Proper Pain Management Research Articles

Effects of Food on Bioavailability of Analgesics; Resulting Dosage and Administration Recommendations.

To evaluate currently approved analgesics, that is, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and serotonin and norepinephrine reuptake inhibitors (SNRIs) used as analgesics, for 1) differences in pharmacokinetic parameters under fed vs fasting conditions and 2) factors involved in dosage recommendations in relation to food. Systematic review. Food effect on the rate, extent of absorption, or shape of concentration-time profile can alter the onset of action, duration of action, or tolerability of a medication. Based on 79 analgesic products reviewed, food effect dosage recommendations depend on whether an analgesic will be dosed on a regular interval around-the-clock vs on an as-needed basis, the shape of concentration-time profile, steady-state concentrations, the type of meals used in the pharmacokinetic study, and drug administration with regard to food in clinical trials. Overall, most opioids do not have food restriction and are taken without regard to food, with the exception of OPANA products and XTAMPZA ER. For many NSAIDs, food does not affect absorption characteristics, with the exception of ZORVOLEX and CELEBREX. Although NSAIDs are commonly to be taken without regard to food, prescribers recommend administering them with food to reduce their propensity for gastrointestinal adverse events. A larger percentage of anticonvulsants and SNRIs used as analgesics are taken with food to improve their tolerability. Of all analgesic products, seven NSAIDs and six opioids lack food effect information, maybe due to their approval before Food and Drug Administration food effect guidance. Overall, because food effects could alter the onset and/or duration of pain relief, analgesic medication should be used as per labeled recommendations for proper pain management.

Objective Pain Assessment Using Vital Signs

Abstract Pain is considered as an emotional experience and unrestful feeling associated with tissue damage. The feeling of pain occurs when the interpretation starts in brain; as a signal is sent through nerve fiber to the brain. Pain allows the body to prevent further tissue damage. Since there are different ways of expressing and feeling pain, the experience of pain is unique for everybody. In this respect, objective pain assessment is a key step and a major challenge in proper management of pain in different individuals. In this study, we offer a computational solution for objective assessment of pain using vital signs. To this end, we have reported the prediction for existence of pain by calculating the performances of several computational methods that take the sequence of vital signs acquired until pain observation as input. We claim that the use of computational intelligence methods can encourage computer-aided monitoring of pain in a hospitalized environment to a certain degree.

Quality of life of oral and oropharyngeal cancer patients attending a tertiary care institute in Kolkata

Background: Assessment of quality of life (QOL) helps to find out factors associated with disease progression and response to treatment, identify vulnerable groups. The objective of this study was to assess the QOL (based on physical, mental, social, emotional and spiritual dimensions) of oral and oropharyngeal cancer patients.Methods: A hospital based cross sectional study was conducted among 126 oral and oropharyngeal cancer patients attending radio therapy department of Calcutta Medical College. QOL was assessed by using validated Bengali version of two self-administered questionnaires: European Organization for the Research and Treatment of Cancer (EORTC)-30 and EORTC-35.Results: Among total 81 patients, most of the patients (45.67%) had stage III diseases. Median global health score (GHS) for all patients were 41.67. GHS deteriorated with advancement of the diseases (p=0.000), GHS significantly improved with increasing level of education (p=0.019). GHS was poorer among female patients (median for male was 45.66 and for female was 36.45; p=0.178) and patients with oropharyngeal cancer (median for oral cancer was 50.00, oropharyngeal cancer was 41.67, p=0.215). As per EORTC-35, pain was the major symptom for both type of cancer and was more among patients with oropharyngeal cancer.Conclusions: QOL deteriorates with advancement of the disease and is poorer among females. Co-morbidity status does not affect the QOL. Pain is a major problem of cancer patients, which is more with oropharyngeal cancer patients. Early detection of the cancer and proper pain management and counselling with special focus on females can improve the quality of life.

