Journal of Perianesthesia Nursing最新文献

Purpose: The aim of this study was to determine the effect of foot reflexology on postoperative pain control and physical parameters in children.

Design: This study is a randomized controlled experimental study.

Methods: The sample included 84 children who received postoperative care in a pediatric surgery clinic. The children in the experimental group underwent foot reflexology for 15 minutes (7.5 minutes on each foot) 1 hour after surgery. Data were collected using a Descriptive Information Form, Physical Parameter Evaluation Form, and Wong-Baker Faces Pain Scale. Statistical analyses included number, percentage, independent-samples t test, and paired t test.

Findings: The mean age of both groups was equal due to randomization. In the experimental group, 71.4% were male, while in the control group, 78.6% were male, with no significant gender distribution difference between the groups. Postoperative pain in immediately after surgery period (pre test) scores was similar when groups compared. After reflexology, the experimental group had significantly lower pain scores compared with the control group. Reflexology also significantly affected blood pressure, pulse rate, and respiratory rate, but had no significant effect on saturation and body temperature.

Conclusions: Foot reflexology applied after surgery alleviated pain and influenced blood pressure, pulse rate, and respiratory rate in children.

Purpose: To investigate the impact of EMLA cream, cold spray, and Buzzy applied during venipuncture on the pain and fear levels of children 7 to 12 years of age.

Design: Randomized controlled trial.

Methods: This study with four parallel groups was conducted in a pediatric blood collection unit in eastern Türkiye. A total of 187 children were randomized into four groups: control (n = 48), EMLA (n = 46), cold spray (n = 47), and Buzzy (n = 46). The control group underwent a routine venipuncture. The specified method was used before venipuncture in the EMLA (60 minutes before the procedure), cold spray (for 5 seconds immediately before the procedure), and Buzzy (1 minute before the procedure) groups. A descriptive characteristics form, the Wong-Baker FACES Scale, the visual analog scale, and the Children's Fear Scale were used to collect the data.

Findings: The venipuncture pain levels of children in the EMLA, cold spray, and Buzzy groups were lower than those in the control group (P < .05). The children in the EMLA group had less venipuncture pain than those in the cold spray and Buzzy groups (P < .05). Based on the children's self-assessment, the children in the cold spray group experienced less pain than those in the Buzzy group (P < .05). The children in the EMLA and cold spray groups had lower fear levels during venipuncture than those in the control and Buzzy groups (P < .05).

Conclusions: EMLA, cold spray, and Buzzy were effective in reducing venipuncture pain, while EMLA and cold spray were effective in reducing venipuncture fear in 7- to 12-year-old children.

At a clinical research hospital, the Department of Perioperative Services has recently implemented an opioid-free anesthesia protocol for selected patients undergoing robotic-assisted prostatectomy. This protocol incorporates intraoperative infusions of ketamine, lidocaine, and magnesium as part of a multimodal analgesic strategy. The present case report describes an unusual occurrence of postoperative delirium in this context and aims to provide educational insights into its clinical presentation, contributing factors, and management.

Purpose: This study examines how pain catastrophizing and pain intensity influence postoperative mobility in patients undergoing laparoscopic abdominal surgery.

Design: The study has a prospective cross-sectional correlational design.

Methods: The study included 92 patients who underwent laparoscopic abdominal surgery. Data were collected using the Patient Information Form, Pain Catastrophizing Scale (PCS), Numeric Rating Scale, Patient Mobility Scale (PMS), and Observer Mobility Scale (OMS). Preoperative pain catastrophizing was assessed. Patients whose vital signs and pain intensity were evaluated during any mobilization after the first mobilization within 48 hours postoperatively were mobilized. The level of pain, difficulty, and dependence experienced during physical movement was assessed.

Findings: The mean age of the patients was 56.12 ± 13.26 years, 54.3% were female, 66.3% underwent laparoscopic cholecystectomy, 19.6% underwent laparoscopic hernia repair, and 14.1% underwent laparoscopic appendectomy. Pain intensity, PCS score, PMS score, OMS score, and body mass index (BMI) were found to be positively correlated (P < .05). After mobilization, there was a significant increase in pulse rate, respiratory rate, mean blood pressure, and pain intensity within the range of clinically normal parameters (P < .01). Medical devices (urinary catheter, drain) were found to cause an increase in PCS, PMS, OMS, and pain severity. In the multivariate regression model, pain intensity, pain catastrophizing, and BMI were found to explain 56% of patient mobility (F_{(4, 87)} = 29.896, P < .01).

Conclusions: The study results showed that pain, pain catastrophizing, and BMI negatively affected postoperative patient mobility. These barriers need to be taken into consideration when making interventions to improve patient mobility.

Purpose: This study aimed to examine the relationship between surgical fear and health literacy in patients undergoing elective open-heart surgery. The primary goal was to determine whether surgical fear and other demographic factors could predict patients' health literacy levels and evaluate how these variables interact in a preoperative cardiac surgical context.

