Method Of Pain Relief Research Articles

Нейропатическая боль на ранних этапах химиотерапии у детей с острыми лейкозами. Эффективность обезболивающей терапии и сроки астенизации

Актуальность. Проблема нейропатической боли у детей приобретает все большую актуальность вследствие роста распространенности патологии и трудности в достижении терапевтического эффекта. Нейропатическая боль в детской онкологии может возникнуть в результате различных повреждений соматосенсорной системы. В Украине в настоящее время нет проведенных исследований касательно нейропатической боли у детей с гемобластозами на ранних этапах лечения. Именно поэтому наше исследование направлено на решение вопроса о ранней реализации нейропатии и улучшении обезболивающей терапии. Цель исследования. Проведение анализа болевого синдрома у детей с гемобластозами на первом этапе химиотерапии и сравнение эффективности различных методов обезболивания, определение взаимосвязи методов обезболивания и степени астенизации. Материалы и методы. Проведено когортное проспективное исследование, в которое вошли 60 детей с впервые диагностированными гемобластозами в возрасте от 6 до 18 лет. Все дети были разделены на три группы в зависимости от степени выраженности болевого синдрома. І группа (n = 20) — дети, у которых интенсивность боли по ВАШ составила ≥ 7 баллов и которым с целью обезболивания вводился морфин. II группа (n = 20) — дети с интенсивностью боли ≥ 7 баллов, которым с целью обезболивания вводился морфин в комбинации с габапентином. III группа (n = 20) — дети с интенсивностью боли ≤ 6 баллов, которым с целью обезболивания вводился парацетамол в сочетании с габапентином. 40 детям проведено исследование венозной крови на активность супероксиддисмутазы (СОД) и каталазы, содержание сиаловых кислот (СК) и малонового диальдегида (МДА). Проводилось определение интенсивности боли, наличия нейропатии и астении на 1-е сутки поступления в отделение анестезиологии и интенсивной терапии, далее — на 30, 64 и 78-е сутки химиотерапии. Результаты. При определении нейропатии на 1-е сутки манифестации боли у 8 детей (13 %) результат был отрицательный, у 48 детей (80 %) — сомнительный и у 4 детей (7 %) — положительный. На 30-е сутки химиотерапии у 2 детей (3 %) данные о нейропатии негативные, у 56 детей (91 %) — сомнительные и у 4 детей (6 %) — положительные. На 64-е и 78-е сутки химиотерапии данные о нейропатии были одинаковыми и у 53 детей (88 %) являлись сомнительными, а у 7 (12 %) — положительными. В результате биохимического исследования крови обнаружены признаки оксидативного стресса: активность СОД ниже нормы в 35,4 раза, количество МДА и СК превышает норму в 7,5 и 1,8 раза соответственно. Интенсивность боли по ВАШ на 30-е сутки составляла в I группе ≤ 5 баллов, в II группе ≤ 4 баллов и в III группе ≤ 3 баллов. На 78-е сутки интенсивность боли в I группе составляла ≤ 5 баллов, во II и III группах ≤ 3 баллов. Выраженная астения отмечалась у 6 детей (10 %), умеренная — у 45 детей (75 %) и реакция утомления — у 9 детей (25 %). Выводы. Формирование нейропатического компонента боли начинается уже на 1-м этапе химиотерапии, следовательно, применение габапентина в комплексной терапии боли является целесообразным. Тщательный мониторинг боли позволяет вовремя выявить наличие болевого синдрома и более точно корректировать обезболивающую терапию для достижения положительного эффекта.

Intravenous analgesia versus thoracic epidural catheterization in moderately severe pancreatitis: A randomized controlled trial in a tertiary care health facility.