Emergency nurses\xb4 knowledge, attitude and perceived barriers regarding pain Management in Resource-Limited Settings: cross-sectional study

BackgroundPain is a common phenomenon among emergency patients which may lead to chronic pain conditions and alteration of physiological function. However, it is widely reported that proper pain assessment and management, which is often accomplished by adequately trained nurses reduce the suffering of patients. Therefore, the aim of this study was to assess the emergency nurses´ knowledge, attitude and perceived barriers regarding pain management.MethodsA cross-sectional quantitative study design was applied to determine the nurses´ knowledge level, attitude and the perceived barriers related to pain management. Hundred twenty-six nurses from the emergency departments of seven referral hospitals of Eritrea participated in the study. Data were collected in August and September 2017. Both descriptive and inferential statistics were used to summarize and elaborate on the results.ResultIn general, the knowledge level and attitude of the emergency nurses was poor. The participants’ correct mean score was 49.5%. Nurses with Bachelor’s Degree had significantly higher knowledge and attitude level compared to the nurses at the Diploma and Certificate level of professional preparation (95% CI = 7.1–16.7 and 9.4–19.1; p < 0.001) respectively. Similarly, nurses who had previous training regarding pain scored significantly higher knowledge level compared to those without training (95% CI =1.82–8.99; p = 0.003). The highest perceived barriers to adequate pain management in emergency departments were measured to be overcrowding of the emergency department (2.57 ± 1.25), lack of protocols for pain assessment (2.45 ± 1.52), nursing workload (2.44 ± 1.29) and lack of pain assessment tools (2.43 ± 1.43). There was no significant difference in perceived barriers among nurses with different demographic characteristics.ConclusionThe emergency nurses’ knowledge and attitude regarding pain management were poor. Nurses with higher educational level and nurses with previous training scored significantly higher knowledge level. This indicates the need for nursing schools and the ministry of health to work together to educate nurses to a higher level of preparation for pain assessment and management.

Factors associated with chronic pain and non-medical opioid use among people who inject drugs

IntroductionDespite rising morbidity and mortality from the opioid epidemic and other addictions, people who inject drugs (PWID) remain understudied regarding pain outcomes. Data among PWID regarding chronic pain and drug use, including non-medical use of opioids, is largely unknown. We examined the prevalence of chronic pain and drug use for pain in this population. MethodsStandardized surveys captured self-report of demographics, chronic pain, and non-prescription drug use in 203 PWID in an urban syringe services program between April and November 2016. Chronic pain was defined as self-report of chronic pain diagnosis or persistent pains over the past 6 months. ResultsOverall, 47% (95% CI, 40%–54%) of PWID reported chronic pain, while 35% (95% CI, 29%–42%) reported non-prescription drug use of any type for pain. Among those with chronic pain, drug use to treat pain was commonly reported (76%; 95% CI, 66%–83%). Non-medical opioid use did not differ among PWID with or without chronic pain or drug use for pain. A multivariable logistic regression model showed chronic pain was more likely among non-Hispanic whites and those with arthritis, older age, and homelessness. ConclusionsChronic pain serves as an important factor in the persistence of drug use in more than one-third of PWID in this sample. The high prevalence of chronic pain with drug use for pain suggests that proper pain management is likely to be an essential component of preventing or regressing injection drug use in PWID, with data needed on effective interventions for this population.

61. Multi-modal analgesia protocol significantly decreased opioid requirements following lumbar spine surgery: results from a feasibility trial

