Acute Pain In Patients Research Articles

Management of acute pain in adults with sickle cell disease: the experience of the Clinical Hematology Department of the University of Dakar.

The evolution of sickle cell disease (SCD) is marked by the occurrence of painful episodes linked to the obstruction of microvessels by sickle cells, known as vaso-occlusive crisis (VOC). The aim of this work was to report the practical aspects of the management of acute pain in adults with SCD. Recommendations based on these practices are also provided. This prospective, cross-sectional, descriptive, and analytical study was conducted over a four-month period of all sickle cell patients admitted to emergency departments for VOC. The parameters studied were sociodemographic, clinicobiological, therapeutic, and evolutionary. There were 118 cases of VOC identified, representing a prevalence of 78.14% of sickle cell emergencies. The mean age of the patients was 28.41 years. The SS sickle cell phenotype accounted for 86.61% of the cases. Osteoarticular pain was the reason for admission for 88.39% of the patients; it was located in the lower limbs in 39.08% and in the spine in 27.1%. Pain intensity was moderate in 6.25% of the patients, intense in 31.25%, and unbearable in 55.55%. Multimodal analgesia was the most commonly used treatment method, combining those of levels one and two (74.31%) and levels one and three (8.25%). The mean dose of morphine administered was 17.14 mg when morphine alone was prescribed for titration, 13.57 mg when paracetamol and morphine were combined, and 15.83 mg when nefopam and morphine were combined. Clinical outcome was favorable in 68.87% of the cases. Wide variability was observed in the modalities of analgesic treatment of sickle cell VOC. These variations reflect different views on the appropriateness of opioids. This study highlights the efficacy of multimodal analgesia in the management of acute pain in patients with SCD, particularly in regard to morphine sparing. Context-specific recommendations will be needed to harmonize practices.

Multifunctional injectable microspheres for osteoarthritis therapy via spatiotemporally modulating macrophage polarization and inflammation

Local injection of anti-inflammatory drugs for osteoarthritis emerged as a promising administration in the clinic, and sustained-release dosage forms have great potential for future therapeutic applications. Controlling the response of patients only in the acute inflammatory phase is currently the focus of therapeutic interventions. To relieve acute pain in patients and to improve the long-term prognosis effect of osteoarthritis treatment, we designed a two-pronged approach in this research: an injectable double-layer microsphere containing a “nonsteroidal anti-inflammatory drug - macrophage polarizing factor” was constructed. The results indicated that microspheres could regulate the intra-articular environment by inhibiting local inflammatory cytokine production, promoting macrophage polarization to the M2-phenotype, and increasing the expression of cartilage repair factors. Polymers chosen could govern the biocompatibility of microspheres and control the release sequence of the two drugs. Injection of microspheres into the degenerative articular cavity of rats leads to suppressed inflammation and well-promoted cartilage regeneration.

Nursing Care for Mr. W Diagnosed with Hemorrhoids in the Kemuning Ward of Waled Hospital in Cirebon Regency

Hemorrhoids are dilated blood vessels in the anus that originate from the hemorrhoidal plexus, which will cause discomfort resulting in swelling commonly called hemorrhoids or hemorrhoids. The purpose of this study was to describe the identification of nursing care in patients with a medical diagnosis of hemorrhoids in the Kemuning room of Waled Hospital, Cirebon Regency. This research method is a qualitative descriptive research conducted at Waled Hospital. Data was collected through observation, interviews, and medical record documentation studies. The main focus of the research is on the nursing problems that arise, such as acute pain, and the interventions provided, such as relaxation techniques. The results showed that relaxation techniques are one of the effective interventions in reducing acute pain in patients with hemorrhoids. Before the intervention, patients often experience pain with a scale level of 5, which is shown by grimacing expressions. However, after doing relaxation therapy, the patient's pain scale decreased to 3, and the patient's expression seemed calmer. This study implies that non-pharmacological techniques such as relaxation can be a practical companion to pharmacological therapy in pain management in hemorrhoidal patients. Emphasis on holistic and individualized nursing care is essential in improving the quality of care for patients with this medical condition.

