This review evaluates nonpharmacological interventions for postoperative ileus (POI) prevention and treatment.
Design
We systematically reviewed articles from various databases between January 2012 and February 2023 on POI prevention in colorectal surgery patients, emphasizing nursing interventions.
Methods
Inclusion was based on criteria such as language (English or Turkish), date range, and study type. The risk of bias was evaluated using Cochrane's RoB2 tool.
Findings
Of the 3,497 articles found, 987 unique articles were considered. After title and abstract reviews, 977 articles were excluded, leaving 52 randomized controlled trials for examination. Common interventions included chewing gum, early hydration, acupuncture, and coffee consumption. Compared to control groups, intervention groups had quicker bowel function return, shorter hospital stays, fewer complications, and enhanced quality of life.
Conclusion
Nondrug nursing interventions post colorectal surgery can effectively mitigate POI, optimize bowel function, and boost patient satisfaction, warranting their incorporation into post-surgery care protocols.
{"title":"Postoperative Ileus and Nonpharmacological Nursing Interventions for Colorectal Surgery: A Systematic Review","authors":"Hande Nur Arslan RN , Sevilay Şenol Çelik PhD, RN , Gamze Bozkul RN","doi":"10.1016/j.jopan.2024.03.012","DOIUrl":"10.1016/j.jopan.2024.03.012","url":null,"abstract":"<div><h3>Purpose</h3><div>This review evaluates nonpharmacological interventions for postoperative ileus (POI) prevention and treatment.</div></div><div><h3>Design</h3><div>We systematically reviewed articles from various databases between January 2012 and February 2023 on POI prevention in colorectal surgery patients, emphasizing nursing interventions.</div></div><div><h3>Methods</h3><div>Inclusion was based on criteria such as language (English or Turkish), date range, and study type. The risk of bias was evaluated using Cochrane's RoB2 tool.</div></div><div><h3>Findings</h3><div>Of the 3,497 articles found, 987 unique articles were considered. After title and abstract reviews, 977 articles were excluded, leaving 52 randomized controlled trials for examination. Common interventions included chewing gum, early hydration, acupuncture, and coffee consumption. Compared to control groups, intervention groups had quicker bowel function return, shorter hospital stays, fewer complications, and enhanced quality of life.</div></div><div><h3>Conclusion</h3><div>Nondrug nursing interventions post colorectal surgery can effectively mitigate POI, optimize bowel function, and boost patient satisfaction, warranting their incorporation into post-surgery care protocols.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 181-194"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jopan.2024.03.010
Ebru Çalışkan MSc, RN , Nilgün Aksoy PhD, RN
Purpose
Preoperative anxiety is considered a common part of the surgerical experience and can be associated with serious postoperative side effects. This study aims to determine the relationship between preoperative anxiety level and postoperative pain outcomes in patients undergoing total hip replacement (THR) and total knee replacement (TKR).
Design
The study used a cross-sectional and correlational research method.
Methods
The study was conducted with a total of 104 participants, who underwent 17 THR and 87 TKR, at the Orthopedic Clinic of a state hospital in southern Turkey between June 2021 and June 2022. The State-Trait Anxiety Inventory (STAI) was used to determine preoperative anxiety level, and the Visual Analog Scale (VAS) and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) were used to assess postoperative pain level.
Findings
The mean preoperative STAI-I and STAI-II scores of the participants who underwent THR and TKR were 53.95 ± 10.51 and 44.20 ± 10.55, respectively. There was a moderate positive correlation between STAI-I scores and VAS pain scores at preoperative and postoperative 6th, 12th, 24th, and 36th hours. There was a moderate positive correlation between STAI-I scores and affective subdimension scores, a moderate positive correlation with pain severity and sleep interference and activity interference, and a weak positive correlation between STAI-II scores and pain severity and sleep interference, activity interference and affective. The factors independently affecting the 6th-hour VAS pain score were determined as male gender, THR procedure, and increasing STAI score.
