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Objective:In the literature, there are confusing data about educational tools and device use. Therefore, it is not clear which method is superior to the other. The aim of this study was to evaluate the effects of educational tools on patient-controlled analgesia (PCA) usage in patients undergoing hysterectomy.Methods:Ninety-six patients undergoing hysterectomy were enrolled in the study. Patients were randomly assigned to a group (verbal, brochure, or video) consisting of 32 patients each using the closed envelope method. After operations, all patients were sent to the ward and evaluated with numerical rating scale score for pain at 15th min., 2nd, 4th, 6th, 12th, 18th, 2nd, 4th, 6th, 12th, 18th, 24th hours. Given dose, the number of button presses, presence of nausea and vomiting, and static and dynamic pain scores were recorded. During visits, patients who had a pain score ≥4 were administered paracetamol 1 g IV. Ondansetron 8 mg IV was injected into patients who had nausea and vomiting.Results:No significant differences were determined in resting and dynamic pain scores, number of button presses, and given doses between groups at 15th min., 2nd, 4th, 6th, 12th, 18th, 24th hours.Conclusion:In this study, education type did not affect PCA device use. We believe that whatever method the infrastructure of hospitals is suitable for, should be used for PCA device education.

INTRODUCTION: Patient-Controlled Analgesia (PCA) is an intravenous selfadministration of small doses of opioids (such as morphine) using a programmable pump, The goal of PCA is to efficiently reduce patients' pain at patient's preferred dose and schedule. Thus, we conducted a study to compare patient PCA morphine with intravenous bolus morphine for acute abdominal pain of non-traumatic origin in the emergency department (ED). MATERIALS AND METHODS: A randomised, non-blinded clinical trial was conducted in patients presented with severe acute non traumatic abdominal pain of less than 24 hours requiring opioid analgesic based on numerical pain score of more than seven at triage. The primary outcome was visual analogue pain score (VAS) recorded at 0, 30th, 60th and 120th minutes during the management in the ED and after admission to wards, and the secondary outcomes were total dosage of morphine used and degree of patient satisfaction. RESULTS: A total of 62 participants who fulfilled study criteria were randomized into PCA morphine group or bolus morphine group. The average amount of analgesic used for bolus morphine group was lower compared to PCA morphine (4.23 mg)(s.d 1.89 vs 5.29 mg)(s.d 2.16) (p=0.027). Despite of significant VAS score changes within group analysis, between group repeated measure ANOVA (RMA) VAS score analysis was not statistically significant. [Bolus group (6.7+2.03) compared to PCA group (5.83 + 2.38)](p=0.089). Patient satisfaction was statistically significant for the PCA group [PCA (1.65+0.709) compared to bolus group (2.23+0.920)](p=0.007). CONCLUSIONS: There was no significant difference in pain score reduction between PCA and intravenous bolus of morphine for the management of severe acute non traumatic abdominal pain in ED. However, PCA provided more patient satisfaction and should be considered as an alternative modality of acute pain management in ED. [ABSTRACT FROM AUTHOR]

Background: Opioids provide good analgesic effect in burn patients during acute phase, but these patients may develop tolerance after prolonged exposure. Alternative analgesic strategies such as peripheral nerve blocks appear to provide adequate pain control while sparing opioid-related side effects. The purpose of this study was to evaluate intravenous patient-controlled analgesia (IV-PCA) and continuous peripheral nerve block (CPNB-PCA) in severe burn patients with relatively young age undergoing repeated debridement and large-area full thickness skin graft (FTSG). Methods: The records of victims in dust explosion in Taiwan in 2016 from Chang Gung Memorial Hospital Pain Service Database between 2016 June and 2017 December were evaluated. The patients' demographic data including age, gender, weight, burn area, degree of burn, type of PCA regimen (IV-PCA versus CPNB-PCA), size of FTSG, and adverse effects were collected. Results: The total in-hospital morphine consumption was significantly lower in CPNB-PCA than IV-PCA group. A trend of decrease in numerical rating scores (NRS) was observed for both groups and CPNB group had comparable NRS than IV-PCA group at rest. On movement, CPNB grouped had significantly lower NRS than IV-PCA on post-operative day 3. Conclusion: Our study demonstrated that in patients requiring high dosage of opioid, CPNB may be a suitable alternative for pain control. [ABSTRACT FROM AUTHOR]