Effects of pregabalin combined with tramadol/paracetamol on acute pain in patients with CT-guided puncture localization of pulmonary nodules

ObjectiveTo investigate the effects of pregabalin combined with tramadol/paracetamol on acute pain in patients with CT-guided puncture localization of pulmonary nodules. Materials and MethodsIn this randomized, placebo-controlled and single-center study, 120 patients were allocated randomly to four groups: the control group (Group P), the pregabalin-placebo group (Group BP), the tramadol/paracetamol-placebo group (Group AP), and the pregabalin-tramadol/paracetamol group (Group AB). The primary outcome was the NRS (Numerical Rating Scale) score. Other outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2), the incidence of moderate to severe pain, the analgesia recovery ratio, the incidence of adverse drug reactions and patients’ satisfaction. ResultsNo significant interaction was detected between the interventions (P = 0.752). The NRS score of the Taking pregabalin group and the Taking tramadol/paracetamol group were significantly lower than those of the Not-taking pregabalin group and the Not-taking tramadol/paracetamol group respectively (P < 0.05). There was significant difference in the NRS scores among the four groups (P < 0.001). The NRS score of Group AB was significantly lower than that of Group P (P < 0.001), Group BP (P < 0.001) and Group AP (P = 0.001). At the same time, the NRS scores of Group BP (P < 0.001) and Group AP (P < 0.001) were significantly lower than those of Group P, but there was no significant difference between Group BP and Group AP (P = 1.000). The SBP, DBP, HR, the incidence of moderate to severe pain and the analgesia recovery ratio of Group AB were significantly lower than those of Group P (P < 0.05), while the SpO2 and the number of people who were very satisfied were significantly higher than those of Group P (P < 0.05). There was no significant difference in the incidence of adverse drug reactions among the four groups (P = 0.272). ConclusionsThe combination or single use of pregabalin and tramadol/paracetamol can effectively relieve the acute pain after localization. Pregabalin combined with tramadol/paracetamol has the best analgesic effect and significantly reduces the hemodynamic fluctuations, with high safety and low incidence of adverse drug reactions, which has a certain clinical popularization and application value.

Analgesic Effectiveness of Truncal Plane Blocks in Patients Undergoing the Nuss Procedure: A Randomized Controlled Trial.

Most patients undergoing the Nuss procedure reported moderate to severe pain after surgery. This study aimed to investigate the efficacy and safety of ultrasound-guided serratus anterior plane block (SAPB) combined with transversus thoracic muscle plane (TTMP) block for relieving acute pain in patients undergoing the Nuss procedure. The enrolled patients in our study were allocated to either receive combined nerve blocks with ropivacaine (NB group) or saline (CON group). The primary outcome of this study was postoperative pain at 2, 4, 8, 16, 24, 36, and 48h during rest and movement (coughing). Secondary outcomes included intraoperative dosage of remifentanil, the time to extubation and the length of stay in the post-anesthesia care unit (PACU), the total acetaminophen and codeine tablet consumption, time to first bowel movement, time to first flatus, opioid-related adverse events, and the length of hospital stay. Patients in the NB group had significantly lower Numerical Rating Scale (NRS) pain scores compared with the CON group. The NB group required significantly less postoperative acetaminophen consumption and lower dosages of perioperative sufentanyl and remifentanil compared with the CON group. The length of stay in the PACU and time to extubation were significantly increased in the CON group compared with the NE group. Time to first bowel movement and time to first flatus were earlier in the NB group. But there were no significant differences between the groups in terms of the length of hospital stay and codeine tablet consumption. Ultrasound-guided SAPB and TTMP blocks in patients undergoing the Nuss procedure could provide effective analgesia. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000038506).

The efficacy of nasal administration of esketamine in patients having moderate-to-severe pain after preoperative CT-guided needle localization: a randomized, double-blind, placebo-controlled trial.

Whether nasal administration of esketamine can provide effective analgesia is unclear in patients with acute pain after preoperative CT-guided needle localization. In this double-blind, randomized, placebo-controlled trial, patients were assigned to receive either nasal administration of esketamine (0.3 mg/kg or 0.5 mg/kg) or saline (identical in appearance to esketamine) when they had visual analog scale (VAS) pain scores >3/10 during deep breathing after preoperative CT-guided needle localization. The primary outcome was the percentage of patients with satisfactory pain relief, which was defined as VAS pain scores ≤3/10 measured 15 min after intranasal of esketamine or saline. Secondary outcomes included VAS measured following esketamine or saline, the incidence and cumulative dose of rescue hydromorphone use, and related adverse events. A total of 90 patients were included in the final analysis. Following intranasal treatment, the percentage of patients with satisfactory pain relief was 16.7% (5/30) in the saline group, 56.7% (17/30) in the 0.3 mg/kg esketamine group, and 53.3% (16/30) in the 0.5 mg/kg esketamine group (p = 0.002). The median VAS during deep breathing was less after the intranasal administration of esketamine {median (IQR), 3 (3, 5) in 0.3 mg/kg or 0.5 mg/kg esketamine compared to the saline group [5 (4, 6)], p = 0.009}. The incidence of rescue hydromorphone use was detected less in the esketamine group compared to the saline group (43.3% in the 0.3 mg/kg esketamine group, 36.7% in the 0.5 mg/kg esketamine group, and 73.3% in the saline group, p = 0.010). The adverse events were similar among the three groups (p > 0.05). Intranasal administration of esketamine is easier and more effective in alleviating acute pain in patients after preoperative CT-guided needle localization without significant adverse effects.