Conclusions
We found that high preoperative state anxiety was associated with early postoperative pain outcomes. State anxiety was associated with pain in the 6th postoperative hour. Considering the multidimensional nature of anxiety, further research is recommended to understand the anxiety domain in surgical patients.
{"title":"The Relationship Between Preoperative Anxiety Level and Postoperative Pain Outcomes in Total Hip and Knee Replacement Surgery: A Cross-sectional Study","authors":"Ebru Çalışkan MSc, RN , Nilgün Aksoy PhD, RN","doi":"10.1016/j.jopan.2024.03.010","DOIUrl":"10.1016/j.jopan.2024.03.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Preoperative anxiety is considered a common part of the surgerical experience and can be associated with serious postoperative side effects. This study aims to determine the relationship between preoperative anxiety level and postoperative pain outcomes in patients undergoing total hip replacement (THR) and total knee replacement (TKR).</div></div><div><h3>Design</h3><div>The study used a cross-sectional and correlational research method.</div></div><div><h3>Methods</h3><div>The study was conducted with a total of 104 participants, who underwent 17 THR and 87 TKR, at the Orthopedic Clinic of a state hospital in southern Turkey between June 2021 and June 2022. The State-Trait Anxiety Inventory (STAI) was used to determine preoperative anxiety level, and the Visual Analog Scale (VAS) and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) were used to assess postoperative pain level.</div></div><div><h3>Findings</h3><div>The mean preoperative STAI-I and STAI-II scores of the participants who underwent THR and TKR were 53.95 ± 10.51 and 44.20 ± 10.55, respectively. There was a moderate positive correlation between STAI-I scores and VAS pain scores at preoperative and postoperative 6th, 12th, 24th, and 36th hours. There was a moderate positive correlation between STAI-I scores and affective subdimension scores, a moderate positive correlation with pain severity and sleep interference and activity interference, and a weak positive correlation between STAI-II scores and pain severity and sleep interference, activity interference and affective. The factors independently affecting the 6th-hour VAS pain score were determined as male gender, THR procedure, and increasing STAI score.</div></div><div><h3>Conclusions</h3><div>We found that high preoperative state anxiety was associated with early postoperative pain outcomes. State anxiety was associated with pain in the 6th postoperative hour. Considering the multidimensional nature of anxiety, further research is recommended to understand the anxiety domain in surgical patients.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 76-82"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jopan.2024.10.012
Oliver C. Radke MD, PhD, DEAA, MHBA
{"title":"Dumbing Down Our Residents or Going With the Times?","authors":"Oliver C. Radke MD, PhD, DEAA, MHBA","doi":"10.1016/j.jopan.2024.10.012","DOIUrl":"10.1016/j.jopan.2024.10.012","url":null,"abstract":"","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 241-242"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jopan.2024.11.007
Sandra Galura PhD, RN, NE-BC
{"title":"Navigating Nursing Leadership: Nursing Leadership in the Aftermath of the COVID-19 Pandemic","authors":"Sandra Galura PhD, RN, NE-BC","doi":"10.1016/j.jopan.2024.11.007","DOIUrl":"10.1016/j.jopan.2024.11.007","url":null,"abstract":"","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 232-233"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jopan.2024.03.001
Ting Li BS,RN, Lihong Chen BS,RN, Yanting Shi BS,RN, Li Mao BS,RN, Qingyan Liu MS,RN
Purpose
To investigate the influencing factors of intraoperative hypothermia (IOH) in patients undergoing total joint arthroplasty (TJA) of the lower extremities, establish a risk prediction model, and test the effect of application.
Design
A prospective, observational study was conducted.
