Background and Aims:Despite advances in postoperative pain management, patients continue to experience moderate to severe pain. This study was designed to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing major gynecological surgery.Material and Methods:This observational study included postoperative patients having major gynecological surgery from February 2016 to July 2016. Data collected on a predesigned data collection sheet included patient's demographics, postoperative analgesia modality, patient satisfaction, acute pain service assessment of numeric rating scale (NRS), number of breakthrough pains, number of rescue boluses, time required for the pain relief after rescue analgesia, and any complication for 48 h.Results:Among 154 patients reviewed, postoperative analgesia was provided with patient-controlled intravenous analgesia in 91 (59.1%) patients, intravenous opioid infusion in 42 (27%), and epidural analgesia in 21 (13.6%) patients with no statistically significant difference in NRS between different analgesic modalities. On analysis of breakthrough pain, 103 (66.8%) patients experienced moderate pain at one time and 53 (51.4%) at two or more times postoperatively. There were 2 (0.6%) patients experiencing severe breakthrough pain due to gaps in service provision and inadequate patient's knowledge. Moderate-to-severe pain perception was irrespective of type of incision and surgery. Vomiting was significantly higher (P = 0.049) in patients receiving opioids.Conclusion:Adequacy of postoperative pain is not solely dependent on drugs and techniques but on the overall organization of pain services. However, incidence of nausea and vomiting was significantly higher in patients receiving opioids.
Background & Aims: Laparoscopic surgery has been associated with troublesome postoperative nausea and vomiting (PONV) in patients. Various regimens have been tried by the anesthesiologist to prevent PONV in laparoscopic cholecystectomy (LapChole). The primary objective of this study was to determine the role of stimulation of acupoint P6 for this purpose in patients undergoing LapChole at our institution. Methodology: A randomized clinical trial was conducted at the Aga Khan University Hospital, Karachi, Pakistan. The research setting took place at the Post Anesthesia Care Unit (PACU) of the hospital. A total of 84 participants undergoing LapChole, ASA Status I or II, were enrolled and randomly allocated into two groups: 41 in control and 43 in the intervention group. In the intervention group, a commercially available band – PressureRight™ was applied at the wrist and the beads were placed exactly at P6 point. In the control group, the band was applied at the wrist with the beads placed on the dorsal surface. In both groups, acupressure band was applied before the induction of anesthesia in the waiting area of the operating room and continued during the intraoperative period and six hours postoperatively. Measurements: Postoperatively, patients were monitored for postoperative nausea and vomiting at the time of arrival in post anesthesia care unit [PACU], after half hour, three hour and six hours postoperatively using numerical pain scale [NPS] from 1-10 [1=none, 2-5=mild, 6-7=moderate, 8-10=severe] for PONV separately. Main Results: The results of PONV in PACU, at 30 minutes, three hours and six hours postoperatively showed an insignificant difference in intervention and control group. The frequencies of mild to moderate PONV were gradually reduced in both groups but the reduction was more pronounced in the control group than in the intervention group. There were no reported events of severe PONV at three hours and six hours postoperatively in both groups. The use of rescue antiemetics was statistically insignificant between the two groups [P = 0.744]. Conclusions: Our study reports that acupressure at Neiguan P6 point starting before the induction of anesthesia till 6 hours postoperative has no significant role in preventing PONV in patients undergoing laparoscopic cholecystectomy. Rescue antiemetics were required in both groups with a similar frequency. Key words: Acupoint P6; Acupressure; PONV; Laparoscopic cholecystectomy; Antiemetics; Randomized Clinical Trial Ethical approval: AKU No. 5365-ane-ERC-18, dated July 17, 2018 Citation: Hamid S, Butt MN, Rehman A, Afshan G. Stimulation of acupoint P6 before induction of anesthesia to prevent postoperative nausea and vomiting; a randomized control trial. Anaesth. pain intensive care 2022;26(1):96-101. DOI: 10.35975/apic.v26i1.1774 Received: August 6, 2021, Reviewed: October 22, 2012, Accepted: December 15, 2021
Objective: To determine the prevalence of smoking and to evaluate the knowledge about preoperative smoking cessation in patients coming for elective surgery. Method: The cross-sectional study was conducted from July 30, 2019, to March 17, 2020, in the preoperative anaesthesia assessment clinic and surgical wards of Aga Khan University Hospital, Civil Hospital Karachi, and Abbasi Shaheed Hospital, Karachi, and comprised all patients of either gender aged >12 years scheduled for elective surgery having American Society of Anaesthesiologists physical status I-IV. Data was analysed using Stata 13.. Results: Of the 811 patients, 478(59%) were male and 333(41%) were female. The overall mean age was 43.4±16.4 years and mean BMI was 25.0±5.8kg/m2. There were 164(20.2%) smokers in the sample. The overall knowledge about preoperative smoking cessation was significantly associated with the level of education and gender (p<0.05). Conclusion: Smoking in surgical patients was about one-fifth of the overall sample, and knowledge related to preoperative smoking abstinence was significantly associated with educational status and gender. Key Words: Prevalence of smoking, Surgical patients, Knowledge of smoking abstinence.
Background Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.
Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound. Methods: All patients who received peripheral nerve blocks (PNB) as a part of their anaesthesia care, in two years were analysed retrospectively. The data included outcomes of PNB effectiveness, complications and limb conditions after block. PNB effectiveness was assessed by monitoring pain scores at rest and on movement and the requirement of co- analgesia. Complications like numbness, motor block, metallic taste, hypotension, respiratory depression were also assessed. Results: A total of 299 patients received ultrasound guided peripheral nerve blocks. Most common block performed was transversus abdominus plane block (TAP) block (46.5%) followed by supraclavicular block (16.7%). Most common complication observed in the recovery room after PNB was numbness 6.2%. Approximately 70% patients remained pain free; however 16% of the patients had moderate pain on movement at 12 hour post-operatively. Sedation score, sensory block and skin conditions were observed to be normal. Conclusion: This study shows that the complications associated with ultrasound guided regional anaesthesia (UGRA) are very few. With advancements in ultrasound guided technique, further studies are required to evaluate benefits and complications in comparison to conventional techniques. Keywords: Regional anesthesia, ultrasound guided blocks, peripheral nerve blocks Continuous....
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.