Objective: In the literature, there are confusing data about educational tools and device use. Therefore, it is not clear which method is superior to the other. The aim of this study was to evaluate the effects of educational tools on patient-controlled analgesia (PCA) usage in patients undergoing hysterectomy. Methods: Ninety-six patients undergoing hysterectomy were enrolled in the study. Patients were randomly assigned to a group (verbal, brochure, or video) consisting of 32 patients each using the closed envelope method. After operations, all patients were sent to the ward and evaluated with numerical rating scale score for pain at 15th min., 2nd, 4th, 6th, 12th, 18th, 2nd, 4th, 6th, 12th, 18th, 24th hours. Given dose, the number of button presses, presence of nausea and vomiting, and static and dynamic pain scores were recorded. During visits, patients who had a pain score ≥4 were administered paracetamol 1 g IV. Ondansetron 8 mg IV was injected into patients who had nausea and vomiting. Results: No significant differences were determined in resting and dynamic pain scores, number of button presses, and given doses between groups at 15th min., 2nd, 4th, 6th, 12th, 18th, 24th hours. Conclusion: In this study, education type did not affect PCA device use. We believe that whatever method the infrastructure of hospitals is suitable for, should be used for PCA device education. [ABSTRACT FROM AUTHOR]

The American Society for Pain Management Nursing (ASPMN) has reviewed and updated its position statement on the use of authorized agent controlled analgesia (AACA) for patients who are unable to independently utilize a self-dosing analgesic infusion pump, commonly known as patient-controlled analgesia (PCA). ASPMN continues to support the use of AACA to provide timely and effective pain management while promoting equitable care for vulnerable patient populations who are unable to use PCA. ASPMN does not support the use of "PCA by Proxy" in which unauthorized individuals activate PCA for a patient. This position statement includes an updated review of the evidence related to AACA. Clinical practice recommendations for authorized agents, nurses, prescribers, and organizations are provided with an emphasis on the importance of appropriate authorized agent selection, education, diligent patient assessment and medication management. [ABSTRACT FROM AUTHOR]

Background: Adequate postoperative pain relief facilitates rapid recovery by enhancing early ambulation. The aim of the study was a comparison between the efficiency of patient-controlled analgesia via continuous fascia iliaca block and continuous epidural block in patients undergoing total knee replacement under Spinal anesthesia. Patients and methods: A comparative prospective clinical trial was performed upon 48 patients undergoing total knee replacement randomly distributed into two equal groups: Continuous Fascia Iliaca Compartment block (CFICB) and Continuous epidural block (CEB). Two hours after spinal anesthesia, a bolus of 30ml and 10 ml of 0.25% bupivacaine were given in the first and second groups respectively; then patientcontrolled analgesia (PCA) infuser was connected to perineural and epidural catheters and bupivacaine (0.125%) was infused for 48 hrs. postoperatively at a rate of 5 ml/h, the bolus infusion volume was 2ml, and the lockout time was set to 15 minutes. Results: Statistically, the analgesic efficacy and the level of patient satisfaction in both groups were comparable. The mean blood pressure was significantly lower in CEB group in 1st hour after activation of the catheter, however no significant difference at other times. Nausea, vomiting, and urine retention occurred exclusively in CEB group. Success in Rehabilitation and duration of hospital stay were comparable between groups. Conclusion: The efficiency of patient-controlled analgesia via CFICB was comparable with that via CEB for pain relief after total knee replacement. Only, CEB was associated with minimal side effects. [ABSTRACT FROM AUTHOR]