BACKGROUND CONTEXT Over the past decade, opioid use in the United States has increased rapidly. However, patient satisfaction with pain management has not improved. Instead, with growing number of overdose deaths, over- and misuse of opioids has been declared a public health crisis. Patients presenting for lumbar spine surgery frequently present with pain related to their spine condition, are frequently consuming opioids to treat this pain and, following surgery, this is exacerbated due to disruption of skin, muscle tissue, vertebrae, intervertebral discs, and facet joints. Proper pain management is necessary to reduce pain-related and medication side effects and to promote recovery. While this pain is often treated with opioids, roughly 40% of patient experience suboptimal pain management. Multimodal pain management strategies have been proposed to (1) control preoperative pain; (2) employ nonopioid medication to pre-empt surgical pain; and (3) monitor and control pain intensity before and after surgery. PURPOSE We provide critical evidence that a multi-modal pain management plan for patients undergoing lumbar spine surgery leads to reduction in opioid requirements following surgery and superior pain relief. STUDY DESIGN/SETTING A randomized clinical trial to determine feasibility of comparing two pain management plans. Multimodal Pain Management (MPM): acetaminophen plus gabapentin in the preparation area prior to surgery; preinduction opioid titration with fentanyl until pain is relieved and/or respiratory depression ensues; volatile anesthetic, intravenous ketamine and nitrous oxide during surgery; acetaminophen, valium plus gabapentin during hospitalization; and prescription for acetaminophen, valium plus gabapentin at discharge. Standard postoperative analgesia (SPA) is a protocol directed and clinically appropriate for postoperative analgesia. In this study, standard postoperative analgesia is defined as: oxygen, fentanyl, hydromorphone preceded by an intraoperative general anesthetic of propofol and remifentanil which is often recommended to facilitate intraoperative monitoring (IOM). PATIENT SAMPLE We enrolled 51 participants (2 canceled surgery) and randomized 49 (24 MPM; 25 SPA). Patient sample was 63% white, 55% female, and 60% over the age of 65 years. A majority of patients underwent fusion procedures (70%). There were no demographic or clinical differences between groups. OUTCOME MEASURES The primary outcome measures were postoperative pain scores and analgesic use. METHODS Postoperative pain score (numeric rating scale, 0-10) and narcotic use (total morphine equivalent units [TME] in milligrams) were compared between groups in the post-anesthesia care unit (PACU), postoperative day (POD) 0, POD 1, and following discharge (tablets used). RESULTS Patients in MPM had significantly lower mean pain rating in the PACU, POD 0, and POD 1 compared to SPA (4.1 vs 8.3; 2.7 vs 5.1; and 2.3 vs 4.2; p CONCLUSIONS In our feasibility trial, we were able to demonstrate that patients in MPM experienced significantly less pain following surgery and required less opioid in hospital compared to patients in SPA. These patients may also use less opioid following discharge. It may be important that the intraoperative anesthetic SPA group is typically what is recommended for patients undergoing IOM. A larger, multicenter trial is needed to further examine the impact of MPM on patient outcomes beyond pain and on postoperative opioid use. FDA DEVICE/DRUG STATUS fentanyl (Approved for this indication), acetaminophen (Approved for this indication), valium (Approved for this indication), gabapentin (Approved for this indication), propofol (Approved for this indication), hydromorphone (Approved for this indication), remifentanil (Approved for this indication).

Reality, Delays, and Challenges within Pain Prevalence and Treatment in Palliative Care Patients: A Survey of First-Time Patients at the National Cancer Institute in Mexico.

Cancer is a major burden of disease and a public health problem, as it is one of the main causes of morbidity and mortality worldwide. It is estimated that 25% of cancer patients die without receiving proper pain management. To acknowledge the epidemiological profile of first-time patients at the palliative care service of a referral center, along with the pharmaceutical treatment and social and familiar implications of the treatment costs in first-time patients. A survey including 28 questions was conducted including 490 first-time patients at the National Cancer Institute in Mexico City. Median age was 53 years; 63.3% (n = 310) were females; 72% were married or single (50.5% and 21.2%, respectively). The most frequent diagnoses were gastrointestinal tumors, followed by urological, and skin/soft tissue carcinomas (19.8%, 12.5%, and 12%, respectively). Pain prevalence was 50.4% among the cohort. From the subgroup of participants with pain, 26.7% presented an intensity ≥7. As most patients in our study presented pain, there is a need of strengthening public policy about opioid treatments.

Assessment and Management of Postoperative Pain among Nurses at a Resource-Constraint Teaching Hospital in Ghana.