Objective: In this study we evaluated the two most commonly used methods for pain relief in acute pancreatitis i.e. epidural analgesia and I/V analgesia and compared the results. Study Design: Randomized Controlled Clinical Trial. Setting: Surgical Unit-1 of Holy Family Hospital, Rawalpindi. Period: June 2019 to June 2020. Material & Methods: Patients presenting with acute pancreatitis with moderate severity were divided into groups A and B. In group A patients, epidural catheter was passed at T9-T10 level epidural space and they received 0.125% Bupivacaine injection every 4 hours, while group B patients received combination analgesia in the form of IV tramadol 100mg TDS and IV Toradol 30mg BD. Pain was assessed by using visual analog scale (VAS) at 12 hour intervals. Rescue analgesia, in the form of IV paracetamol 1g given in the case of >7 VAS score was also recorded. Results: Total 100 patients were included according to the inclusion criteria of the study. Patients were randomly divided into two groups; Group A (Epidural) and group B (intravenous). Mean age (years) in the study was 42.39+11.21 whereas there were 37 male and 63 female patients who were included in the study. In our study, mean pain score in group A was 3.16+1.23 which was significantly lower than group B (5.42+1.01), p-value < 0.0001. There was a single mortality in the study. 6 patient’s required ventilatory support due to respiratory complications, 5 in group B and 1 in group A. Conclusion: Epidural analgesia is superior to I/V analgesics in pain management of moderately severe pancreatitis and it also reduces respiratory morbidity in these patients.

Perceptions of primiparous women about the effect of childbirth preparation classes on their childbirth experience: A qualitative study

Objectiveto evaluate the perceptions of primiparous women about the effect of childbirth preparation classes on their childbirth experience. Designdescriptive qualitative study. Participants and setting13 Iranian women who participated in childbirth preparation classes and had a vaginal delivery were interviewed. Measurementssemi-structured interviews were used to collect data. Findingssix main themes were extracted from the data analysis: incentive and learning about pregnancy and childbirth; active participation in labour; sense of self-control; use of non- medical pain relief methods during labour; preferring vaginal birth to caesarean section; and positive childbirth experience. Key conclusionswomen reported that participation in childbirth preparation classes prepared them well for a vaginal birth, and these classes were perceived to be associated with a positive childbirth experience. Implications for practiceattendance at childbirth preparation classes is perceived to have a positive effect on vaginal birth. Therefore, encouraging and supporting women to attend the full course of classes has the potential to increase women's preference towards vaginal birth, resulting in a reduction in the caesarean section rate.

Оцінка стану особистої та ситуативної тривожності, показників стрес-реалізуючої і стрес-лімітуючої систем організму як маркера ефективності допологової підготовки

As a result of research conducted on the basis of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova NAMS of Ukraine», the issue of the transcranial electrostimulation introduction in preparation for partnership labor was shown. Purpose — to study the features of changes in the state of personal and situational anxiety, stress-implementing and stress-limiting systems of the body in healthy women depending on the method of prenatal training. Materials and methods. 120 somatically healthy women without severe extragenital and obstetric pathology with a physiological course of singleton pregnancy were examined. In the first group — 45 women set up for partner childbirth, the second group also included 45 patients who underwent a course of transcranial electrical stimulation (TES) of mesodiencephalic structures of the brain in comprehensive preparation for partner childbirth. The control group included 30 women who did not receive prenatal training, did not have individual support in childbirth and were tuned to traditional methods of pain relief as needed. Results. Following the results of the determination of pain rate in the dynamic of the TES procedure, a progressive growth of the pain tolerance threshold was recorded with the subsequent stabilization of this value after the 5th procedure of electrical stimulation. Methods of psychophysical preparation for childbirth using transcranial electrostimulation and partner support made it possible to reduce medical induced pain relief during childbirth, which is what the data we obtained indicate. Conclusions. The use of TES in complex prenatal preparation for partner labor allows to achieve and maintain a stable psycho-emotional adaptation of pregnant women and increases the tolerance of the consonant to labor pain without additional medication load, which helps to make more physiological course of labor. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: labor, prenatal preparation, transcranial electrostimulation, pain threshold, anesthesia, partnership labor.

