Analgesia For Control Research Articles

Thorakale Paravertebralblockade

Thoracic paravertebral block for postoperative pain control has been introduced more than a century ago. It is currently gaining increasing popularity. This simple and safe technique can be used for postoperative analgesia, as well as sole anesthetic technique. When compared to epidural analgesia for postthoracotomy pain control, thoracic paravertebral analgesia provides comparable analgesic efficacy, but less side-effects. Regarding concomitant use of anticoagulants and antiplatelet drugs, paravertebral blockade is considered a central nerve block.

Impact of nursing intervention on the adverse reaction of PCEA after abdominal operation

Objective To explore impact of nursing intervention on the adverse reaction of patient con-trol epidural analgesia (PCEA) after abdominal operation. Methods 258 patients underwent PCEA after ab-dominal operation were selected from 2006 to 2007. The clinical data of 126 patients without nursing interven-tion were analyzed as the control group admitted to our hospital from January to December, 2006 and compared with those of 132 patients receiving nursing intervention as the experimental group from January to December, 2007. The control group was managed by the anesthetists and nurses only conducted routine nursing instruction, while the experimental group was given systematic and normative nursing intervention besides routine nursing instructions, including psychological intervention, behavioral intervention, close observation, of discovery of ad-verse reaction in time and giving early disposal. The incidence of adverse reaction of PCEA of the two groups such as urinary retention, nausea and vomiting, abdominal distension, skin indentation, catheter shedding, skin itching, numbness of lower limbs, respiratory depression was observed. Results Compared with the control group,the incidence of adverse reactions of PCEA in the experimental group such as urinary retention,nansea and vomiting, abdominal distension,skin indentation,catheter shedding was significantly lower. Conclusions The implementation of nursing intervention can reduce the adverse reaction of PCEA after abdominal operation, alle-viate the suffering of patients, and promote functional recovery and the body rehabilitation. Key words: PCEA; Nursing intervention; Adverse reaction

Parent or Nurse-Controlled Analgesia for Pain Control in Developmentally Delayed Children

Bioethics| March 01 2009 Parent or Nurse-Controlled Analgesia for Pain Control in Developmentally Delayed Children AAP Grand Rounds (2009) 21 (3): 32. https://doi.org/10.1542/gr.21-3-32 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Parent or Nurse-Controlled Analgesia for Pain Control in Developmentally Delayed Children. AAP Grand Rounds March 2009; 21 (3): 32. https://doi.org/10.1542/gr.21-3-32 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: developmental delay, pain management, pain Source: Czarnecki ML, Ferrise AS, Jastrowski Mano KE, et al. Parent/nurse-controlled analgesia for children with developmental delay. Clin J Pain. 2008;24(9):817–824; doi: 10.1097/AJP.0b013e3181773b69 Investigators from three Wisconsin hospitals collaborated to conduct a retrospective chart review to evaluate the effectiveness of parent/nurse-controlled analgesia (PNCA) in children unable to independently use patient-controlled analgesia (PCA) because of developmental delay. With PNCA, either a nurse or parent administers a predetermined intravenous dose of opioid analgesia using a PCA pump when they feel the patient is experiencing substantial pain. The medical records of patients 0–19 years old with developmental delay who had both received PNCA between 1999 and 2004 and monitored pain using the Neonatal Infant Pain Scale (NIPS), a behavioral pain scale with scores ranging from 0–7,1 were reviewed. Data were collected for 72 hours or until PNCA was discontinued. Mean pain scores as well as dose, rate, and toxicity of analgesia were assessed. Toxicity of opioid analgesia was assessed by identifying supplemental oxygen usage, the administration of medications used to treat nausea, emesis, and pruritus, and naloxone use to treat respiratory depression. The medical records of 71 children with a mean age of 9.99 years (range 5.71–15.27) were reviewed. Almost all (95.8%) of the children used PNCA because of postoperative pain. In addition to PNCA, 95.8% of the children had a basal infusion of analgesia. All but two children used morphine sulfate PNCA. Mean pain scores for each 12-hour period ranged from 0.7 to 1.1, indicating good analgesia. Average opioid use ranged from 0.04 mg/kg/hr of morphine equivalents during the first 24 hours to 0.026 mg/kg/hr during the last 24-hour period, and PNCA use averaged less than one dose/hour. Medications to treat pruritus were used in 32.4% of study patients, 14.1% received anti-emetics, and 78.9% received supplemental oxygen. Two patients required naloxone to treat respiratory depression. The authors conclude that PNCA appears to be a safe and effective method for treating acute pain in pediatric patients with developmental delay unable to manage pain control on their own. Dr. Yates has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The management of physical pain is a dynamic aspect of the health care plan and medical decision-making for many patients. In addition, the evaluation and assessment of pain is often an important part of a patient’s recuperation. Barriers to pain control include failure to understand the significance of pain, lack of a comprehensive approach to identifying it, inappropriate pain management (eg, physicians providing inadequate dosing or fear of patient addiction), and cost containment.2 This study demonstrates that both parents and nurses are able to recognize the signs of pain in the developmentally delayed child and that intervention is adequate using PNCA. The opioid consumption by the study population was not notably different from that in other studies of infants who received PNCA.3 In addition, this study shows that PNCA is an efficient... You do not currently have access to this content.