Methods
Patients who underwent total knee arthroplasty and total hip arthroplasty from June 2020 to December 2021 were prospectively analyzed. According to the occurrence of IOH, patients were divided into the IOH group (temperature less than 36 °C) and non-IOH group (temperature ≥36 °C). We collected demographic, anesthesia, and surgical data for both groups to identify risk factors for IOH and develop a predictive model. The model's goodness of fit was assessed using the Hosmer-Lemeshow test, and its predictive efficacy was evaluated using the receiver operating characteristic curve.
Findings
A total of 258 patients were included in this study, with 79 patients in the IOH group and 179 patients in the non-IOH group. Logistic regression analysis showed that American Society of Anesthesiologists' grade, blood loss, and duration of surgery were independent risk factors for IOH in lower extremity TJA patients. Hosmer-Lemeshow test P = .803, area under receiver operating characteristic curve was 0.846, Youden index was 0.490, sensitivity was 65.4%, specificity was 83.6%. In the external validation cohort, the application accuracy of the model was 83.3%.
Conclusions
The prediction model established in this study is suitable for the risk assessment of IOH in TJA patients with good prediction effect, which can provide a tool for clinical medical staff to identify high-risk populations preoperatively.
{"title":"Construction of a Risk Prediction Model for Intraoperative Hypothermia in Patients Undergoing Lower Extremity Joint Replacement","authors":"Ting Li BS,RN, Lihong Chen BS,RN, Yanting Shi BS,RN, Li Mao BS,RN, Qingyan Liu MS,RN","doi":"10.1016/j.jopan.2024.03.001","DOIUrl":"10.1016/j.jopan.2024.03.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the influencing factors of intraoperative hypothermia (IOH) in patients undergoing total joint arthroplasty (TJA) of the lower extremities, establish a risk prediction model, and test the effect of application.</div></div><div><h3>Design</h3><div>A prospective, observational study was conducted.</div></div><div><h3>Methods</h3><div>Patients who underwent total knee arthroplasty and total hip arthroplasty from June 2020 to December 2021 were prospectively analyzed. According to the occurrence of IOH, patients were divided into the IOH group (temperature less than 36 °C) and non-IOH group (temperature ≥36 °C). We collected demographic, anesthesia, and surgical data for both groups to identify risk factors for IOH and develop a predictive model. The model's goodness of fit was assessed using the Hosmer-Lemeshow test, and its predictive efficacy was evaluated using the receiver operating characteristic curve.</div></div><div><h3>Findings</h3><div>A total of 258 patients were included in this study, with 79 patients in the IOH group and 179 patients in the non-IOH group. Logistic regression analysis showed that American Society of Anesthesiologists' grade, blood loss, and duration of surgery were independent risk factors for IOH in lower extremity TJA patients. Hosmer-Lemeshow test <em>P</em> = .803, area under receiver operating characteristic curve was 0.846, Youden index was 0.490, sensitivity was 65.4%, specificity was 83.6%. In the external validation cohort, the application accuracy of the model was 83.3%.</div></div><div><h3>Conclusions</h3><div>The prediction model established in this study is suitable for the risk assessment of IOH in TJA patients with good prediction effect, which can provide a tool for clinical medical staff to identify high-risk populations preoperatively.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 45-49"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jopan.2024.03.005
Shelby L. Wallen BS, BSN, RN, Tony V. Paul MS, BSN, RN, Tito D. Tubog PhD, DNAP, CRNA
Purpose
Examine the effectiveness of using intracuff lidocaine to minimize postoperative complications.
Design
Systematic review.
Methods
This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. PubMed, CINAHL, Cochrane, Google Scholar, and gray literature databases were searched to obtain eligible studies and minimize selection bias. The Johns Hopkins Nursing Evidence-Based Practice Model was used to appraise the level of evidence for the varying studies. Only randomized controlled trials (RCT) and systematic reviews with meta-analyses of RCTs were included in the review.