Comparison of effect of auriculotherapy and mefenamic acid on the severity and systemic symptoms of primary dysmenorrhea: a randomized clinical trial

BackgroundPrimary dysmenorrhea (PD) is the most common complaint in young women and adolescents. Side effects of non-steroidal anti-inflammatory drugs can limit their use. Therefore, non-pharmacological pain relief methods such as auriculotherapy may play an important role in PD management. This study was conducted to compare the effect of auriculotherapy and mefenamic acid on the severity and systemic symptoms of PD.MethodsIn a randomized clinical trial, 83 students were randomized into two groups. In the auriculotherapy group, electrical stimulation of the ear was conducted once a week for two menstrual cycles. In each cycle close to menstruation, ear seeds were inserted on pressure points to be pressed in times of pain. In the mefenamic acid group, subjects took mefenamic acid capsules upon seeing the initial symptoms of menstruation until the pain reduces. The primary outcomes were mean pain intensity and systemic symptoms associated with it. Pain intensity was measured through the visual analog scale (VAS) and the verbal multidimensional scoring system (VMS). Systemic symptoms were assessed using VMS, as well as the yes/no question form.ResultsMean pain intensity with the VAS was significantly lower in the auriculotherapy group than the mefenamic acid group in the first and second cycles of intervention. There was a significant difference in VMS grade between both groups during the second cycle of intervention. In terms of the systemic symptoms in the second cycle of intervention, no subjects had dysmenorrhea grade 3 (common systemic symptoms) in the auriculotherapy group. Whereas in the mefenamic acid group, 16.7% of the subjects still had dysmenorrhea grade 3. There was no significant difference between the two groups in the frequency of systemic symptoms of PD. There was a significant decrease in the frequency of fatigue and diarrhea in both groups. However, there was a significant reduction in the frequency of nausea, headache, and anger in the auriculotherapy group.ConclusionMean pain intensity with the VAS was lower with the auriculotherapy. Also, 65.9% of auriculotherapy group subjects were in the dysmenorrhea grades 0 and 1. Therefore, auriculotherapy is recommended because of its fewer complications and more effect on PD.Trial registrationClinicalTrials.gov IRCT20181207041873N1. Registered on February 24, 2019. https://en.irct.ir/user/trial/35967/view

Machine Learning in Pain Medicine: An Up-To-Date Systematic Review.

IntroductionPain is the unpleasant sensation and emotional experience that leads to poor quality of life for millions of people worldwide. Considering the complexity in understanding the principles of pain and its significant impact on individuals and society, research focuses to deliver innovative pain relief methods and techniques. This review explores the clinical uses of machine learning (ML) for the diagnosis, classification, and management of pain.MethodsA systematic review of the current literature was conducted using the PubMed database library.ResultsTwenty-six papers related to pain and ML research were included. Most of the studies used ML for effectively classifying the patients’ level of pain, followed by use of ML for the prediction of manifestation of pain and for pain management. A less common reason for performing ML analysis was for the diagnosis of pain. The different approaches are thoroughly discussed.ConclusionML is increasingly used in pain medicine and appears to be more effective compared to traditional statistical approaches in the diagnosis, classification, and management of pain.

Nurses' perceptions of infants’ procedural pain assessment and alleviation with non-pharmacological methods in Estonia

PurposeThe purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs). Design and methodsA descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods. ResultsMore than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year. ConclusionsThere is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them. Practice implicationsNurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

BackgroundObstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it.MethodsObservational study, based on a cross-sectional design, carried out with data deriving from the study “Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento” (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of–delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients’ profile.ResultsResults have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2.Conclusion(s)Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

Interaction Effects Between BDNF Gene rs6265 Polymorphism and Parental Harsh Discipline on Preschoolers’ Working Memory Performance