Background Postoperative pain remains one of the greatest concerns for patients following surgical procedures. Nurses play an essential role in postoperative pain assessment and management, especially within the first few days after surgery. Objective The study investigated how nurses in a resource-constraint hospital in Ghana assessed and managed postoperative pain. Methods This was an explorative qualitative study involving 12 registered nurses practising in the largest referral hospital in Ghana. Data was gathered using a semistructured interview guide. Demographic characteristics of participants were summarized using descriptive statistics. Data were analysed using Kvale's three phases for analysing qualitative data. First, the entire text was read again to identify meaning units which were then condensed. Second, the condensed texts were read again and interpreted. Finally, the condensed data containing similar meaning were coded and then sorted into subthemes. Results It was found that some nurses have never used any pain assessment tool due to lack of standard tool for assessing postoperative pain. The majority of nurses reported that managing pain by using medication was the norm especially in the first 24 hours after surgery. Conclusion Although participants may have some knowledge of assessing and managing postoperative pain, this knowledge was not largely used to manage postoperative pain effectively, partly because of resource constraints. Therefore, there is the need for adequate training and with provision of resources, it is imperative that the use of standardized pain assessment scales could help in the proper assessment and management of postoperative pain in this setting.

Dental anxiety in 18-year-old Norwegians in 1996 and 2016

Objective: To estimate the prevalence of dental anxiety, and to explore factors that may increase the risk of reporting dental anxiety among 18-year-old Norwegians in 2016. A further objective was to report changes in dental anxiety since 1996.Material and methods: An anonymous survey from a strategic sample of upper secondary students (n = 351) in 2016 with high response rate (93%) was compared with the results of an investigation of a similar population conducted in 1996.Results: The prevalence of dental anxiety and dental distrust was reduced from 1996 to 2016. Dental Fear Survey (DFS) from 19 to 8% (p < .001), and Dental Belief Survey (DBS) from 15 to 6% (p < .001). Geer Fear Scale (GFS) which measure phobic anxiety did not show a similar reduction (17 versus 15%, p = .37). Phobic anxiety, avoidance behaviour, self-reported poor oral health and previous experiences of pain were all associated with dental anxiety.Conclusion: The prevalence of dental anxiety was reduced from 1996 to 2016, but 8% still report dental anxiety. Proper pain management and use of behavioural management techniques still needs to be highlighted to prevent development of dental anxiety, avoidance behaviour and poor oral health.

Effect of Adding Dexmedetomidine to Bupivacaine in Ultrasound Guided Rectus Sheath Block: A Randomized Controlled Double-blinded Study

Background: Extended midline laparotomy incision is accompanied by intense pain postoperatively which affects patients’ physiology; therefore, good control of postoperative pain is mandatory to decrease the adverse effects on the body. Ultrasound-guided Bilateral Rectus Sheath Block (BRSB) is one of the options to achieve this goal. Objective: The study aimed to assess the analgesic potency of adding dexmedetomidine to bupivacaine in ultrasound-guided BRSB in cancer patients with a midline laparotomy incision. Methods: Sixty adult cancer patients planned for laparotomies with extended midline incision were included. Ultrasound-guided BRSB was performed immediately after the induction of anesthesia. Patients were classified randomly into two groups; B group, where only bupivacaine was used for BRSB and BD group in whom a mixture of bupivacaine and dexmedetomidine was used. Results: A significant decrease in visual analogue scale scores, total morphine consumption, postoperative nausea and vomiting and postoperative cortisol levels was observed in group BD. Conclusion: Dexmedetomidine as an adjuvant to bupivacaine in US-guided rectus sheath block bilaterally proved to be effective for proper pain management postoperatively in cancer patients after extended midline abdominal incision.

