Complain Of Postoperative Pain Research Articles

A Novel Pain Relief Approach for the Treatment of Multiple Dental Caries and Pulpitis

Anxiety and stress toward treatment can hamper treatment completion in patients with dental caries and pulpitis. Therefore, effective management of post-treatment pain is important because poor pain management can lead to patient dissatisfaction. Ultrasound-guided nerve blocks provide good postoperative analgesia in maxillofacial surgeries. These surgeries can be performed under general or local anesthesia without complications. Here, we present the case of a patient with dental phobia who was successfully treated with these techniques. The patient was a 22-year-old woman with a history of manic-depressive illness who presented with 23 decayed teeth. She had previously undergone vital pulp therapy; however, post-treatment pain led to treatment-related stress, and the patient discontinued the dental treatment. She preferred the dental treatment to be completed with as little pain as possible and wanted to avoid a pulpectomy. The patient’s history of heavy use of non-steroidal anti-inflammatory drugs (NSAIDs) made her resistant to NSAIDs. As a result, the analgesic effect of NSAIDs could not be expected. After intravenous midazolam and propofol sedation, an ultrasound-guided inferior alveolar nerve block was performed bilaterally, and 0.375% ropivacaine was used as a local anesthetic. The patient did not complain of post-operative pain, and no post-operative analgesics were required.

Mastication after craniotomy: pilot assessment of postoperative oral health-related quality of life

BackgroundNeurosurgical approaches to the brain often require the mobilization of the temporal muscle. Many patients complain of postoperative pain, atrophy, reduced mouth opening, and masticatory problems. Although the pterional, frontolateral-extended-pterional, and temporal craniotomies are the most frequently used approaches in neurosurgery, a systematic assessment of the postoperative oral health-related quality of life has never been performed so far. This study evaluates the oral health-related quality of life of patients after pterional, frontolateral-extended-pterional, or temporal craniotomy using a validated and standardized dental questionnaire, compares the results with the normal values of the general population, and investigates whether this questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle.MethodsThe “Oral Health Impact Profile” (OHIP14) is a validated questionnaire to assess the oral health-related quality of life. It asks the patients to assess their oral health situation within the past 7 days in 14 questions. Possible answers range from 0 (never) to 4 (very often). Sixty patients with benign intracranial processes operated through a lateral cranial approach were included. The questionnaire was answered before surgery (baseline) and 3 months and 15 months after surgery.ResultsOverall, postoperative OHIP scores increase significantly after 3 months and decrease after 15 months, but not to preoperative values. No factors can be identified which show a considerable relationship with the postoperative OHIP score.ConclusionsPostoperative impairment of mouth opening and pain during mastication can be observed 3 to 15 months after surgery and sometimes cause feedback from patients and their dentists. However, in line with existing literature, these complaints decrease with time. The study shows that the OHIP questionnaire is sensitive to changes caused by surgical manipulation of the temporal muscle and can therefore be used to investigate the influence of surgical techniques on postoperative complaints. Postoperatively, patients show worse OHIP scores than the general population, demonstrating that neurosurgical cranial approaches negatively influence the patient’s oral health-related wellbeing. Larger studies using the OHIP questionnaire should evaluate if postoperative physical therapy, speech therapy, or specialized rehabilitation devices can improve the masticatory impairment after craniotomy.Trial registrationClinical trial register: DRKS00011096.

Patient satisfaction with anaesthesia services at the tertiary care hospital, a cross-sectional study patient satisfaction and anesthesia services

Introduction: Patient satisfaction is an integral part of the quality of healthcare processes. The survey performed by the ASA Committee on Performance and Outcomes Measurement (CPOM) in 2013 states that the assessment of patient satisfaction is a reality of practice today. Thus, this study aimed to assess patient satisfaction with perioperative anaesthesia services and determine the factors influencing patient satisfaction in our hospital. Methods: We performed the cross-sectional study at our tertiary care institute after getting institutional review board approval. This study included 200 patients who underwent elective or emergency surgeries under anesthesia from April 2019 to June 2019. The long-form questionnaire was prepared based on various references and validated in our department. Results: Out of 200 patients, 76.5% (n = 153) were satisfied with anaesthesia services. Male gender [87.03% (n = 94/108)], younger [86.66% (78/90)] and literate patients [ 88.52% (108 pts/122)] were more satisfied. Better satisfaction was recorded in patients who had regional anaesthesia [85.18% (92/108)] and no complain of post-operative pain [83.58% (112/134)] or postoperative nausea and vomiting (PONV) [87.90% (109/124)]. Patients with intraoperative awareness were less satisfied. Conclusion: In our study group, type of anaesthesia, postoperative pain, PONV, and intraoperative awareness were factors that affected patient satisfaction.