Background: Pain is an everyday challenge during all surgeries and it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Urologic surgeries with lumbar incision are usually associated with acute postoperative pain and restricted mobility. Ultrasound guided nerve block is considered a recent technique for pain management. It provides better visualization of the nerves and reduces the risk for complications e.g. unintended injury to adjacent structures. Aim of the Work: The present study was designed to detect the effectiveness of ESPB for post-operative analgesia in urologic surgeries with lumbar incision and its effectiveness to decrease the use of analgesic drugs requirements compared to PCA. Patietns and Methods: The study was conducted in Ain Shams university Hospitals after approval of the ethics committee and written patients" consent. It included a total of 60 adult patients aged 21-60 years, Scheduled for urologic surgeries with lumbar incision e.g: open nephrectomy. Patients were randomly divided into two equal groups, 30 each, according to the inclusion and exclusion criteria. Group A (n = 30): will receive fentanyl 1-2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation in addition 40 ml bupivacaine 0.25% as a single level unilateral injection for ESPB after induction of anesthesia and before skin incision. Group B (n = 30): will receive only fentanyl 1- 2 mcg/kg during induction of anesthesia and will be maintained by additional boluses of fentanyl 0.5 mcg/kg, also will receive ketrolac 30mg and paracetamol 1gm before extubation and PCA will be started after the end of the surgery. Results: The main finding in this study was that ultrasound guided ESPB at level of thoracic process provides a good analge-sic effect in patients undergoing urologic surgeries with lumbar incision also reduced the total amount of postoperative morphine consumption in comparison to the PCA group, Prolonged the time to first request of analgesia (duration of analgesia), Provided early mobilization, Increase patient satisfaction in first 24 hour and Decrease incidence of nausea, vomiting and constipation due to decrease opioids intake. Conclusion: Ultrasound-guided unilateral ESPB reduced postop-erative morphine consumption, alleviated postoperative pain scores and improved patients" satisfaction in the first 24 hours after urologic Surgeries with Lumbar Incision, without associated any adverse effects or complications like nausea and vomiting, nerve injury, respiratory depression and hematoma formation. The ESPB markably decreased the rate of PONV. This might be because the use of ESPB might have decreased the use of intraoperative opioids. [ABSTRACT FROM AUTHOR]

A common reason for admission to palliative care wards is severe cancer-related pain. The delivery of therapy, an essential component in combating pain, is complicated by boundaries imposed by the law and quality use of medicines standards, which patients do not necessarily face in their own homes. These boundaries significantly delay the time until the patient is relieved of pain. Subcutaneous patient-controlled analgesia (PCA), delivered via a continuous ambulatory drug device, offers a potential method of mitigating these boundaries. This case series describes the experiences of the first four patients treated when subcutaneous PCA was introduced to an Australian palliative care ward and offers comments for consideration for future studies and wider implementation of use. It is noted that although PCA was generally effective overall, considerations about the patient's mental state and pain behaviours should be made before deciding to initiate PCA in lieu of nurse-administered breakthroughs. [ABSTRACT FROM AUTHOR]

Background: Areas of activity with many intersections pose an increased risk for errors and critical incidents. Therefore, procedures for acute pain therapy are potentially associated with an increased risk for adverse patient outcomes.Objective: The aim was to identify and grade the risk of critical incidents in the context of acute pain management.Material and Methods: The register of the nationwide reporting system critical incident reporting system of the Professional Association of German Anesthesiologists, the German Society for Anesthesiology and Intensive Care Medicine and the Medical Center for Quality in Medicine (CIRSmedical Anesthesiology) was screened for incidents concerning pain management. Out of 5365 cases reported nationwide up to 24 March 2020, 508 reports with the selection criterion "pain" could be identified and reviewed and 281 reports (55%) were included in a systematic analysis.Results: Of the 281 reports most came from anesthesiology departments (94%; 3% from surgery departments and 3% from other departments). The reported cases occurred most frequently on normal wards but a relevant proportion of the reports concerned intermediate and intensive care units or areas covered by a pain service (PS). Based on the description of the incident in the report, an involvement of the PS could be assumed for 42% of the cases. In terms of time, most of the events could be assigned to normal working hours (90%) and working days (84%; weekends 16%). The analyzed reports related to parenteral administration of analgesics (40%) and central (40%) or peripheral regional anesthesia procedures (23%) and 13% of the reports related to patient-controlled intravenous analgesia (PCIA; multiple answers possible). Most of the events were caused by technical errors, communication deficits and deviations from routine protocols. A relevant number of the cases were based on mix-ups in the administration route, the dosage, or the active agent. About one third of the sources of error were of an organizational nature, 59% of the cases posed a possible vital risk and in 16% of cases patients had vital complications. The risk grading by risk matrix resulted in an extremely high risk in 7%, a high risk in 62%, a moderate risk in 25% and a low risk in 6% of the cases. Comparing risk assessment of events with involvement of different analgesic methods, multiple medication, combination of analgesic methods or involvement of PS showed no significant differences. Likewise, no differences could be identified between the risk assessments of events at different superordinate cause levels. If more than one overriding cause of error had an impact, initially no higher risk profile was found.Conclusion: Incidents in the context of acute pain management can pose high risks for patients. Incidents or near-incidents are mostly related to mistakes and lack of skills of the staff, often due to time pressure and workload as well as to inadequate organization. [ABSTRACT FROM AUTHOR]

