Acute Pain最新文献

Background

Pain is an important symptom in emergency departments. The purpose of this study was to evaluate possible obstacles to pain management in a surgical emergency department.

Methods

All patients arriving in the ED (N = 100) during the time period were asked to participate in an interview. Information about medication, patient history, and documented pain intensity were extracted from patient records. In addition, a questionnaire with six demographic and 31 pain-related items was distributed to 50 physicians and 82 nurses.

Results

Pain was the most important symptom of 60.3% (N = 46) of the respondents. Severe pain was reported by 45.8% of the patients. Analgesics were administered to 46.6% of the respondents (N = 34). None of the patients received nonsteroidal anti-inflammatoric analgesics (NSAIDs). Male gender, lower educational level and high age correlated with reluctance to accept analgesics. Experience of pain and the healthcare system correlated with unwillingness to talk about pain. The nurses were more positive towards measurement of pain (p < 0.05) and encouragement (p < 0.001) than the physicians. The physicians were less concerned about problems with analgesics than the nurses (p < 0.01).

Conclusion

The patients should be encouraged to talk about their pain. The emergency department personnel needs education about measurement of pain and pain medication.

The aim of this study was to assess the efficacy and side-effects of mefenamic acid as compared to naproxen administered postoperatively to patients following elective tonsillectomy.

Methods

Fifty patients received either naproxen or mefenamic acid given postoperatively in a randomized fashion following elective tonsillectomy. General anaesthesia for the tonsillectomies was administered in a standardized fashion. Pain intensity was assessed postoperatively at rest and on exertion using the numeric rating scale (NRS) and analgesic consumption. The side-effects were also documented.

Results

Forty-one patients were included in the assessment. There were no significant differences with respect to the demographic data. After the 48th postoperative hour the NRS score demonstrated a significant difference in pain intensity at rest and on exertion in favour of the mefenamic acid group. There was no difference in the rate of side-effects between the two groups.

Conclusion

Mefenamic acid is a more effective analgesic than naproxen given postoperatively following elective tonsillectomies.

Introduction

This prospective randomized double-blind study compared the effectiveness and duration of analgesia of epidural morphine 4 mg and 5 mg for postoperative analgesia after Caesarean section.

Materials and methods

Sixty ASA I and II patients were randomized into 2 groups, Group A received epidural morphine 4 mg while Group B received epidural morphine 5 mg. All patients were provided with patient controlled analgesia (PCAM), for use as rescue analgesia. Pain was assessed using visual analogue score at 4, 8, 12, 16, 20 and 24 h. Time to first demand of patient controlled analgesia, cumulative morphine consumption and side effects were documented.

Results

The VAS for pain was significantly lower in Group B at 16, 20 and 24 h. The mean cumulative PCAM consumption was significantly lower in Group B. The incidence of nausea, vomiting (PONV) and pruritus was significantly higher in Group B, p < 0.05. There was no incidence of excessive sedation or respiratory depression.

Conclusion

Epidural morphine 5 mg provided adequate and longer duration of analgesia but resulted in higher frequency of pruritus and vomiting.

Purpose

To explore and describe the role of nurses working in a specialty practice of pain management in Canada.

Methods

A convenience sample of 60 nurses from across Canada with a specialty practice in pain management completed a self-administered questionnaire, which covered a broad range of topics including demographic data, sources of pain education, role responsibilities, positive outcomes and challenges of the role.

Results

Forty-six nurses responded with the majority of respondents from Ontario. Most of nurses worked at a University affiliated teaching hospital, and were baccalaureate or masters prepared, with 28% completing nurse practitioner preparation. The main clinical responsibility of the role involved daily patient visits, with 78% of nurses performing daily patient visits independently. Nurses were also engaged in pain management education for: health care professionals in the hospital setting, students in educational institutions and presentations at conferences. Other role components included administrative, research and leadership responsibilities. Identified benefits of the role include increased accessibility and continuity of care, the ability to act as a liaison between members of the health care team, and increased patient satisfaction. Identified challenges of the role fell into four broad categories including role implementation, clinical tools and support, health care provider education, and administrative support.

Conclusion

This study builds on previous work examining the role of nurses in pain management. Respondents to the survey reported several benefits and challenges to the role of nurses with a specialty practice in pain management.