In the present study, muscle pain was induced experimentally in healthy subjects by administrating hypertonic saline injections into the tibialis anterior (TA) muscle. We first aimed at comparing the analgesic effects of mechanical vibration applied to either cutaneous or muscle receptors of the TA or to both types simultaneously. Secondly, pain alleviation was compared in subjects in whom muscle tendon vibration evoked kinesthetic illusions of the ankle joint. Muscle tendon vibration, which primarily activated muscle receptors, reduced pain intensity by 30% (p<0.01). In addition, tangential skin vibration reduced pain intensity by 33% (p<0.01), primarily by activating cutaneous receptors. Concurrently stimulating both sensory channels induced stronger analgesic effects (−51%, p<0.01), as shown by the lower levels of electrodermal activity. The strongest analgesic effects of the vibration-induced muscle inputs occurred when illusory movements were perceived (−38%, p=0.01). The results suggest that both cutaneous and muscle sensory feedback reduce muscle pain, most likely via segmental and supraspinal processes. Further clinical trials are needed to investigate these new methods of muscle pain relief.

Effectiveness of Mindfulness on Labour Pain Among Nulliparous Women

The management of labour pain, despite much research in its regard, remains a complex and difficult subject. Mindfulness-based cognitive therapy is addressed as a relatively new method of managing acute pain; however, it is less often used in midwifery. Therefore, the present study was carried out to evaluate the effectiveness of mindfulness-based interventions on labour pain. METHODS: This is a clinical trial study in which 158 women, who referred to childbirth preparation classes, were allocated to two groups using simple randomisation. The intervention group was trained in mindfulness techniques during eight sessions by a trained midwife. Women in the control group received routine pregnancy care. On the day of delivery, the pain intensity and the immediate pregnancy outcomes in both groups were assessed. Data were collected using the Visual Analogue Scale and the delivery checklist. Collected data were then analysed using SPSS (a software package used for statistical analysis) and a Mann-Whitney U test. RESULTS: During admission to the labour ward, the pain intensity among participants in both groups was moderate, and there was no significant difference (0.10). At the beginning of the active phase (4 – 6 cm of dilation), and 7 – 8 cm of dilatation and 9 – 10 cm of dilatation, the pain intensity was significantly lower in women in the intervention group (p=0.001). No difference regarding the maternal and fetal complications in pregnancy was observed between participants in the intervention and control groups. In addition, the need to apply other pain relief methods in participants in the intervention group was significantly less than participants in the control group (p=0.001). CONCLUSIONS: According to the findings of this study, it can be concluded that mindfulness is a successful and uncomplicated method to reduce labour pain. These findings could be used by midwives to provide holistic care to pregnant women.

Evaluation of the effects of cotton roll-biting on debonding pain: a split-mouth study

Introduction: Debonding pain is an unpleasant sensation that is frequently encountered during debonding procedure.&#x0D; Aim of the study: To investigate the effectiveness of cotton roll-biting on pain caused by the debonding procedure.&#x0D; Materials and methods: 102 patients (61 females, 41 males) who were at the debonding stage in orthodontic treatment were included in the research. The study was planned using a split-mouth design: one side of the jaw was the study, and the other side was the control. The anxiety level of participants was measured before debonding. On the study side, debonding was performed while patients were biting a cotton roll. On the control side, debonding was implemented as a routine debonding procedure. Study and control sides were assigned differently in each successive patient. The debonding pain of each tooth was recorded using the Visual Analog Scale prepared separately for each tooth. Shapiro–Wilk and Mann–Whitney U tests were used for statistical analysis. For both gender groups, patients were sequenced according to the average amount of pain per tooth. Subsequently, statistical analysis was repeated by using 50% of patients suffering more pain.&#x0D; Results: In the lower second premolar tooth, a statistically significant difference was detected. Pain scores were statistically higher in the study side for this tooth. No statistically significant differences were found for all other teeth.&#x0D; Conclusions: Cotton roll-biting has no alleviating effect on debonding pain. When debonding is performed gently using a squeezing action without applying torsional forces, additional pain relief methods are not required.

Pain Prevalence, Management and Interference Among University Students in South Korea: An Exploratory Cross-Sectional Study.