Findings
Three RCTs and three systematic reviews with meta-analyses incorporating a total of 2,337 patients were included in this review. Intracuff lidocaine (alkalinized and nonalkalinized) had the lowest incidence of postoperative sore throat in the early and late postoperative periods compared to intracuff air or intracuff saline. Furthermore, the evidence suggested that the use of intracuff lidocaine reduced postextubation cough and the incidence of hoarseness but had little or no effect on dysphagia. All studies were Level 1 and Grade A, indicating clinically solid evidence in analyzing intracuff lidocaine’s effect on all outcomes measured.
Conclusions
The current literature suggests the feasibility of using intracuff lidocaine as an effective method to reduce the incidence of postoperative sore throat, postextubation cough, and hoarseness. The implications to practice include improving the norm of postoperative throat mucosal injuries by implementing an evidence-based practice intervention of intracuff lidocaine.
{"title":"Intracuff Lidocaine and Postoperative Throat Mucosal Injuries: An Evidence-based Review","authors":"Shelby L. Wallen BS, BSN, RN, Tony V. Paul MS, BSN, RN, Tito D. Tubog PhD, DNAP, CRNA","doi":"10.1016/j.jopan.2024.03.005","DOIUrl":"10.1016/j.jopan.2024.03.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Examine the effectiveness of using intracuff lidocaine to minimize postoperative complications.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. PubMed, CINAHL, Cochrane, Google Scholar, and gray literature databases were searched to obtain eligible studies and minimize selection bias. The Johns Hopkins Nursing Evidence-Based Practice Model was used to appraise the level of evidence for the varying studies. Only randomized controlled trials (RCT) and systematic reviews with meta-analyses of RCTs were included in the review.</div></div><div><h3>Findings</h3><div>Three RCTs and three systematic reviews with meta-analyses incorporating a total of 2,337 patients were included in this review. Intracuff lidocaine (alkalinized and nonalkalinized) had the lowest incidence of postoperative sore throat in the early and late postoperative periods compared to intracuff air or intracuff saline. Furthermore, the evidence suggested that the use of intracuff lidocaine reduced postextubation cough and the incidence of hoarseness but had little or no effect on dysphagia. All studies were Level 1 and Grade A, indicating clinically solid evidence in analyzing intracuff lidocaine’s effect on all outcomes measured.</div></div><div><h3>Conclusions</h3><div>The current literature suggests the feasibility of using intracuff lidocaine as an effective method to reduce the incidence of postoperative sore throat, postextubation cough, and hoarseness. The implications to practice include improving the norm of postoperative throat mucosal injuries by implementing an evidence-based practice intervention of intracuff lidocaine.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 150-157"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia.
Design
A qualitative design with a critical incident approach.
Methods
Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals. The critical incident technique approach was used to guide the interviews, and data were analyzed inductively using thematic analysis.
Findings
The main finding was the CCNs’ and RNAs’ description of how they “watch over the children and stay close” to provide emotional and physical safety. CCNs’ and RNAs’ experiences of observing and managing the children’s small, immature airways were reflected in the theme “using situation awareness of the small, immature airways.” The theme “understanding emergence agitation” describes the challenge that arises when children are anxious, feel insecure, and have pain, and the theme “having parents nearby” shows the necessity and value of involving parents in their children’s care.
Conclusions
Findings from this study suggest that caring for infants and toddlers recovering from anesthesia requires experience and both technical and nontechnical skills. These are prerequisites for achieving readiness for planning, setting priorities, and adapting one’s behavior if an adverse event occurs. Alertness and the ability to solve acute problems and make quick decisions are essential because of the risks associated with children’s small, immature airways, as is the ability to understand and respond to emergence agitation. Having parents nearby is equally important for creating the conditions for compassionate child- and family-centered care.