Terapi Pijat Punggung Effleurage terhadap Intensitas Nyeri Akut Pasca Bedah Fraktur Tulang Panjang

This study examines the effect of effleurage back massage therapy on the intensity of acute pain after long bone fracture surgery. This research method is true experimental with a pretest-posttest control group design. The results showed a significant difference between the NSAID and NSAID groups with effleurage with a p-value &lt;0.05. The range of changes in VAS in the NSAID group with effleurage tended to be higher than in the NSAID group on days 3 and 4. The conclusion is that NSAIDs with effleurage are effective in reducing the intensity of acute pain in patients after long bone fracture surgery and are recommended as a nursing intervention. Independently to ease the pain intensity of fracture patients. Keywords: Effleurage, Fracture, Pain

Characterizing acute and postsurgical pain management in patients receiving buprenorphine or buprenorphine/naloxone

BackgroundThere is currently a clinical dilemma in treating acute pain in patients receiving long-term buprenorphine products. MethodsThis is a retrospective cohort review involving patients receiving long-term buprenorphine therapy who either underwent a surgical procedure or presented to an emergency department (ED) for acute pain between January 1, 2012 and January 1, 2022. Patients were excluded if opioids were prescribed 30 days before the index date. Chart reviews were conducted to characterize buprenorphine treatment strategies and the addition of new pain medications. Chart review revealed (1) incidence of opioid use disorder (OUD) relapse, (2) hospital re-presentation for pain or OUD, (3) fatal and non-fatal overdose, and (4) all-cause mortality and suicidality. Descriptive statistics were used to analyze results. ResultsA total of 70 of 259 screened patients met inclusion criteria. The mean (±SD) age was 50.3 ± 13 years, 92.9% male, 64.3% White, and 78.6% had an OUD diagnosis. While 84.3% presented to the ED, 15.7% underwent surgical procedures. For the primary endpoint, the total daily dose of buprenorphine or buprenorphine/naloxone from index date to discharge was continued in 90.0%, increased in 2.9%, decreased in 1.4%, and discontinued in 5.7% of cases. At discharge, 46.2% were prescribed an additional pain medication. A total of 7.1% re-presented for pain or OUD relapse, 15.7% experienced an OUD relapse, 1.4% experienced new-onset suicidality, and 1.4% experience all-cause mortality within 90 days of the index date. No fatal or non-fatal opioid overdoses were observed. ConclusionThe most commonly observed practice was continuing buprenorphine doses in patients with acute or postsurgical pain, which was effective and safe. Although further data is necessary to fully elucidate these findings, the data herein may suggest that clinicians can safely continue buprenorphine doses in the acute pain setting in patients receiving these products chronically.

Strategies for treating acute pain in patients with opioid dependence: a scoping review protocol

IntroductionPeople who are dependent on opioids experience acute pain similar to other individuals. However, treating acute pain in these patients renders unique challenges such as opioid-induced hyperalgesia, opioid tolerance, withdrawal...

Comparison of intrathecal low-dose bupivacaine and morphine with intravenous patient control analgesia for postoperative analgesia for video-assisted thoracoscopic surgery