BackgroundPain is a global health issue with a significant impact on young adults. Adverse effects caused by inappropriate pain management among university students are related to poor mental/physical health. This study aimed to explore pain prevalence, management, and interference among university students in South Korea.MethodsPain intensity, painful body areas, pain management, and pain interference were measured in a convenience sample of 404 students. Descriptive statistics are reported, and a multivariable binomial logistic regression was conducted to reveal factors associated with pain interference.ResultsThe prevalence of acute and chronic pain was 73.5%, while 7.8% reported chronic pain (≥ 3 months). Half of university students who experienced pain reported at least four painful body areas. The average pain intensity during the past 6 months was 4.8/10. About 56% of university students who experienced pain used over-the-counter pain pills for pain management. Rest and massage were the most used non-pharmacological pain management strategies. Mood was the most reported pain interference complaint amongst university students. Greater pain interference was associated with longer pain duration, more painful body areas, and greater pain intensity.DiscussionPain is highly prevalent among South Korean university students. Pain management programs, including education about appropriate methods of pain relief, should be developed for university students. Attention should be given to university students with widespread acute and chronic pain of high intensity to mitigate the negative impacts caused by pain interference.

Combination of Dexmedetomidine and Bupivacaine for Caudal Anesthesia In Children

Background: Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Aim: To evaluate the efficacy and safety of the caudal use of dexmedetomidine in caudal anesthesia in children. Methods: The subject of the study was 46 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Results: The duration of caudal analgesia was determined from the moment the anesthetic was injected until the moment the child first complained of pain or the time when the first postoperative analgesia was required. The average duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. More data is also needed on the neurological safety of dexmedetomidine. Key words: dexmedetomidine,caudal block, bupivacaine.

Analgesic effect of the main components of Corydalis yanhusuo (yanhusuo in Chinese) is caused by inhibition of voltage gated sodium channels

Ethnopharmacology relevancePain often causes a series of abnormal changes in physiology and psychology, which can lead to disease and even death. Drug therapy is the most basic and commonly used method for pain relief and management. Interestingly, at present, hundreds of traditional Chinese medicines have been reported to be used for pain relief, most of which are monomer preparations, which have been developed into new painkillers. Corydalis yanhusuo is a representative of one of these medicines and is available for pain relief. Aim of the studyThis study aims to determine the analgesic effect and the potential targets of the monomers derived from Corydalis yanhusuo, and to explore any possible associated cardiac risk factors. Materials and methodsIn this study, four monomers derived from Corydalis yanhusuo (tetrahydropalmatine, corydaline, protopine, dehydrocorydaline) were tested in vivo, using the formalin-induced pain model to determine their analgesic properties. Their potential targets were also determined using whole cell patch clamp recordings and myocardial enzyme assays. ResultsThe results showed that all monomers showed analgesic activity and inhibited the peak currents, promoted the activation and inactivation phases of Nav1.7, which indicating that Nav1.7 might be involved in the analgesic mechanism of Corydalis yanhusuo. Protopine increased the level of creatine kinase-MB (CK-MB) and inhibited the peak currents, promoted the activation and inactivation phases of Nav1.5, indicating that Nav1.5 might be involved in the cardiac risk associated with protopine treatment. ConclusionThese data showed that tetrahydropalmatine produced the best analgesic effect and the lowest cardiac risk. Thus, voltage gated sodium channels (VGSCs) might be the main targets associated with Corydalis yanhusuo. This study, therefore, provides valuable information for future studies and use of traditional Chines medicines for the alleviation of pain.

Pain in dementia

Increasing life expectancy of the world’s population is accompanied by increasing number of elderly patients with dementia. According to various studies, the prevalence of pain syndrome in elderly patients with dementia ranges from 35.3% to 63.5%. The review represents data on the epidemiology, clinical manifestations, methods of diagnosis and treatment of pain syndrome in patients with dementia. Medicinal and non-pharmacological methods of pain relief are discussed.