{"title":"How to Achieve Highly Professional Care in the Postoperative Ward: The Care of Infants and Toddlers","authors":"Carina Sjöberg PhD, RNA , Mona Ringdal PhD, CCN , Pia Lundqvist PhD, RN , Pether Jildenstål PhD, CRNA, SC","doi":"10.1016/j.jopan.2024.03.019","DOIUrl":"10.1016/j.jopan.2024.03.019","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to describe the experiences of critical care nurses (CCNs) and registered nurse anesthetists (RNAs) when monitoring and observing infants and toddlers recovering from anesthesia.</div></div><div><h3>Design</h3><div>A qualitative design with a critical incident approach.</div></div><div><h3>Methods</h3><div>Semistructured individual interviews were conducted with a purposeful sample of CCNs and RNAs (n = 17) from postanesthesia care units at two hospitals. The critical incident technique approach was used to guide the interviews, and data were analyzed inductively using thematic analysis.</div></div><div><h3>Findings</h3><div>The main finding was the CCNs’ and RNAs’ description of how they “<em>watch over the children and stay close</em>” to provide emotional and physical safety. CCNs’ and RNAs’ experiences of observing and managing the children’s small, immature airways were reflected in the theme “<em>using situation awareness of the small, immature airways</em>.” The theme “<em>understanding emergence agitation</em>” describes the challenge that arises when children are anxious, feel insecure, and have pain, and the theme “<em>having parents nearby</em>” shows the necessity and value of involving parents in their children’s care.</div></div><div><h3>Conclusions</h3><div>Findings from this study suggest that caring for infants and toddlers recovering from anesthesia requires experience and both technical and nontechnical skills. These are prerequisites for achieving readiness for planning, setting priorities, and adapting one’s behavior if an adverse event occurs. Alertness and the ability to solve acute problems and make quick decisions are essential because of the risks associated with children’s small, immature airways, as is the ability to understand and respond to emergence agitation. Having parents nearby is equally important for creating the conditions for compassionate child- and family-centered care.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 95-99"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of perineural dexamethasone as an adjuvant drug to peripheral nerve block for postoperative pain is controversial. This systematic review aimed to determine the effectiveness of adding dexamethasone to lidocaine in upper limb nerve blocks.
Design
Systematic review.
Methods
This review used a comprehensive search strategy to retrieve relevant published randomized trial articles that fulfilled the inclusion and exclusion criteria, without time limits, (until December 2023) that assessed the effects of a combination of dexamethasone to lidocaine in upper limb nerve blocks. The databases used for the electronic literature search included PubMed, Embase, and Clinical Trials.gov, dbGaP, Cochrane library, and Google Scholar. There was no language, gender, or age limitation. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
Findings
Of 3,926 articles identified by the initial search, 8 studies that met our inclusion criteria. All articles were original research studies. All eight articles were clinical trials. The sample size in the selected studies ranged from 30 to 90 people. Studies demonstrated that combining dexamethasone with lidocaine significantly improved the quality of peripheral nerve blocks, increased the analgesia period, and decreased analgesic consumption.
Conclusions
This review supported that the combination of dexamethasone (dose of 4 to 10 mg) and lidocaine (concentration of 1.5% to 2%) for upper limb block was more effective and beneficial without any side effects. However, further clinical trials in this regard with more data, various regions, and larger sample sizes to support our hypothesis are recommended.
