASA physical status I–II patients, undergoing elective uterine apoxesis, were allocated to this randomized double-blind controlled study and assigned into one of two groups (n = 45). In the flurbiprofen group, patients received an i.v. injection of flurbiprofen 50 mg in 5 ml 10 min prior to propofol anesthesia. The control group received the same volume of saline injection. Morphine 0.04 mg/kg was used as the rescue drug for uncontrolled pain. Visual analog scale for analgesia at rest, satisfaction with analgesia, morphine consumption and side effects were recorded.

Results

A total of 87 patients completed the study. The intention-to-treat number of patients was 45 in each group. Flurbiprofen group evidenced effective analgesia (vs. saline P = 0.019), with better satisfaction (P = 0.015), lower incidence of nausea, dizziness and drowsiness, pruritus, dry mouth and uterine bleeding than the saline control. The flurbiprofen group consumed less morphine in 1 h 0.6 mg (interquartile 0.1–1.2), vs. saline group 3.7 mg (interquartile 1.5–4.6) (P = 0.049). The number of patients needed to treat was 2 in the flurbiprofen group.

Conclusion

Preoperative flurbiprofen axetil 50 mg is a clinically effective analgesic means after uterine curettage on abortion.

Background

Postoperative analgesic modalities include patient-controlled techniques via various routes such as intravenous and epidural. A transdermal delivery route using iontophoretic technology appears promising. Recent randomised controlled trials have suggested that fentanyl iontophoretic transdermal system (ITS) was of equivalent efficacy to intravenous morphine patient-controlled analgesia (PCA). The objective of this meta-analysis was to assess the efficacy and safety of this system in the management of acute postoperative pain.

Methods

A meta-analysis of two placebo-controlled and four active-controlled randomised trials which satisfied the inclusion criteria was performed according to the QUOROM guidelines.

Results

Fentanyl ITS was superior to placebo for postoperative analgesia using withdrawal secondary to inadequate analgesia and pain scores as outcome measures. Fentanyl ITS was equivalent to morphine PCA when Patient Global Assessment was used as primary outcome measure. However, there were significantly more patients in the fentanyl ITS group who withdrew due to inadequate analgesia. This may be related to the pharmacokinetic profile of fentanyl ITS. Adverse effect and safety profile seemed favourable.

Conclusions

Fentanyl ITS is a promising novel modality for postoperative analgesia that is superior to placebo but may not be equivalent to morphine PCA as claimed by individual trials and recent reviews. Its use appears to be safe.

Objective

This prospective observer-blinded clinical trial is designed to evaluate the effectiveness and the safety of 0.5% ropivacaine 30 ml (150 mg) administrated via subcutaneous infiltration at incision with or without combination of intraperitoneal spray for analgesia after laparoscopically assisted gastrointestinal surgery.

Methods

Ninety ASA grade I–III patients were randomized into three groups: Group R1 (29 patients) in which patients received infiltration of 0.5% ropivacaine 30 ml at all incision sites before the suturing, Group R2 (31 patients) in which patients received 0.5% ropivacaine 20 ml at all incision sites and intraperitoneal spray of 0.5% ropivacaine 10 ml before the suturing and Group C (30 patients) in which patients received no ropivacaine as control. VAS scores at rest and during coughing were recorded immediately after emergence (H0), at 2 h (H2), 4 h (H4), 6 h (H6) and 24 h (H24) after operation. Serum cortisol concentration of cortisol was measured preoperatively (F0) and 2 h after operation (F2). Subcutaneous pethidine blouses given for additional pain treatment were counted for the first 24 h after operation and follow-up examination of incisions were performed at the 1st, 4th, 7th day after operation.

Results

Within 6 h postoperatively, the patients in Groups R1 and R2 reported significantly lower VAS scores at rest and during coughing than those in Group C (P < 0.05). Serum cortisol concentrations at 2 h (F2) after operation were significantly lower in Group R2 than in Group C. There was no difference among the three groups in administration of pethidine boluses within 6 h and 24 h after the surgery. In this trial, no neurological or cardiac complications were observed in any patient.

Conclusion

Thirty millilitres of 0.5% ropivacaine can be used effectively and safely for pain control in the early hours after laparoscopically assisted gastrointestinal surgery and subcutaneous infiltration at incision sites combined with intraperitoneal spray can provide more complete analgesia. However, analgesia provided by ropivacaine via subcutaneous infiltration at incision sites with or without intraperitoneal spray would gradually become less effective 6 h after the operation, hence requiring additional pain treatment.

Background

Neostigmine is a spinal analgesic that could be a useful adjunct. This study was conducted to evaluate the postoperative analgesic efficacy and the safety of two low doses of intrathecal (IT) neostigmine in patients undergoing knee arthroscopy under spinal bupivacaine anaesthesia.

Methods

By using a double-blinded study design, 80 patients undergoing knee arthroscopy during spinal anaesthesia were divided into four groups: bupivacaine group (Group B) received 15 mg hyperbaric bupivacaine; bupivacaine + fentanyl group (Group BF) received 15 mg hyperbaric bupivacaine mixed with 25 μg fentanyl; bupivacaine + neostigmine group 1 (Group BN1) received 15 mg hyperbaric bupivacaine mixed with 25 μg neostigmine; bupivacaine + neostigmine group 2 (Group BN2) received 15 mg hyperbaric bupivacaine mixed with 35 μg neostigmine. The postoperative visual analog scale (VAS) and the incidence of adverse effects were recorded for 24 h after administration of study drugs.

Results

VAS scores were significantly lower in group BN2 compared with group B, group BF and group BN1 at 2, 4, 6, 12, and 24 h after operation (P < 0.05). The time to the first patients’ demand for morphine administration after surgery was significantly prolonged in group BN2 compared with group B or group BN1 (P < 0.05). There was no significant difference between four groups in incidence of nausea and vomiting.

Conclusion

Our study showed that IT neostigmine (35 μg) enhanced bupivacaine spinal anaesthesia (15 mg) and produced prolonged postoperative analgesia for about 24 h without producing significant more adverse effects such as nausea and vomiting.

Renal artery embolization (angio-infarction) of a large renal cell carcinoma, prior to excision, is an acceptable surgical option. It may reduce the tumour's size and vascularity. However, postembolization syndrome, as characterized by flank pain, fever, nausea, and/or vomiting, is a potential complication of such an approach. The flank pain of this syndrome may be resistant to conventional opioid therapy. Here we report the successful use of a unilateral paravertabral block for the control of the unilateral flank pain of postembolization syndrome secondary to renal artery embolization.