Effectiveness of transverse abdominis plane blocks in abdominal surgery in hernioplasty

BACKGROUND: Transverse abdominis plane (TAP) block is one of the methods of regional anesthesia, which is characterized by injecting a large volume of anesthetic into the fascial space between the internal oblique and transverse abdominal muscles that contains the nerves from Th7 to L1.&#x0D; THIS STUDY AIMED to study the effectiveness and safety of TAP block in hernioplasty and conduct a comparative analysis of the TAP block with general anesthesia and extended epidural anesthesia.&#x0D; MATERIALS AND METHODS: A comparative analysis of 78 patients who underwent hernioplasty was carried out. Patients are divided into three groups (n=26) depending on the features of the anesthesiological aid. The control group had a surgery that was performed in a multicomponent-combined anesthesia setting with total myoplegia and ALV. Group 1 had general anesthesia that was supplemented by TAP, a unit under the United States navigation. Group 2 had general anesthesia in combination with an extended epidural block. The need for narcotic analgesics and the severity of pain syndrome in the perioperative period were determined in the three groups to assess the effectiveness and safety of the method and compare the hemodynamic parameters. The severity of pain syndrome was determined using a visual analog scale (ALV). Changes in hemodynamic parameters were compared to evaluate the safety of the TAP block. The groups were comparable in terms of volume of surgery, age, and sex.&#x0D; STUDY RESULTS: The need for narcotic analgesics was significantly lower in patients in groups 1 and 2 in intra- and postoperative periods than in the control group. Hemodynamic indicators (blood pressure and HS) were characterized by greater stability without significant fluctuations at all major stages of surgery, which indicates the development of adequate analgesia. A significantly decreased intensity of pain syndrome in the group of patients with a TAP block and extended EA was also noted.&#x0D; CONCLUSION: Performing a bilateral TAB unit under ultrasound navigation in hernioplasty is an effective and safe method of perioperative pain relief of patients, which in most cases is a preferred alternative to extended EA.

Fascial-sheath regional anesthesia for operations on the anterior abdominal wall and abdominal organs

The use of central segmental blockades (spinal and epidural) is associated with a large number of contraindications and complications including life-threatening. The combination of general anesthesia with opioids is associated with a slow recovery of the gastrointestinal tract and other side effects of their systemic application. Therefore the search for alternative methods of pain relief in the context of Enhanced Recovery After Surgery protocols is becoming an increasingly relevant research topicn. Relative to central blocks, the fascial sheath block of peripheral nerves under ultrasound guidance is a technically simple and safe technique. This article provides a brief overview of the main blocks used for anesthesia of the anterior abdominal wall.

Examining feedback mechanisms of postural control in Chiari Malformation by average wavelet coefficient decomposition and the Hurst exponent.

Chiari Malformation (CM) is a congenital disorder occurring when the cerebellar tonsils descend into the foramen magnum, inhibiting cerebrospinal fluid (CSF) flow, causing headaches, dizziness, difficulty swallowing, muscle weakness, and loss of neuromuscular coordination. While there is no cure, surgical decompression of the hindbrain is used to alleviate symptoms. Loss of postural control is a main symptom reported by these patients; however, no study has examined postural stability in this cohort of patients. Do patients with CM exhibit impaired postural stability compared to healthy controls?. Twelve female participants diagnosed with CM performed a postural stability test where six participants had undergone decompression (CM-D) surgery while six had not (CM-ND). Participants stood in Romberg fashion on an AMTI force plate according to an IRB-approved protocol. Postural stability measures were quantified by computing Hurst exponents. These values were determined from the Average Wavelet Coefficient method using a level 12 Symlet-2 wavelet to analyze anterior-posterior (AP) center-ofpressure (COP) trajectories in MATLAB. Identical procedures and analyses were performed on healthy control participants with no known neuromuscular disorders. CM participants displayed significantly impaired postural stability compared to healthy controls (p = 0.0002). CM-D participants displayed significantly impaired postural stability compared to CM-ND (p = 0.002). CM-D and CM-ND both displayed significantly impaired postural stability compared to controls (p < 0.0001 and p < 0.003, respectively). Loss of postural stability is considered a main symptom of CM, however no study has previously quantified human postural control in this cohort of patients. Quantifying this relationship can provide further insight to neurologists studying the disorder and to therapists planning rehabilitation and pain relief methods.