{"title":"Effectiveness of Adding Dexamethasone to Lidocaine in Upper Limbs Nerve Blocks: A Systematic Review","authors":"Mohammad-Reza Rafiei MD, PhD , Ali Karbalai Khani MD, PhD , Behroz Kheradmand MD, PhD , Munther Kadhim Abosaoda PharmD , Irodakhon Rasulova MD, PhD , Oranous Khordad MD, PhD , Arian Moayer BSc , Behzad Kazemi Haki BSc , Mehrshad Namazi","doi":"10.1016/j.jopan.2024.02.014","DOIUrl":"10.1016/j.jopan.2024.02.014","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of perineural dexamethasone as an adjuvant drug to peripheral nerve block for postoperative pain is controversial. This systematic review aimed to determine the effectiveness of adding dexamethasone to lidocaine in upper limb nerve blocks.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>This review used a comprehensive search strategy to retrieve relevant published randomized trial articles that fulfilled the inclusion and exclusion criteria, without time limits, (until December 2023) that assessed the effects of a combination of dexamethasone to lidocaine in upper limb nerve blocks. The databases used for the electronic literature search included PubMed, Embase, and Clinical Trials.gov, dbGaP, Cochrane library, and Google Scholar. There was no language, gender, or age limitation. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.</div></div><div><h3>Findings</h3><div>Of 3,926 articles identified by the initial search, 8 studies that met our inclusion criteria. All articles were original research studies. All eight articles were clinical trials. The sample size in the selected studies ranged from 30 to 90 people. Studies demonstrated that combining dexamethasone with lidocaine significantly improved the quality of peripheral nerve blocks, increased the analgesia period, and decreased analgesic consumption.</div></div><div><h3>Conclusions</h3><div>This review supported that the combination of dexamethasone (dose of 4 to 10 mg) and lidocaine (concentration of 1.5% to 2%) for upper limb block was more effective and beneficial without any side effects. However, further clinical trials in this regard with more data, various regions, and larger sample sizes to support our hypothesis are recommended.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 140-149"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to evaluate the effect of carbohydrate loading prior to the cesarean surgery under spinal anesthesia on thiols and ischemia-modified albumin (IMA) levels.
Design
Prospective, randomized placebo-controlled study.
Methods
Seventy-nine pregnant women planned for cesarean sections under spinal anesthesia at Karaman Training and Research Hospital were randomized into a control group (group C) (n = 42), and an oral carbohydrate preloading group (group OCH) (n = 37). OCH loading requires consuming 400 mL the night before surgery and 200 mL up to 2 hours before anesthesia. Group OCH consumed an oral carbohydrate-rich beverage (Nutricia-Fantomalt), and group C consumed an equal volume of water. This study investigated thiol-disulfide homeostasis after preoperative carbohydrate consumption. Preoperative gastric fluid, volume, antral cross-sectional area, hypotension following the birth, and fetal blood gas parameters were compared across groups.
Findings
Thiols and IMA levels did not differ across groups before and after surgery (P > .05). Gastric ultrasonography showed similar antral cross-sectional area and stomach volume between groups (P = .172, P = .128, respectively). When surgery caused hypotension, group OCH received more ephedrine for surgery-induced hypotension, although this difference is not statistically significant (P = .704). A clustered error bar (95% confidence interval) plot with an interpolation line was used for a time-based comparison of mean differences in heart rate and mean arterial pressure between the groups.
Conclusions
This study supports that mothers' thiols and IMA levels were unaffected by preoperative OCH loading before cesarean surgery. We did not examine thiol and its derivatives in umbilical cord blood; hence, we can not comment on thiol/disulfide homeostasis levels in neonates.