BackgroundThoracoscopic surgical techniques continue to advance, yet the intensity of postoperative pain remains significant, impeding swift patient recovery. This study aimed to evaluate the differences in postoperative pain and recuperation between patients receiving intrathecal morphine paired with low-dose bupivacaine and those administered general anesthesia exclusively.MethodsThis randomized controlled trial enrolled 100 patients, who were allocated into three groups: Group M (5 μg/kg morphine intrathecal injection), Group B (5 μg/kg morphine combined with bupivacaine 3 mg intrathecal injection) and Group C (intrathecal sham injection). The primary outcome was the assessment of pain relief using the Numeric Rating Scale (NRS). Additionally, intraoperative remifentanil consumption was quantified at the end of the surgery, and postoperative opioid use was determined by the number of patient-controlled analgesia (PCIA) compressions at 48 h post-surgery. Both the efficacy of the treatments and any complications were meticulously recorded.ResultsPostoperative NRS scores for both rest and exercise at 6, 12, 24, and 48 h were significantly lower in groups M and B than in group C (P<0.05). The intraoperative remifentanil dosage was significantly greater in groups M and C than in group B (P<0.05), while there was no significant difference between groups M and C (P>0.05). There was no significant difference in intraoperative propofol dosage across all three groups (P>0.05). Postoperative dosages of both sufentanil and Nonsteroidal anti‐inflammatory drugs (NSAIDs) were significantly less in groups M and B compared to group C (P<0.05). The time of first analgesic request was later in both groups M and B than in group C (P<0.05). Specific and total scores were elevated at 2 days postoperative when compared to scores at 1 day for all groups (P<0.05). Furthermore, at 1 day and 2 days postoperatively, both specific scores and total scores were higher in groups M and B compared to group C (P<0.05).ConclusionIntrathecal administration of morphine combined with bupivacaine has been shown to effectively ameliorate acute pain in patients undergoing thoracoscopic surgery.Trial registrationThe trial was registered on ClinicalTrials.gov: ChiCTR2200058544, registered 10/04/2022.

Eficácia da realidade virtual no manejo da dor pediátrica: contribuições da inovação tecnológica em saúde

Assessing and managing pain in the post-operative period is essential, as acute pain, if left untreated, can alter several organic systems. Virtual reality is a promising low-cost tool for pain relief. This study aimed to determine the effectiveness of virtual reality in the management of mild to moderate acute pain in patients in the immediate postoperative period. This is a randomized clinical study, carried out in a pediatric hospital in Curitiba. Research participants were randomized and allocated into two groups, and shown a relaxing thematic video and virtual reality. Data were subjected to descriptive and inferential statistical analysis. Pain reduction provided by virtual reality is statistically significant and superior when compared to the reduction induced by the relaxing thematic video, and can optimize the hospitalization experience, with attention focused on the patient's experience, mitigating side effects related to the use of opioids.

Patient motivators to use opioids for acute pain after emergency care.

Patients are stakeholders in their own pain management. Factors motivating individuals to seek or use opioids therapeutically for treatment of acute pain are not well characterized but could be targeted to reduce incident iatrogenic opioid use disorder (OUD). Emergency departments (EDs) commonly encounter patients in acute pain for whom decisions regarding opioid therapy are required. Decision-making is necessarily challenged in episodic, unscheduled care settings given time pressure, limited information, and lack of pre-existing patient provider relationship. Patients may decline to take prescribed opioids or conversely seek opioids from other providers or non-medical sources. Using a framework analysis approach, we qualitatively analyzed transcripts from 29 patients after discharge from an ED visit for acute pain at a large, urban, academic hospital in the midwestern United States to describe motivating factors influencing patient decisions regarding opioid use for acute pain. A semi-structured interview guide framed participant discussion in either a focus group or interview transcribed and analyzed with conventional content analysis. Four major themes emerged from our analysis including a) pain management literacy, b) control preferences, c) risk tolerance, and d) cues to action. Our findings suggest targets for future intervention development and a framework to guide the engagement of patients as stakeholders in their own acute pain management.

Benson's Relaxation Therapy to Reduce Postoperative Pain Intensity of TUR-P: A Case Study

Introduction: Benign Prostate Hyperplasia (BPH) is a disease condition in which there is enlargement of the prostate gland. This study aims to conduct a case study by analyzing nursing care by providing benson relaxation therapy on pain levels in TUR-P postoperative patientsMethods: Research design using case studies. The respondents used were 3 postoperative TUR-P people with acute pain nursing problems. The intervention provided was Benson's relaxation therapy. The instrument used is a pain assessment sheet. Data was analyzed using descriptive analysisResults: The results showed the main complaints of lower abdominal pain, pain like being stabbed, pain intensity disappeared arising and pain scale 6. The nursing diagnosis that emerged in 3 patients was acute pain with pain management intervention. The implementation of benson relaxation is carried out for 15 minutes Decrease in pain level 6 to 5 on the first day, 5 to 4 on the second day and 4 to 3 on the third day.Conclusion: Benson's relaxation therapy can reduce acute pain in patients with postoperative TUR-P.