Design: A multicenter, cross-sectional, and correlational study design was employed to investigate the relationship between surgical fear and health literacy among preoperative cardiac surgery patients.

Methods: The study was conducted in the cardiovascular surgery departments of three hospitals in the Aegean region of Turkey. A purposive sampling method was used, and data were collected from 430 patients who were scheduled to undergo open-heart surgery for the first time. Data were gathered through face-to-face interviews using three instruments: a patient information form, the Surgical Fear Questionnaire, and the Turkish Health Literacy Scale. Descriptive statistics, t tests, one-way analysis of variance, Pearson's correlation, and multiple regression analyses were used to analyze the data.

Findings: Among the participants, 86.3% had inadequate health literacy levels, and the average surgical fear score was found to be high (60.91 ± 12.07). A statistically significant negative correlation was found between surgical fear and health literacy (r = -0.492, P < .001). Multiple regression analysis revealed that surgical fear and age were significant predictors of health literacy, collectively accounting for 32% of the total variance. Patients with higher surgical fear and those of older age demonstrated significantly lower health literacy levels. Notably, lower educational attainment and prior surgical experience were also associated with lower health literacy scores.

Conclusions: The findings suggest that surgical fear and health literacy are closely linked in patients awaiting open-heart surgery. As health literacy increases, surgical fear levels decrease. Health literacy is influenced by psychological and demographic factors, particularly surgical fear and age. These results underscore the importance of implementing tailored preoperative educational interventions to enhance health literacy and reduce fear, thereby supporting better surgical outcomes and emotional well-being.

Purpose: About 6.3% to 14% of children undergoing surgery develop postanesthetic shivering (PAS). Many drugs were used to relieve PAS in adults. However, no relevant meta-analyses have been conducted in children. The network meta-analysis (NMA) was performed to evaluate different medical interventions in children.

Design: Systematic review and NMA.

Methods: Randomized controlled trials were retrieved through PubMed, CINAHL, Web of Science, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The outcome was the incidence of PAS. For the NMA, a frequentist Mantel-Haenszel approach was adopted. The common effect model was employed. Results were synthesized into pooled odds ratios (ORs). P scores were generated to rank the treatments.

Findings: Overall, 13 trials were included in the study. In NMA, ketamine was superior to magnesium sulfate, midazolam, and placebo: OR 0.01 (95% confidence interval [CI] 0.00 to 0.09), OR 0.06 (95% CI 0.01 to 0.46), and OR 0.04 (95% CI 0.01 to 0.16). α₂-Adrenoceptor agonists were superior to magnesium sulfate, midazolam, and placebo: OR 0.02 (95% CI 0.00 to 0.21), OR 0.16 (95% CI 0.07 to 0.35), and OR 0.10 (95% CI 0.03 to 0.30). 5-Hydroxytryptamine type 3 receptor antagonists were superior to magnesium sulfate and placebo: OR 0.03 (95% CI 0.00 to 0.38) and OR 0.18 (95% CI 0.06 to 0.51). Ketamine was ranked higher than other interventions.

Conclusions: While ketamine, α₂ adrenoceptor agonists, and 5-hydroxytryptamine type 3 receptor antagonists all demonstrate significant efficacy in preventing PAS, the extreme effect size observed for ketamine is particularly vulnerable to small-study effects.

Purpose: To evaluate the effects of personalized music therapy on perioperative anxiety, physiological stress responses, postoperative pain, sedation, and recovery quality in patients undergoing knee arthroscopy.

Design: A prospective, randomized, double-blind, controlled trial.

Methods: Sixty-four American Society of Anesthesiologists I to III patients (aged 18 to 75 years) scheduled for elective knee arthroscopy were randomized to either a music therapy group (MTG, n = 32) or a control group (CG, n = 32). The MTG received personalized receptive music therapy during the preoperative holding phase and postanesthesia care unit (PACU) stay, while the CG wore identical headphones delivering silence. Outcomes included the State-Trait Anxiety Inventory-6, Numeric Rating Scale for pain, Observer's Assessment of Alertness/Sedation, Quality of Recovery-15, and continuous physiological monitoring (blood pressure, heart rate, respiratory rate, and oxygen saturation).

Findings: Compared with the CG, the MTG demonstrated significantly lower postoperative state anxiety scores (P < .001), reduced pain intensity across all postoperative timepoints (all P < .001), and shorter PACU stay (33.44 ± 4.30 vs 41.56 ± 7.77 minutes, P < .001). A greater proportion of MTG patients achieved full alertness in the PACU (96.9% vs 59.4%, P < .001). Quality of Recovery-15 scores at 24 hours were also higher in the MTG (86.19 ± 3.05 vs 73.94 ± 6.49, P < .001). Additionally, the MTG exhibited more stable hemodynamic parameters throughout the perioperative period.