目的：本研究旨在评估脊髓麻醉下剖腹产手术前碳水化合物负荷对硫醇和缺血修饰白蛋白（IMA）水平的影响：前瞻性、随机安慰剂对照研究：将计划在卡拉曼培训与研究医院进行脊髓麻醉下剖腹产的 79 名孕妇随机分为对照组（C 组）（n = 42）和口服碳水化合物预负荷组（OCH 组）（n = 37）。OCH 组需要在手术前一晚摄入 400 毫升，并在麻醉前 2 小时内摄入 200 毫升。OCH 组口服富含碳水化合物的饮料（Nutricia-Fantomalt），C 组口服等量的水。本研究调查了术前摄入碳水化合物后的硫醇-二硫化物稳态。对各组的术前胃液、容量、前胃横截面积、产后低血压和胎儿血气参数进行了比较：研究结果：各组硫醇和 IMA 水平在手术前后无差异（P > .05）。胃超声波检查显示，各组的前胃横截面积和胃容量相似（分别为 P = .172 和 P = .128）。当手术导致低血压时，OCH 组因手术引起的低血压接受了更多的麻黄碱治疗，但这一差异无统计学意义（P = .704）。使用带内插线的聚类误差条（95% 置信区间）图对各组间心率和平均动脉压的平均差异进行了基于时间的比较：本研究证实，剖腹产手术前母亲体内的硫醇和 IMA 水平不会受到术前 OCH 负荷的影响。我们没有检查脐带血中的硫醇及其衍生物，因此无法对新生儿体内的硫醇/二硫平衡水平做出评论。
{"title":"The Effect of Preoperative Carbohydrate-containing Fluid Consumption on Maternal Oxidative Stress Markers During Elective Cesarean Delivery","authors":"Ozlem Dulger MD , Betul Basaran MD , Muhammet Korkusuz MD , Ozcan Erel MD , Salim Neselioglu MD , Usame Omer Osmanoglu PhD , Aliye Nigar Serin MD , Rahim Kocabas PhD , Volkan Ecesoy MD , Mehmet Ali Goren RD","doi":"10.1016/j.jopan.2024.02.007","DOIUrl":"10.1016/j.jopan.2024.02.007","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study was to evaluate the effect of carbohydrate loading prior to the cesarean surgery under spinal anesthesia on thiols and ischemia-modified albumin (IMA) levels.</div></div><div><h3>Design</h3><div>Prospective, randomized placebo-controlled study.</div></div><div><h3>Methods</h3><div>Seventy-nine pregnant women planned for cesarean sections under spinal anesthesia at Karaman Training and Research Hospital were randomized into a control group (group C) (n = 42), and an oral carbohydrate preloading group (group OCH) (n = 37). OCH loading requires consuming 400 mL the night before surgery and 200 mL up to 2 hours before anesthesia. Group OCH consumed an oral carbohydrate-rich beverage (Nutricia-Fantomalt), and group C consumed an equal volume of water. This study investigated thiol-disulfide homeostasis after preoperative carbohydrate consumption. Preoperative gastric fluid, volume, antral cross-sectional area, hypotension following the birth, and fetal blood gas parameters were compared across groups.</div></div><div><h3>Findings</h3><div>Thiols and IMA levels did not differ across groups before and after surgery (<em>P</em> > .05). Gastric ultrasonography showed similar antral cross-sectional area and stomach volume between groups (<em>P</em> = .172, <em>P</em> = .128, respectively). When surgery caused hypotension, group OCH received more ephedrine for surgery-induced hypotension, although this difference is not statistically significant (<em>P</em> = .704). A clustered error bar (95% confidence interval) plot with an interpolation line was used for a time-based comparison of mean differences in heart rate and mean arterial pressure between the groups.</div></div><div><h3>Conclusions</h3><div>This study supports that mothers' thiols and IMA levels were unaffected by preoperative OCH loading before cesarean surgery. We did not examine thiol and its derivatives in umbilical cord blood; hence, we can not comment on thiol/disulfide homeostasis levels in neonates.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 22-29"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jopan.2024.02.013
Pervin Kurtoglu RN, PhD , Emine Iyigun RN, PhD , Alper Sonmez MD , Mehmet Fatih Can MD
Purpose
This study aimed to reveal the effects of a glycemic control protocol directed by nurses during the perioperative period on glycemic outcomes in diabetic patients undergoing major abdominal surgery.
Design
This was a prospective cohort study
Methods
The study was conducted at the Department of General Surgery of a research and training hospital in Turkey. The study included 47 patients with type 2 diabetes mellitus who underwent elective major abdominal surgery between September 2017 and December 2018. The number of patients in the intervention and the control groups was 22 and 25, respectively. Routine clinical glycemic control was implemented in the control group, whereas a glycemic management protocol developed by a multidisciplinary team was implemented in the intervention group. We collected data on the control group first, followed by the introduction of the glycemic management protocol to clinical staff and glycemia data collection using the new protocol. Blood glucose (BG) levels in patients and the factors that may affect BG were measured in the preoperative, intraoperative, and postoperative periods. Data on glycemic control was also collected. Furthermore, we measured the satisfaction of the nurses implementing the glycemic management protocol.