Using intravenous acetaminophen in the reduction of opioids in spinal cord surgeries by patient-controlled analgesia

Background: Proper management of postoperative pain results in improved quality of patient's' life, early postoperative recovery, reduced hospitalization period and decreased treatment costs. Regarding significant efficacy and higher pain relief functions, opioids are amongst the best pain relief drugs. However, use of theses narcotics as pain killers is somehow controversial. Current study investigated the effects of IV acetaminophen in reduced use of opioids in surgeries of spinal cord by PCA method.Methods: Current double blinded clinical trial study performed upon 86 patients of 20-70 years of age who candidate for spinal CD implant with ASA class I or II. Patients randomly divided into two groups of IV Acetaminophen therapy (N=43) and placebo group (N=43) and each group were put equally under general anesthesia in which both received pain pump containing Fentanyl during recovery. Patients were examined regarding pain score, amount of opioid use and request for extra narcotics and the related complications including nausea, vomiting, dizziness, allergy, gastrointestinal bleeding and Ileus every 6 hours for 24 hours and the obtained results were recorded.Results: Regarding VAS, pain was significantly lower during 24 hours of study in IV Acetaminophen group (p&lt;0.05). Mean use of opioid via pain pump was significantly lower in IV Acetaminophen group compared with placebo group (p=0.00). Request for extra doses of narcotics was higher in placebo group while regarding demand for extra pain relief, there was no significant difference between both groups. Regarding other results, no significant difference observed between both study groups.Conclusions: Results of the study indicated that use of a combination of IV acetaminophen along with opioids would be much more effective than use of narcotics alone in postoperative pain control of CD implant surgery of spinal cord and that leads to lower pain score and decreased use of opioids and its related complications.

Opioid Medication Access during Palliative Radiation Therapy

Pain management is a primary goal of care for patients receiving palliative radiotherapy. Historically, minority populations have had less access to proper pain management regimens; it is important to examine whether there are disparities in the setting of palliative radiation pain management. The purpose of this study is to examine the impact of treatment location, minority status, Spanish language preference, and socioeconomic status on access to opioid medications for pain management during palliative radiation treatments. A retrospective study was performed involving patients receiving palliative radiation to the brain, spine, or bone between January 1, 2016 and June 30, 2016. Patients receiving radiation at either a private academic hospital or an adjacent safety-net hospital were eligible for inclusion. Variables analyzed included treatment location, gender, socioeconomic status (SES), age, race, ethnicity, preferred language, comorbidity, and Karnofsky Performance Status (stratified into good, fair, and poor). Patients who received palliative radiation to the brain were analyzed separately from patients who received spine or bone radiation. Opioid access was defined as the presence of an active opioid medication prescription in the electronic medical record during palliative radiation therapy. Univariable (UVA) and multivariable (MVA) analyses were conducted to estimate odds ratios, corresponding 95% confidence intervals, and p-values using a logistic regression model. A total of 145 patients were included in the study. 34.5% (50) of patients received brain radiotherapy and 65.5% (95) of patients received spine or bone radiotherapy. 46.9% of patients were Hispanic, 32.4% of patients were non-Hispanic White, and 18.6% of patients were non-Hispanic Black. 54.0% of brain radiation patients had an opioid prescription during treatment, and 75.8% of spine or bone radiation patients had an opioid prescription during treatment. On MVA for brain radiation patients, less access to an opioid prescription was associated with higher SES vs. lower SES (OR 0.04, p = 0.05) and older age (65+ years old) vs. younger age (<65 years old) (OR 0.01, p = 0.03). On MVA for spine and bone patients, fair (OR 4.52, p = 0.03) and poor (OR 18.3, p = 0.02) vs. good functional status was associated with increased access to opioid medications. Treatment location, minority status, Spanish language preference, and SES had no impact on access to opioid medications during palliative radiation treatment. Instead, functional status played a major role in the receipt of medications for pain control. Continued vigilance is necessary to ensure underserved populations receive adequate pain control during palliative radiation.