Patient and/or family controlled palliative sedation with midazolam for intractable symptom control: a case series

IntroductionOur case series prospectively evaluate the concept of Patient/Family-Controlled Sedation with midazolam, as an alternative to sedation by continuous infusion in terminal cancer patients.Cases presentationOur method was applied in 8 pts. Midazolam was administered in a Patient Control Analgesia mode. The infusion pump was activated "as-needed" by the pt or a caretaker. Sedation was rated as: 1) awake 2) arousable to voice 3) arousable to light pain or 4) unarousable. Family satisfaction was rated as: 1) good, 2) fair, 3) poor, or 4) unacceptable. Mean midazolam consumption was 12 – 40 mg/24 hours. We did not observe respiratory depression. Death occurred 1–6 days after sedation started. Family satisfaction was mainly good and median sedation was in the range 2 – 3.ConclusionPatient/Family-Controlled Sedation with midazolam was effective in providing comfort, by allowing titration of sedation to each patient's needs.

Clinical practice guideline improves the treatment of sickle cell disease vasoocclusive pain

Pain is the most common complication of sickle cell disease requiring emergency department (ED) visits and hospitalization. A Clinical Practice Guideline (CPG) to manage acute sickle cell pain offers clinicians a standardized approach for the provision of evidence-based, cost-effective care. After CPG implementation, monitoring of pre-established indicators is a strategy to evaluate progress toward meeting the goal of providing rapid, effective pain relief for patients with acute sickle cell pain. A retrospective chart review of patients with sickle cell disease admitted through the ED at Children's Hospital Boston with the primary diagnosis of vaso-occlusive pain was performed for a period before and after implementation of the CPG. Endpoints measured were: use of a validated pain scale, time from ED triage to first dose of analgesic, use of adequate weight-based analgesic dosing, frequency and location of PCA initiation, and time from ED triage to patient controlled analgesia (PCA) initiation. Two hundred sixty three sickle cell pain admissions in 93 unique subjects were analyzed, 51 pre-CPG and 212 post-CPG. Statistically significant improvements in use of pain scale, appropriate weight-based analgesic dosing, utilization of PCA, and time to initiation of PCA were observed. There was not a statistically significant improvement in the percentage of subjects who received their 1st dose of analgesic within 1 hr; however the median time to first analgesic was reduced significantly from 80 to 65 min (P = 0.003). Implementation of a CPG to manage acute sickle cell pain in the ED improves the ability to deliver timely, effective analgesia to this patient population. Establishing and monitoring internal benchmarks provides a means for ongoing evaluation of the pre-established goals for patient care.

The comparative study of flow rate between IV extension tube and epidural catheter connected to patient controlled analgesia device.

