Health management is still a challenge in health services. An instrument that can cure pain is easy, easy, with accurate interpretation and can be used by every party involved in pain management. The purpose of this study was to analyze the Numeric Rating Scale (NRS), Visual Analogue Scale (VAS), and Wong Baker Faces Scale (WBFS), which can be interpreted well by postoperative care patients. The research method used was an observational analytic study with a cross-sectional study design that analyzed the scale application (NRS, VAS, WBFS) in patients after elective orthopedic surgery at RSUD Dr. Soetomo Surabaya. This study analyzed primary data of postoperative patients which contained socio-demographic characteristics, type of anesthesia given, pain scores and patient interpretation of pain scales through special instruments. The results showed that 102 research subjects were needed. The pain scale interpretation instrument was declared valid and reliable (Cronbach Alpha> 0.60). Mean pain scores from the VAS scale (4.29), NRS (4.82) and WBFS (4.81). No significant difference was obtained NRS scale and WBFS scale (Sig> 0.05). Mean interpretation of pain scale from the VAS scale (13.62), NRS (17.14) and WBFS (21.33). There was a significant difference in the pain score of the VAS scale against the NRS scale, also the WBFS scale (Sig
Background & Objective: General anesthesia is commonly used during clavicular fracture surgery; however, it has been associated with hemodynamic fluctuations, airway and respiratory problems, stress response, and postoperative nausea and vomiting. We assessed the effectiveness and side effects of ultrasound-guided interscalene block when used for anesthesia and postoperative analgesia for clavicle fracture surgery. Methodology: This study was conducted on 48 patients who were planned for clavicle fracture surgery. Patients were given premedication with midazolam 0.05 mg/kg and pethidine 0.5-1 mg/kg intramuscularly. Patients received ultrasound-guided interscalene block using nerve stimulator and 0.5% ropivacaine 30 ml or bupivacaine 0.375%. Postoperatively, almost all patients received non-steroidal anti-inflammatory drugs (NSAIDs) (COX–1 or COX–2). Postoperative pain was evaluated using a visual analog scale (VAS) at 12, 24, 36, and 48 h postoperatively. Patients received a rescue dose of intravenous fentanyl when the VAS > 4. Block was successful if the surgery was completed without shifting to general anesthesia. The data was analyzed using the T-test and Man Whitney-test using SPSS 20. Result: 95.83% of patients received a successful block. The mean pre-operative VAS was 3.48 ± 1.27 and significantly decreased in the post-operative period; 1.48 ± 0.77 (12 h post-op), 1.79 ± 1.05 (24 h post-op), 1.21 ± 0.41 (36 h postop), and 1.04 ± 0.20 (48 h postoperative) (p=0.000). The preoperative and postoperative mean arterial pressure (MAP) and pulse rate of the patients remained stable. There was no incidence of nausea, vomiting, or other complications. Conclusion: Ultrasound-guided interscalene block is effective and safe as an anesthetic and for postoperative analgesia in clavicle fracture surgery. Key words: Clavicular fracture; Interscalene block; Analgesia; Anesthesia Cittion: Susila D, Laksono RM. Ultrasound-guided interscalene block is effective for anesthesia and postoperative analgesia for clavicle fracture surgery. Anaesth. pain intensive care 2021;26(1):25–30 DOI: 10.35975/apic.v26i1.1762 Received: May 6, 2921, Reviewed: November 5, 2021, Accepted: December 21, 2021
Background: The use of certain opioids associated differently with the incidence of postoperative delirium (POD). Remifentanil and fentanyl are short-acting opioids widely used in surgery; however, studies assessing their relationship with POD incidence are still limited. This study aimed to determine the association of remifentanil and fentanyl uses with the incidence of POD in elective orthopedic surgery patients. Methods: A cross-sectional study was conducted in Surgical Unit at Dr Soetomo General Academic Hospital in Surabaya, Indonesia from August to September 2022. Patients who underwent elective orthopedic surgery and used remifentanil (n=16) and fentanyl (n=14) as postoperative analgesia were enrolled in the study. Delirium was assessed using Confusion Assessment Method-ICU tool (CAM-ICU). The associations of remifentanil and fentanyl use as well as patients’ characteristics with POD incidence were assessed statistically. Results: Our data found that there was no significant difference between the incidence of POD with the use of remifentanil (p=0.125) in orthopedic surgery patients. The total doses of fentanyl and morphine equivalent (of remifentanil or fentanyl) were associated significantly with the POD incidence (p=0.010 and p=0.002, respectively). Other factors associated with POD incidence were the use of bone cement during the surgery (p=0.034), duration of surgery (p<0.001), and bleeding volume during the surgery (p=0.024). Conclusions: Our study showed high dose of fentanyl, use of bone cement, longer duration of surgery, and high bleeding volume have greater risk of developing POD in orthopedic surgery patients.
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