Conclusions: Personalized music therapy is a safe and effective nonpharmacological intervention that reduces perioperative anxiety and pain, enhances physiological stability, accelerates postoperative emergence, and improves recovery quality in patients undergoing knee arthroscopy. Its integration into Enhanced Recovery After Surgery pathways may provide substantial benefits for perioperative care.

Purpose: Effective postoperative pain management is a cornerstone for optimizing patient outcomes and enhancing overall patient satisfaction. The purpose of this quality improvement (QI) project was to decrease postoperative pain in the postanesthesia care unit (PACU) for patients undergoing exploratory laparotomy, noncervical spine, gynecologic, and prostatectomy surgeries by implementing a PAIN management checklist into clinical practice. This QI project aimed to implement a PAIN management checklist to reduce postoperative pain scores among four surgical populations at a large level two hospital.

Design: The Plan-Do-Study-Act QI model was used to guide the project.

Methods: The target population was adult patients aged 18 and older, undergoing noncervical spine, gynecologic, prostatectomy, and exploratory laparotomy procedures at level two trauma center. The participants were physician anesthesiologists, Certified Registered Nurse Anesthetists, and PACU registered nurses. After orienting the participants to the project, the PAIN checklist was implemented, and retrospective chart reviews were conducted to gather 3 months of pre- and postimplementation data. The primary outcome measure for this project was pain scores in the immediate postoperative period, as measured by the Numeric Rating Scale.

Findings: A total of 1,584 cases were reviewed, 813 preimplementation and 771 postimplementation. The mean pain score upon arrival to the PACU decreased from 1.66 preimplementation to 1.29 postimplementation (P = .03). The mean pain score upon discharge from the PACU increased from 1.94 preimplementation to 2.21 postimplementation (P = .008).

Conclusions: Implementation of the PAIN management checklist resulted in improved pain scores upon arrival to the PACU but did not result in improved pain scores upon discharge from PACU. Future Plan-Do-Study-Act cycles will focus on improving the use of preemptive analgesia by anesthesia staff and the assessment and treatment of pain by PACU staff.

Spinal anesthesia (SA) is a commonly used technique in urological surgery and is generally regarded as a reliable, safe, and effective method of anesthesia. However, non-traumatic spinal subdural hematomas (NTSSH) that develop following SA are extremely rare and potentially life-threatening complications if not diagnosed and treated promptly. This case report describes a 66-year-old male scheduled for holmium laser enucleation of the prostate. His medical history included mitral valve replacement, for which he was receiving oral warfarin 10 mg once daily. Fifty-two hours after receiving nontraumatic SA, the patient developed progressive motor weakness, urinary retention, and fecal incontinence. Clinical examination revealed complete motor paralysis below the T₁₀ level (0/0) and total sensory loss, including vibration, proprioception, pain, temperature, and touch. At the 72nd postoperative hour, magnetic resonance imaging revealed an NTSSH extending from the T₁₂ vertebral level to the filum terminale, compressing the spinal cord and cauda equina. Despite urgent surgical decompression, evacuation of the hematoma, and intensive medical management, no neurological recovery was observed. This case highlights the critical importance of thorough preoperative evaluation, a multidisciplinary approach, individualized patient management, vigilant postoperative monitoring, and the prompt diagnosis and treatment of rare but severe complications. Perioperative nurses play a vital role in caring for patients with NTSSH, contributing significantly to recovery, ensuring patient safety, and optimizing clinical outcomes.

Purpose: To formulate and implement a sustainable, structured educational approach for preanesthesia testing (PAT) nurses focused on best practices in conducting preanesthesia interviews and capturing associated charges.

Design: This quality improvement project utilized a pre- and post-implmentation design as well as a retrospective chart review.

Methods: All nine PAT nurses assigned to the PAT clinic at a community hospital in the Southeastern United States were asked to complete online educational modules on preoperative anesthesia interview (PAI) concepts and on proper PAI documentation, charge capture, and the use of a documentation checklist. Pre-/postimplementation data were collected on registered nurse (RN) knowledge and confidence, PAI documentation and subsequent charge capture accuracy, and the financial impact of improper charge capture.

Findings: RN knowledge increased significantly postimplementation from 82.6% to 97.2%, yet RN confidence did not show statistically significant improvement. Four months postimplementation, nursing documentation showed a 3.8% improvement in accuracy from 92.76% preimplementation to 96.25% postimplementation. This change in documentation accuracy led to improved charge capture, which yielded a significant decline (63.6%) in mean monthly monetary discrepancies from $2,962.50 preimplementation to $1,078.13 postimplementation.

Conclusions: This quality improvement project demonstrates a significant impact of structured education and a standardized checklist on PAT nursing practices. These interventions increased RN knowledge of preoperative interview components, improved documentation practices, and increased charge capture accuracy, which was associated with a marked reduction in charge discrepancies. This underscores the importance of thorough documentation practices, the correlation between documentation and institutional revenue, and the fiduciary responsibility of PAT nurses.