Patient controlled analgesia (PCA) device is known to be an effective method for acute and chronic pain control and the administration route for PCA pump is various. The representative routes are intravenous and epidural space. The aim of this study is to investigate the influence of catheter diameter on flow rate. IV extension tube or epidural catheter connected to Mechanical- or balloon-type PCA devices were examined (100 ml, 2 ml/hr). There were four groups each of 5 experiments: Group I: Mechanical-type pump + IV extension tube, Group II: Mechanical-type pump + epidural catheter, Group III: Balloon-type pump + IV extension tube, Group IV: Balloon-type pump + epidural catheter. The flow rate was indirectly measured by the weight change of collecting infusate bottle. Infusion fluid was distilled water. Experiment was carried out in a laboratory room with a constant room temperature of 20-22degrees C. Infusion rate differed significantly among the groups, exhibiting flow rates within +/-15% of their expected rate for 28% (group IV) to 100% (group I) of their infusion duration. The mean Infusion rate in group I was significantly more rapid than that in other groups. The mean flow rate in group III was higher than that in group IV (P<0.05). These results indicate that the use of an epidural catheter with a small internal diameter could decrease the flow rate of PCA device.

Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes

Background Pain arising in burns sufferers is often severe and protracted. The prospect of a dressing change can heighten existing pain by impacting both physically and psychologically. In this trial we examined whether pre-procedural virtual reality guided relaxation added to patient controlled analgesia with morphine reduced pain severity during awake dressings changes in burns patients. Methods We conducted a prospective randomized clinical trial in all patients with burns necessitating admission to a tertiary burns referral centre. Eligible patients requiring awake dressings changes were randomly allocated to single use virtual reality relaxation plus intravenous morphine patient controlled analgesia (PCA) infusion or to intravenous morphine patient controlled analgesia infusion alone. Patients rated their worst pain intensity during the dressing change using a visual analogue scale. The primary outcome measure was presence of 30% or greater difference in pain intensity ratings between the groups in estimation of worst pain during the dressing change. Findings Of 88 eligible and consenting patients having awake dressings changes, 43 were assigned to virtual reality relaxation plus intravenous morphine PCA infusion and 43 to morphine PCA infusion alone. The group receiving virtual reality relaxation plus morphine PCA infusion reported significantly higher pain intensities during the dressing change (mean = 7.3) compared with patients receiving morphine PCA alone (mean = 5.3) ( p = 0.003) (95% CI 0.6–2.8). Interpretation The addition of virtual reality guided relaxation to morphine PCA infusion in burns patients resulted in a significant increase in pain experienced during awake dressings changes. In the absence of a validated predictor for responsiveness to virtual reality relaxation such a therapy cannot be recommended for general use in burns patients having awake dressings changes.

Thoracic Epidural versus Morphine Patient Controlled Analgesia After Laparoscopic Colectomy

Despite the benefits of the laparoscopic approach to colorectal surgerypatients still experience significant levels of pain post- operatively.This study aimed to compare the use of thoracic epidural vs. morphinepatient controlled analgesia in the management of pain afterlaparoscopic colorectal surgery. A retrospective analysis of hospitalrecords was performed for 16 patients undergoing laparoscopiccolorectal surgery (8 thoracic epidural, 8 patient controlled analgesia).Visual rating scale pain scores (0 � 10) were significantly lower forpatients managed with thoracic epidural in recovery (mean [95% CI] )(0 vs. 5.3 [3.6-6.9]), at 6 hours (1 [0-2.0] vs. 5.4 [4.2-6.5]), 12 hours(0.4 [0-1.1] vs. 4.4 [3.3-5.4]) and 24 hours (1.3 [0-2.8] vs. 5.9 [4.9-6.9]). Thoracic epidural offers the optimal analgesia and quality ofcare to the patient following laparoscopic colectomy.

Postoperative pain management

Intravenous patient-controlled analgesia (i.v. PCA) for parenteral postoperative pain control is considered standard therapy as patients can individually titrate the amount of analgesic as needed. Iontophoretic patient-activated transdermal systems (IPATS) are a new non-invasive pre-programmed method for postoperative pain control. By pressing the dosing button a 40 microg dose of fentanyl is delivered over a 10 min period via iontophoresis through the intact skin. Several comparative randomized controlled trials have demonstrated that IPATS provide postoperative pain control equivalent to i.v. PCA with morphine. Thus, IPATS is a new method in the management of acute postoperative pain which increases patient mobility and reduces time and effort of care as well as the risk of programming errors. In this review the efficacy, pharmacokinetics, handling and process cost-effectiveness of IPATS are discussed.