Combination of deep breathing relaxation techniques and aromatherapy to reduce pain in patient with thoracic myeloradiculopathy: a case report

Thoracic myeloradiculopathy is a gradual loss of nerve function caused by spinal cord tumor metastases at the thoracic level resulting in pain and reduced sensation or paralysis. Mrs. N, 59 years old with thoracic myeloradiculopathy, has acute pain as the main nursing problem. The patient has been given pharmacological pain management by administering the analgesic paracetamol 3×500 mg. Acute pain in patients with thoracic myeloradiculopathy can occur in all phases of treatment which causes additional days of treatment so it is necessary to provide complementary therapy which can reduce the days of hospitalization. One of the nonpharmacological complementary therapies that have been proven effective in relieving pain in patients with thoracic myeloradiculopathy is a combination of deep breathing relaxation techniques using aromatherapy. Aromatherapy is given to the patient by dripping an essential oil containing Lavandula angustifolia (lavender), Citrus nobilis (mandarin orange), and Origanum majorana (marjoram) onto cotton and inhaled by the patient. Implementation is carried out once during a 7-day treatment period with a duration 0f 20-30 minutes after the patient performs personal hygiene or when going to rest. The evaluation results showed that the patient's pain scale decreased significantly from a score of 4 to a score of 2. Giving a combination of deep breathing relaxation techniques and aromatherapy is effective in reducing pain complaints in patients with thoracic myeloradiculopathy in addition to pharmacological therapy given by the medical team).

Comparison of the Effect of Injectable Acetaminophen with Injectable Ketamine by Morphine Pump on Reducing Acute Pain after Laparoscopic Cholecystectomy Surgery

Introduction: At the issues that have always been the concern of the surgical team is finding a way to better control post-operative pain, because pain controls a significant role in the length of time the patients stay in the hospital, the level of patient satisfaction, the recovery period and the patient's return to normal life activities. Millions of patients in the world undergo surgery every year, and most of them report unrelieved pain after the surgery. Aim: To compare the control and reduction of acute pain in patients after laparoscopic gallbladder surgery by injectable acetaminophen and injectable ketamine. Materials and methods: this RCT study, which was conducted as a non-blind randomized clinical trial, 50 laparoscopic gallbladder surgery patients who referred to the teaching hospitals of Qazvin University of Medical Sciences in 2022 were selected as available and as Injectable acetaminophen and injectable ketamine were randomly divided into two drug groups and pain reduction was investigated and analyzed. Results: this study, the average age group of patients (in two groups) was 49.34 ± 13.52, and the pain reduction in both groups was less in those under 30 years of age, and more pain reduction in those over 30 years old, so that over 50 years of age had the greatest pain reduction, and The reduction of pain in the acetaminophen group was more than that of ketamine and it was statistically significant (P = 0.02). The reduction in pain intensity in the patients in the injectable acetaminophen drug group after receiving the full dose of the drug showed a noticeable and greater decrease compared to the ketamine group. Therefore, injectable acetaminophen was seen as an effective drug in reducing pain after laparoscopic surgery and it was statistically significant. (P = 0.002). Conclusion: In this study, the effect of injectable acetaminophen was very effective in reducing the amount of pain and the intensity of pain after laparoscopic surgery, but ketamine not only does not reduce the effect of pain, but it also changes the effect of other.

Shared Decision Making in Acute Pain Management in Patients with Opioid Use Disorder: A Scoping Review.

The treatment of acute pain over the years has changed with increasing alternative therapies and increased scrutiny of opioid prescriptions. Shared Decision Making (SDM) has become a vital tool in increasing patient engagement and satisfaction in treatment decisions. SDM has been successfully implemented in the management of pain in a variety of settings; however, information regarding the use of SDM for treating acute pain in patients with a history of opioid use disorder (OUD) remains scarce. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR), we conducted a review to understand how SDM is used in acute pain management in patients with OUD. We searched Medline, Embase, CINAHL, and PsychInfo databases for relevant articles. Articles were screened and SDM outcomes of eligible articles were charted. The results were grouped by sub-theme based on a 1997 SDM model. There were three original research studies and one quality improvement study. The remaining articles were split evenly between reviews and reviews of clinical guidelines. Four themes emerged from the review: prior judgment and stigma related to OUD, trust and sharing of information, clinical tools, and interprofessional teams. This scoping review consolidated and expounded the current literature on SDM in the management of acute pain in patients with OUD. More work is needed to address prior judgments by both providers and patients and to build greater dialogue. Clinical tools may aid this process as well as the involvement of a multidisciplinary team.

Treatment of Acute Pain in Patients on Naltrexone: A Narrative Review.