Spinal Anaesthesia for Infra-umbilical Surgeries - A Prospective Randomized Study to evaluate the effectiveness of Dexmedetomidine as an adjuvant to Bupivacaine.

Background: Spinal anesthesia is commonly used anesthetic modality worldwide but with the limitation of relatively short duration of action and complain of post-operative pain. However, the addition of adjuvants have intensified and increased the duration of sensory block with concommitent prolongation of the duration of postoperative analgesia.
 Study design and settings: This prospective randomized study was conducted in the Department of Anesthesia, Pain and Critical Care at the University Teaching Hospital.
 Methods: 60 patients irrespective of their age and gender were randomized equally into two groups, and received 3ml of total drug volume intrathecally (IT) viz 2.5 ml of hyperbaric bupivacaine 0.5% mixed with 0.5 ml of normal saline in Group I and 0.5 ml of 5 mcg of Dexmedetomidine in Group II respectively.
 Results: The maximum height of sensory block achieved were dermatomes T 6.5 ± 1.43 in Group I, and T 6.20 ± 1.28 in Group II (P value, 0.794 > 0.05) with time required to reach T10 sensory block level was 6.70 ± 0.98 min. in Group I and 5.50 ± 1.00 min. in Group II (P value, 0.001) The time to reach Bromage scale 3 was 15.70 ± 2.56 min. in Group I and 8.55 ± 1.67min. in Group II (P value, < 0.001) The time of first rescue dose requested by patient was 196.75 ± 15.16 min. in Group I, and 359.50 ± 49.79 min. in Group II (P value, 0.01) 
 Conclusions: Dexmedetomidine in doses of 5 µg as adjuvants to hyperbaric 0.5% bupivacaine intrathecally produced a significantly quick onset and longer duration of motor and sensory block with benefit prolonged postoperative analgesia. JMS 2018: 21 (2):95-100

Single incision thoracoscopic right upper lobectomy with systematic lymph node dissection

Video-assisted thoracic surgery (VATS) provides less postoperative pain, preservation of the immune response and shorter recovery period, compared with thoracotomy. However, many patients complain of postoperative pain and paresthesia because VATS requires 3 or 4 incisions including a utility incision of 3–5 cm. To overcome this problem, single incision thoracoscopic surgery has emerged; this technique has been adopted for lung cancer surgery since 2010. Complete mediastinal lymph node dissection is the major role of lung cancer surgery. We describe a case of a right upper lobectomy with complete mediastinal lymph node dissection via single incision thoracosopic surgery.

A drug utilization study of analgesics for management of postoperative pain in patients admitted at a tertiary care teaching hospital

Background: Postoperative pain is very common and develops naturally as a warning. After surgery, its development can be predicted and should be prevented and treated. Besides the disagreeable aspects and physiological repercussions of postoperative pain, it delays ambulation and hospital discharge. Despite the drugs and anesthetic techniques available, the prevalence of postoperative pain is still high. Methods: Pain assessment was done by BP cuff inflation method and Numerical rating scales both pre and postoperatively. Results: Complain of postoperative pain is more in female patient. Over all complain of postoperative pain was observed more in 31-45 year age group. Complain of postoperative pain was more at 18 hour time interval. Postoperative pain complains was more in patients undergoing general surgery. Postoperatively out of 310 patients 298 patients were received diclofenac only and 18 patients were received diclofenac + tramadol combination of these 112 and 13 patients complained of post-operative pain respectively. Conclusions: 112 patients from diclofenac only received group and 13 patients from diclofenac + tramadol received group complain of post operative pain. Post-operative pain control at 12 hours is sufficient but high post-operative pain scores at 18 hour of post-operative time interval suggesting needs of additional pain control. Majority of study patients received single analgesic (Diclofenac sodium).