The Critical-Care Pain Observation Tool: A useful tool for pain assessment in intensive care units

Pain is a major concern in all intensive care units (ICUs). The proper assessment and management of pain is one of the main goals of patient care in ICUs. Improper evaluation of pain and its over or under treatment can cause significant problems in the process of patient management in ICU. Since most ICU patients are unable to communicate correctly with the ICU team and explain their level of pain, pain assessment can be challenging. Thus, several assessment tools for the evaluation of pain were developed, few of which were validated. Critical Care Pain Observation Tool is a valid and reliable instrument for pain assessment in different ICUs.

Orthopedic Professionals' Recognition and Knowledge of Pain and Perceived Barriers to Optimal Pain Management at Five Hospitals.

Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP’s recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors’ (n = 63) vs. nurses/physiotherapists’ (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments’ pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children’s pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs’ pain competencies/clinical practices in pain assessment and administration of analgesics.

Assessment and pathophysiology of pain in cardiac surgery.

Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.

Neuropathic Pain Experiences of Spinal Cord Injury Patients.

Neuropathic pain (NP) is a common, severe problem that affects spinal cord injury (SCI) patients. Only SCI patients truly understand the impact and extent of this type of pain. The aim of this study was to understand the NP experienced by SCI patients and the influence of this type of pain on their daily life. A qualitative design was used. An interview guide including a semistructured questionnaire and in-depth interviews was conducted with SCI patients with NP in a neurorehabilitation department at a medical center in northern Taiwan. The data were collected using a purposive sampling method. Content analysis was performed on the interview data, which were obtained from 13 SCI patients with NP. Three themes and eight subthemes were identified that described the NP experience of the participants and the influence of NP on their daily life. The three themes included elusive pain (changing and individual pain sensations, erratically haunting threat, and phantom limb sensations), complicated feelings about pain (converting depression into an active attitude toward life, having feelings of anticipation and anxiety about future pain relief, and facing and experiencing pain), and renewed hope (bravely fighting pain and seeking pain relief methods). This study revealed three important themes of NP experienced by SCI patients, including elusive pain, complicated feelings about pain, and renewed hope. Nurses should understand the nature of NP, provide a thorough pain assessment, and design a proper pain management plan to care effectively for patients with NP.

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing Inguinal Hernia or Infra Umbilical Incisional Hernia

Background: since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post operative analgesia. The proper management of post operative pain ensures early ambulation of patients and obviates many postoperative complications. Aim of the Work: to compare the efficacy of transversus abdominis plane (TAP) block versus wound infiltration with local anesthetic agent as regarding postoperative analgesia, its effect on hemodynamic changes (HR, BP) during rest, opioid (pethidine) consumption. The patients included in this study were either of inguinal hernia or infra umbilical incisional hernia. Patients and Methods: after obtaining approval from the medical ethical committee in Ain Shams University, this prospective randomized clinical trial study was conducted in Ain Shams University Hospital. It included fifty adult undergoing inguinal hernia or infra umbilical incisional hernia repair. Results: patients were assigned randomly into two equal groups: Group A: (n = 25) TAP Block: patients received general anesthesia followed by Tap block at the end of the operation. Group B: (n=25) Local Wound Infiltration: patients received general anesthesia followed by local wound infiltration at the end of the operation. Conclusion: bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12 hours and lower total 24-h postoperative opioid and analgesic consumption after inguinal hernia or infra umbilical incisional hernia repair under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Comparison of Ultrasound Guided Transversus Abdominis Plane Block versus Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing Inguinal Hernia or Infra Umbilical Incisional Hernia