Findings
The rate of hyperglycemia in intensive care unit was 21% in the intervention group and 59% in the control group (P < .05). Time spent in the target BG range during insulin infusion was 76% in the intervention group and 35% in the control group (P < .05). The time required to achieve target BG range during insulin infusion was 6 hours for the intervention group and 15 hours for the control group, indicating that less time was required to achieve the target BG range in the intervention group (P < .05). Moreover, the insulin consumption rate in the intensive care unit was lower in the intervention group (P < .05). The satisfaction levels of the nurses that used the glycemic management protocol was 92.61 ± 7.93%.
Conclusions
Results of this study showed that the implementation of a glycemic management protocol by nurses for patients undergoing major abdominal surgery decreases the rate of hyperglycemia, insulin consumption rate, and the time required to achieve the targeted BG range during the perioperative period. Therefore, it is recommended to use a glycemia management protocol to control glycemia in patients during the surgical process.
{"title":"Effects of Perioperative Glycemic Management Protocol on Glycemic Outcomes of Type 2 Diabetic Patients Undergoing Major Abdominal Surgery: A Prospective Cohort Study","authors":"Pervin Kurtoglu RN, PhD , Emine Iyigun RN, PhD , Alper Sonmez MD , Mehmet Fatih Can MD","doi":"10.1016/j.jopan.2024.02.013","DOIUrl":"10.1016/j.jopan.2024.02.013","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to reveal the effects of a glycemic control protocol directed by nurses during the perioperative period on glycemic outcomes in diabetic patients undergoing major abdominal surgery.</div></div><div><h3>Design</h3><div>This was a prospective cohort study</div></div><div><h3>Methods</h3><div>The study was conducted at the Department of General Surgery of a research and training hospital in Turkey. The study included 47 patients with type 2 diabetes mellitus who underwent elective major abdominal surgery between September 2017 and December 2018. The number of patients in the intervention and the control groups was 22 and 25, respectively. Routine clinical glycemic control was implemented in the control group, whereas a glycemic management protocol developed by a multidisciplinary team was implemented in the intervention group. We collected data on the control group first, followed by the introduction of the glycemic management protocol to clinical staff and glycemia data collection using the new protocol. Blood glucose (BG) levels in patients and the factors that may affect BG were measured in the preoperative, intraoperative, and postoperative periods. Data on glycemic control was also collected. Furthermore, we measured the satisfaction of the nurses implementing the glycemic management protocol.</div></div><div><h3>Findings</h3><div>The rate of hyperglycemia in intensive care unit was 21% in the intervention group and 59% in the control group (<em>P</em> < .05). Time spent in the target BG range during insulin infusion was 76% in the intervention group and 35% in the control group (<em>P</em> < .05). The time required to achieve target BG range during insulin infusion was 6 hours for the intervention group and 15 hours for the control group, indicating that less time was required to achieve the target BG range in the intervention group (<em>P</em> < .05). Moreover, the insulin consumption rate in the intensive care unit was lower in the intervention group (<em>P</em> < .05). The satisfaction levels of the nurses that used the glycemic management protocol was 92.61 ± 7.93%.</div></div><div><h3>Conclusions</h3><div>Results of this study showed that the implementation of a glycemic management protocol by nurses for patients undergoing major abdominal surgery decreases the rate of hyperglycemia, insulin consumption rate, and the time required to achieve the targeted BG range during the perioperative period. Therefore, it is recommended to use a glycemia management protocol to control glycemia in patients during the surgical process.</div></div>","PeriodicalId":49028,"journal":{"name":"Journal of Perianesthesia Nursing","volume":"40 1","pages":"Pages 35-44"},"PeriodicalIF":1.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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