Use of patient-controlled analgesia for pain control in dying children

In the last week of life, the daily opioid dose in children is highly variable, making the use of patient-controlled analgesia (PCA) a useful therapy option. Scientific data on the use of PCA in paediatric palliative care are rare. Retrospective chart review over a 7-year period (Jan 1998-Jan 2005) of PCA treated children dying of cancer was used. Eight children were on PCA for a median duration of 9 days (range, 1 to 50). The daily median intravenous morphine equivalent dose referenced to body weight increased significantly when PCA was initiated and during the last week of life. In the last week of life, the median daily number of delivered and undelivered bolus requests ranged from 7.5-21 and 0-4.5, respectively. To meet children's individual needs, 39 PCA parametre changes on 22 opportunities were performed. Median daily mean pain scores remained low (range, 0-3; numerical rating scale 0-10) throughout the period. PCA proved an ideal, dependable and feasible mode of analgesic administration for the individual titration of dose to effect.

Maternal satisfaction with single-dose spinal analgesia for labor pain in Indonesia: a landmark study

The purpose of this study was to assess maternal satisfaction with single-dose spinal analgesia for the management of obstetric pain in Indonesian women. The investigation included 62 laboring women with single pregnancy at term, with 45 primigravidas and 17 multigravidas. The participants' ages ranged from 15 to 29 years. All participants were screened for physical health and were classified as healthy according to the American Society of Anesthesiologists classification system. All 62 parturients received single-dose spinal anesthesia with a 27-gauge pencil-point needle at either the L3-4 or L4-5 intervertebral interspace, with a combination of bupivacaine, 2.5 mg; morphine, 0.25 mg; and clonidine, 45 microg. Maternal satisfaction, duration of pain relief, and side effects were studied. The overall maternal satisfaction with the single-dose spinal technique for labor analgesia in our study group was high, with 50 patients (81%) being very satisfied, and 7 patients (11%) being satisfied with the quality of labor analgesia. Forty-nine patients (79%) stated that they would select single-dose spinal analgesia for pain control in labor in the future. Our study was the first one in Indonesia to assess maternal satisfaction with single-dose spinal analgesia for labor pain. We concluded that single-dose spinal analgesia with a combination of bupivacaine, morphine, and clonidine provided effective labor pain control for Indonesian women, and maternal satisfaction with this technique was very high. This technique is very cost-effective and should be recommended for routine obstetric pain control in Indonesia and other developing countries.

78-Year-Old Man With Emesis and Jaundice

78-Year-Old Man With Emesis and Jaundice

Analgesia for pain control during extracorporeal shock wave lithotripsy: Current status

A cooperative patient is essential in maintaining stone targeting for optimal fragmentation during extracorporeal shock wave lithotripsy (ESWL). Therefore, it is important to choose an appropriate analgesic with minimal adverse effects. The guidelines for pain management during ESWL have not been established. Various analgesic agents including opioids (morphine, pethidine, and fentanyl), nonsteroidal anti-inflammatory drugs (NSAIDS - diclofenac, propofol, ketorolac, and piroxicam), local anesthetic agents and a number of combinations have been used during ESWL by various techniques (general anesthesia, regional anesthesia, subcutaneous and intravenous injections, patient-controlled analgesia, and monitored anesthesia care). Cutaneous creams like eutectic mixture of local anesthesia (EMLA) whether used alone or in combination with oral NSAIDS have also been used and are able to reduce analgesic requirements. Topical application of a combination of dimethyl sulfoxide and lidocaine has also been found to be effective. The ideal analgesic, offering optimal pain control, minimal side effects, and cost-effectiveness is still elusive. Opioids administered using various techniques, provide effective analgesia, but require active monitoring of patient for potential adverse effects. Combination therapy (oral NSAID and occlusive dressing of EMLA, DMSO with lidocaine) offers an effective alternative mode for achieving analgesia with minimal morbidity. This therapy avoids the need for general anesthesia, injectable analgesics, and opioids along with their side effects.