The tissue damage and trauma associated with surgery almost always result in acute postoperative pain. The intensity of postoperative pain can range from mild to severe. Naltrexone is suitable for patients who do not wish to be on an agonist treatment such as methadone or buprenorphine. However, naltrexone has been shown to complicate postoperative pain management. Multiple studies have found that the use of naltrexone can increase the opioid requirement for postoperative pain control. Other modalities exist that can help outside of opioids such as ketamine, lidocaine/bupivacaine, duloxetine, and non-pharmacological management can help manage pain. Multimodal pain regiments should also be employed in patients. In addition to traditional methods for postoperative pain management, other methods of acute pain control exist that can help mitigate opioid dependence and help control pain in patients who use naltrexone for their substance use disorders.

Manajemen Nyeri Akut pada Pasien dengan Batu Ureter Level UVJ dan Batu Ginjal Dextra

This study aims to identify the effectiveness of collaborative interventions providing analgesic therapy of the Nonsteroidal Anti-Inflammatory Drugs (NSAID) class in treating acute pain problems in patients with ureteral stones and right kidney stones. The method used is a single case study of patients with grade II &amp; IV right hydronephrosis and right hydroureter ecausa distal ureterolithiasis UVJ level and right nephrolithiasis. The results showed that administering the NSAID class of analgesic therapy was effective as the first therapy for acute pain problems. Nurses have an important role in implementing collaborative interventions in administering analgesics, namely conducting pain assessments, assessing patient history, monitoring pain scales, observing patient responses to administering analgesics and helping patients improve comfort. In conclusion, the collaborative intervention of providing NSAID-class analgesics is effective in treating acute pain in patients with ureteral and kidney stones. &#x0D; Keywords: Dextra Kidney Stones, Ureteral Stones, Acute Pain, NSAID Therapy

Nursing Acute Pain in Patients With Bladder Cancer: A Case Study

Background: Severe pain in the lower right abdomen is often found in bladder cancer patients. Bladder cancer is a complex disease associated with high morbidity and mortality if not treated optimally. Patients who suffer from bladder problems say that the influence of medical personnel influences the most significant role in pain control. Nursing care for acute pain in patients with bladder cancer is still unknown. This study aims to describe nursing care for acute pain in bladder cancer patients. Methods: This research uses a case study design. Data collection from assessment to nursing evaluation was carried out in the Punai room of the Simpang Lima Gumul Hospital, Kediri Regency, in December 2021. The bladder patient was observed or treated for at least two days. Data collection techniques used were interviews, observation, and documentation. Data analysis was carried out using narrative analysis. Results: Mr. R, the main complaint felt by the patient is a pain in the lower right abdomen penetrating to the back. The nursing diagnosis in the case of Mr. R is the actual diagnosis of acute pain associated with physical injury (D.0077). Nursing intervention for Mr. R was compiled based on the diagnosis of acute pain using pharmacological techniques. Conclusion: The nursing problems Mr. R resolved after 48 hours of nursing intervention. The patient shows a decreased pain level with a pain scale of 2, and the patient plans KRS after 2 days the problem is resolved.

Feasibility of patient-controlled analgesia (PCA) for rural and remote transfers.

In rural Canada, the majority of prehospital care is provided by basic life support paramedics, who cannot administer opioids or parenteral analgesics. Patients requiring transfer to a higher level of care have limited options for pain control. We aim to determine if ambulance-based patient-controlled analgesia (PCA) is feasible during inter-facility transfers. This is a prospective non-consecutive cohort feasibility study conducted in the East Kootenay region of British Columbia from 2016 to 2020. Patients in acute pain from an illness or injury requiring an opioid and transfer to a higher level of care were offered PCA. The study used respiratory depression as a marker of safety, assessed if PCA during transport provided efficacious analgesia, measured satisfaction scores from patients and paramedics, and tracked adverse events. 84 patients received PCA. The majority had orthopaedic trauma and the average transfer time was 3h 22min. The average pain score at the start and end of the transfer was unchanged, at 4 out of 10. Patient and paramedic satisfaction scores at the end of the transfer were 4.6 and 4.7 out of 5, respectively. Three out of the 84 patients (3.6%) had desaturation episodes below or equal to 90% oxygen saturation; however, all resolved with supplemental oxygen. Ambulance-based PCA is feasible and has a high level of satisfaction among paramedics and patients. It has significant potential for inter-facility transport in rural regions in Canada where ambulances are staffed with paramedics who cannot administer opioids or other parenteral analgesics.