Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

Background and objectives: Post-operative airway symptoms can be troublesome to patients following an uneventful general anesthesia with endotracheal intubation. In this study, we compared the effectiveness of lubricating an endotracheal tube with betamethasone gel or lidocaine jelly with using an unlubricated tube in reducing the incidence and severity of postoperative sore throat, hoarseness and cough.Methods: This was a prospective, randomized, single-blind comparative study carried out among 120 ASA I and II patients aged 18-65 years undergoing elective surgery under general anesthesia with endotracheal intubation. Patients were randomly divided into three groups of 40 patients each. Endotracheal tube used for patients in group C was unlubricated, while that for group B and group L were lubricated up to 15 cm mark with 2.5 ml of 0.05% betamethasone gel or 2% lidocaine jelly respectively. Incidence and severity of postoperative sore throat, hoarseness and cough were observed at 1, 6 and 24 h following extubation. Results:At 24 h following extubation, group B had the lowest incidence of postoperative sore throat among the three groups (group B: 12.5% vs group L: 37.5% vs group C: 25%; p = 0.036). Severity of postoperative sore throat at 24 h was less with betamethasone (score 0: 87.5%, 1: 10%) compared with lidocaine (score 0: 62.5%, 1: 37.5%) and control (score 0:75%, 1: 20%) (p = 0.006). Observations at other times and of other variables were comparable. Conclusion:Wide spread application of 0.05% betamethasone gel to lubricate the endotracheal tube significantly reduces the incidence and severity of sore throat at 24 h of extubation but not of hoarseness or cough.

IntroductionThe rapid increase of COVID-19 cases since the beginning of May 2020, imposition of lockdown, and preparation activities to detect, manage and treat COVID-19 in public hospitals have impacted on the provision of non-COVID health care services resulting in increased morbidity and mortality in Nepal. This study aims to explore challenges in providing non-COVID as well as COVID-19 health care services through public hospitals in Eastern Nepal.MethodsA qualitative study with 25 key informants from three public hospitals in Eastern Nepal was conducted. Key informants were health care workers (HCWs) and managers of the hospitals. A thematic analysis was carried out to identify challenges in providing non-COVID and COVID-19 health care services.ResultsWe identified four themes: weak implementation; weak co-ordination and management; low accountability of HCWs and staff; and risk of infection and stigma as the challenges to provide COVID-19 health care services. We identified three themes: maintaining safety measures in hospitals, managing patients, and fear of infection as the challenges in provision of non-COVID health care services. Inadequate resources and HCWs, lengthy procurement process, and poor jobs specification were the main reasons for weak implementation. HCWs stated weak hospital administration while managers and focal persons complained of low accountability of HCWs and staff to manage COVID-19 health care services.ConclusionIn addition to inadequate resources; the risk of infection of COVID-19, maintaining safety measures in hospitals, ensuring clear leadership and governance, and preparing motivated and accountable HCWs and staff to get ‘work done’ are unique challenges observed in the study hospitals; and consequently need to be addressed.

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