Interpleural analgesia in breast reconstruction

To investigate the safety and efficacy of interpleural analgesia for postoperative pain control in patients having breast reconstruction we did a retrospective audit of 114 women who had had their breasts reconstructed by the same team. A group of 22 women given morphine postoperatively acted as a historical control. Ninety-two women were given continuous postoperative interpleural bupivacaine with free access to morphine. We recorded complications, morphine consumption, postoperative pain, nausea and vomiting scores, and duration of hospital stay. There was one episode of air entrapment. Morphine consumption was significantly reduced in the interpleural group (p<0.000). Pain scores were similar in all groups (p=0.11). Nausea and vomiting scores were significantly lower in the interpleural group (p=0.04) and hospital stay was shorter in the interpleural group but not significantly so (p<0.9). We conclude that interpleural analgesia improves the quality of postoperative care in breast reconstruction with latissimus dorsi flaps.

Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

Comparison of epidural analgesia and intercostal nerve cryoanalgesia for post-thoracotomy pain control

Epidural analgesia is regarded as the gold method for controlling post-thoracotomy pain. Intercostal nerve cryoanalgesia can also produce satisfactory analgesic effects, but is suspected to increase the incidence of chronic pain. However, randomized controlled trials comparing these two methods for post-thoracotomy acute pain analgesic effects and chronic pain incidents have not been conducted previously. We studied 107 adult patients, allocated randomly to thoracic epidural bupivacaine and morphine or intercostal nerve cryoanalgesia. Acute pain scores and opioid-related side effects were evaluated for three postoperative days. Chronic pain information, including the incidence, severity, and allodynia-like pain, was acquired on the first, third, sixth and twelfth months postoperatively. There was no significant difference on numeral rating scales (NRS) at rest or on motion between the two groups during the three postoperative days. The patient satisfaction results were also similar between the groups. The side effects, especially mild pruritus, were reported more often in the epidural group. Both groups showed high incidence of chronic pain (42.1–72.1%), and no significance between the groups. The incidence of allodynia-like pain reported in cryo group was higher than that in Epidural group on any postoperative month, with significance on the sixth and the twelfth months postoperatively ( P < 0.05). More patients rated their chronic pain intensity on moderate and severe in cryo group and interfered with daily life ( P < 0.05). Both thoracic epidural analgesia and intercostal nerve cryoanalgesia showed satisfactory analgesia for post-thoracotomy acute pain. The incidence of post-thoracotomy chronic pain is high. Cryoanalgesia may be a factor that increases the incidence of neuropathic pain.

Patient−controlled epidural analgesia: a nursing perspective

This article discusses the use of patient−controlled epidural analgesia (PCEA) for patients undergoing gastrointestinal surgery, from a nursing perspective. Despite progress in postoperative pain relief over the last decade, a number of patients experience severe pain after major surgery, which can include gastrointestinal surgery. Optimal postoperative pain relief needs to be further improved as it is not only about sensation management, but the whole person. Numerous studies have indicated that patient−controlled analgesia is generally an effective method of delivering postoperative analgesia, but more safety considerations are highlighted for PCEA. However, the literature suggests that these safety issues can be effectively managed with specific nurse and patient education programmes. Thus, the article addresses PCEA as a potentially useful post−surgical analgesic technique for gastrointestinal surgery that is not commonly used in the UK. The three issues discussed, as related to nursing, are efficacy, safety and the nursing implications in the management of PCEA.

256: Multimodal analgesia for pain control after laparoscopic cholecystectomy

256: Multimodal analgesia for pain control after laparoscopic cholecystectomy

Multimodal analgesia for pain control after laparoscopic cholecystectomy

Multimodal analgesia for pain control after laparoscopic cholecystectomy

344: Safety and effficacy of intravenous fentanyl patient control analgesia (PCA) for intractable pain

344: Safety and effficacy of intravenous fentanyl patient control analgesia (PCA) for intractable pain