Background: since the concept of day case surgeries are getting more popular, surgeons and anesthesiologists are trying their best to provide adequate post operative analgesia. The proper management of post operative pain ensures early ambulation of patients and obviates many postoperative complications. Aim of the Work: to compare the efficacy of transversus abdominis plane (TAP) block versus wound infiltration with local anesthetic agent as regarding postoperative analgesia, its effect on hemodynamic changes (HR, BP) during rest, opioid (pethidine) consumption. The patients included in this study were either of inguinal hernia or infra umbilical incisional hernia. Patients and Methods: after obtaining approval from the medical ethical committee in Ain Shams University, this prospective randomized clinical trial study was conducted in Ain Shams University Hospital. It included fifty adult undergoing inguinal hernia or infra umbilical incisional hernia repair. Results: patients were assigned randomly into two equal groups: Group A: (n = 25) TAP Block: patients received general anesthesia followed by Tap block at the end of the operation. Group B: (n=25) Local Wound Infiltration: patients received general anesthesia followed by local wound infiltration at the end of the operation. Conclusion: bilateral TAP block was effective in reducing postoperative pain scores at rest and movement for 8-12 hours and lower total 24-h postoperative opioid and analgesic consumption after inguinal hernia or infra umbilical incisional hernia repair under general anesthesia, compared to local wound infiltration. This technique can be a promising mode of postoperative analgesia where epidural catheter insertion is contraindicated.

Trackable pill digital technology in PRM & pain: Hype or hope?

Technological advances in the domain of wearable rehabilitation medical technology holds promise to optimize delivery and efficiency of healthcare. In no area of PRM is this more evident than in acute pain management. The combination of wearable technology with a “digital ingestion tracking program” (DITP) embedded within a pain pill may allow patients, caregivers as well as healthcare providers to track ingestion of pills through the web or a smartphone app. Monitoring of pill consumption compliance and adherence may be optimized. This study will explore the DITP system and assess its clinical utility and applicability to rehabilitation medicine. A systematic review of the literature will be presented along with the illuminating case history of a PMR patient who's functional outcome was significantly impacted by the technology. Photos of DITP technology will be shared for didactic purposes. While there are many advantages of DITP including fostering enhanced compliance, improved adherence, empowerment of patients; several disadvantages exist such as cost and potential privacy concerns. DITP can aide physiatrists in the daily management of pain patients by electronic verification of whether the patient has taken their prescribed pill and at what time. For patients on opioid medication, this is immensely important as compliance is a cornerstone of proper pain management. Enforcement and support of statutory safeguards can prevent improper diversion and abuse of pills. In an age of international concern over opioid abuse, DITP may offer an innovative strategy for enforcing proper use of pain medication in PRM.

English

Maternal satisfaction is a means of evaluating quality of maternal health care given in health facilities. The objective was to assess the level of maternal satisfaction and associated factors at Asrade Zewude Memorial Primary Hospital. Cross-sectional study was conducted on 420 clients by systematic sampling method from February 8, 2017 to September 25, 2017. Structured questionnaire that was prepared by Ethiopian Federal Ministry of Health was used. Pre-testing was done prior to the actual data collection process on a sample of 20 respondents and modified accordingly. The study was approved by Asrade Zewude Memorial Primary Hospital Senior Management Committee. The collected data were checked for completeness and consistency before being coded, entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 16. Logistic regression was used to assess the presence of association between dependent and independent variables using SPSS at 95% confidence interval (CI) and 5% margin of error. The study revealed that level of satisfaction among delivering mothers was 88%. Educational level (AOR=2.15, 95% CI=[1.02-3.71]), access to ambulance service (AOR=3.15, 95% CI=[1.02-3.78]), respectful delivery service (AOR=6.85, 95% CI=[4.35-6.95]), welcoming hospital environment (AOR=3.09, 95%CI=[2.30-2.69]), proper labor pain management (AOR=4.51, 95% CI=[3.12-5.01]) and listening to their questions (AOR=3.95, 95% CI=[2.35-4.36]) were independent predictors for maternal satisfaction. Even though most of the participants were satisfied, they still had unmet needs and expectations in the delivery service provider. The identified main determinants were level of education, access to ambulance service, welcoming hospital environment, proper pain management and listening to their questions. Therefore, there is need to improve the care given to maternity and appropriate strategy should be designed to address the unmet needs of mothers delivered in the hospital. Key words: Maternal satisfaction, associated factors, delivery, West Gojjam Zone, Ethiopia.