Quadratus Lumborum Block is an Effective Postoperative Analgesic Technique in Pediatric Patients Undergoing Lower Abdominal Surgery: A Meta-Analysis

Quadratus lumborum (QL) block has shown promising analgesic efficacy in the adult population in previous meta-analyses. However, the response of the pediatric group to pain stimulation is stronger than that in the adult population, and the management of pediatric pain is constrained by limited available analgesia agents. All data analyzed during this study are collected from published articles. The purpose of our systematic review was to evaluate whether QL block is also an effective postoperative analgesic technique, compared to other analgesic skills in pediatric patients undergoing lower abdominal surgery. A meta-analysis. We identified randomized controlled trials (RCTs) from PubMed, Embase, the Cochrane Library, Web of Science, and Science Direct to compare QL block with other analgesic methods for relief of postoperative pain in pediatric patients undergoing lower abdominal surgeries under general anesthesia. The primary outcome was the rate of postoperative rescue analgesia; secondary outcomes include: pain scores at 30 minutes and 1, 2, 4, 6, 12, and 24 hours postoperatively, patient satisfaction, and block related complications. A total of 7 studies with 346 patients were included. QL block showed a significant reduction in the rate of postoperative rescue analgesia in the first 24 hours (RR = 0.41; 95% CI = 0.28 to 0.59; P < 0.001) compared to other analgesic techniques, without significant heterogeneity among the articles (I2 = 49%, P = 0.08). Compared with other analgesic methods, QL block significantly reduced the pain scores at 2 hours (Std.MD = -0.76; 95% CI = -1.16 to -0.35; P < 0.001) (I2 < 0.001%, P = 0.41), 4 hours (Std.MD = -0.34; 95% CI = -0.67 to -0.01; P = 0.04) (I2 < 0.001%, P = 0.53) and 12 hours postoperatively (Std.MD = -0.95; 95% CI = -1.44 to -0.47; P < 0.001) (I2 = 27%, P = 0.24). No significant differences were found between techniques at 30 minutes and 1, 6, or 24 hours postoperatively (P > 0.05). There was no statistically significant change in patient satisfaction (Std.MD = 0.49; 95% CI = -0.32 to 1.29; P = 0.24) or side effects (RD = -0.02; 95% CI = -0.06 to 0.02; P = 0.31) with QL block. The major limitation of this meta-analysis is the relatively few RCTs and limited results included. Similarly, the differences in block approaches among the control groups (TAP, ESP, caudal block, opioid-based analgesia), drug types and concentrations, and multimodal analgesia programs led to considerable heterogeneity. Furthermore, some relevant outcomes were not investigated. Our systematic review and meta-analysis suggests QL block use for the pediatric population undergoing lower abdominal surgery, based on the current limited research evidence, as this method was an effective postoperative analgesic technique.

Obstetric practices in childbirth care and usual risk birth

Abstract Objectives: to analyze the incidence of obstetric practices in labor and childbirth care at usual risk in a tertiary hospital. Methods: cross-sectional, descriptive study with a quantitative approach. Data were collected from 314 Monitoring Sheets of Labor and Childbirth Care of women who had their birth attended at the institution, from July 2017 to July 2018. The study was approved by the research ethics committee, with the embodied opinion number 2.822.707. Results: most women in the study were between 20 and 34 years old, coming from the city of Fortaleza, Ceará; had completed high school; and had unpaid work. The prevalence of good practices was identified: umbilical cord clamping in a timely manner (81.5%), immediate skin-to-skin contact (73.9%), breastfeeding in the childbirth room (74.2%), freedom of position and movement (72.3%), completion of the partograph (66.6%), presence of a companion (66.2%), offer of a liquid diet (65%), and non-pharmacological methods for pain relief (54.8%). As for interventional practices, we identified: venoclysis (42.4%), oxytocin infusion (29%), and amniotomy (11.1%). Conclusions: advances in the adoption of good practices based on scientific evidence are noteworthy; however, the technocratic model of childbirth care for women at normal risk persists.