Background and Aims: Our aim was to assess the postoperative analgesia after ultrasound-guided transmuscular “Quadratus lumborum block” (QLB) and lumbar “Erector spinae plane block” (ESPB) in hip surgeries postoperatively. Design: Double-blinded, randomized prospective study. Materials and Methods: Sixty-three patients who underwent hip surgeries were divided into three groups, with 21 patients each. Each group was given spinal anesthesia using 30 ml of 0.5% hyperbaric bupivacaine. After the completion of the surgery, Group I patients were given ipsilateral transmuscular QLB and Group II patients were given ipsilateral lumbar ESPB. No block was given in Group III. In the postanesthesia care unit (PACU), pain was assessed using the Numeric Rating Scale (NRS) scoring. The time of first analgesic requirement and the total postoperatively tramadol consumption in first 24 h was recorded. Results: No significant difference was seen between the three groups pertaining to patient's demographic data, type, and duration of surgery. Statistically significant lower NRS scores were present in QLB group and ESPB group than the control group in the first 24 h (P < 0.001). The total tramadol consumption was significantly more in the control group (346.67 ± 71.37) mg than QLB group (159.05 ± 39.74) mg and ESPB group (190.48 ± 33.83) mg with P < 0.001. Time duration of first analgesic requirement in PACU was 344.05 min, 267.86 min, and 105.24 min for QLB, ESPB, and control group, respectively. Conclusion: In conclusion, both QLB and ESPB provide good postoperative pain control in hip surgeries with QLB providing a better analgesic profile when compared to ESPB.

Background: Prevention and treatment of acute postoperative pain have an important role in improvement of patients conditions. This study aimed to compare between two methods (IV- patient controlled analgesia and Thoracic Epidural Analgesia) in terms of analgesia and surgical complications in patients with upper abdominal surgery. Materials and Methods: In this clinical trial study, the subjects were chosen from the patients referred to Besat hospital in Hamadan for upper abdominal surgery. Sample size in each group was 72 patients. Data was collected by a questionnaire that included assessment of pulmonary function, pain levels (in both quantitative and qualitative scales), postoperative complications, analgesic usage, and patient satisfaction. After all data was analyzed by SPSS V: 21. Results: Postoperative pain during the first 24 hours after surgery was higher in epidural group by using quantitative and qualitative methods but in second 24 hours, pain in this group only by qualitative method was more (Which was statistically meaningful). Complications of analgesic techniques were similar in both groups, but nausea in the PCA group and paresthesia in the epidural group was higher. The respiratory parameters measured didn't show significant differences between two methods. Patient satisfaction was greater in the PCA group but there are no differences between groups in satisfaction of nurses. Conclusion: The PCA method is effective as the thoracic epidural analgesia method in reducing post-operative pain, and since this method is simpler and less expensive, it can be used safely for post-operative analgesia. Also, it's better not to use a thoracic epidural method in patients with spinal, neuromuscular and sensory disorders.

Amaç: Çalışmamızda preemptif oral tramadol-plasebo, tramadol-pregabalin ve tramadol–parasetamol kombinasyonlarının postoperatif tramadol tüketimi üzerine etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntem: Çalışmaya meme küçültme ameliyatı yapılacak, 18-65 yaş aralığında, 60 hasta alındı. Hastalar rastgele üç gruba ayrıldı. Operasyondan bir saat önce her üç gruba tramadol 35 mg oral damla ile grup I’e (n=20) pregabalin 75 mg tablet, grup II’ye (n=20) parasetamol 500 mg tablet, grup III’e (n=20) ise plasebo tablet verildi.Grupların postoperatif 24 saatlik ağrı skorları, total tramadol tüketimleri, ek analjezi ihtiyaçları, ekstübasyon ve derlenme zamanları ve yan etkiler kaydedildi. Bulgular: Vizüel Analog Skala (VAS) 10. ve 60. dakika değerleri grup II’de diğer gruplardan daha düşük saptandı. Tramadol tüketiminde gruplar arasında istatiksel olarak anlamlı farklılık saptanmamış olmakla birlikte tüketilen toplam tramadol miktarı 120 mg  ve 120 mg  olarak gruplandırıldığında grup I’de tramadol tüketimi diğer iki gruptan daha düşük saptandı.Sonuç: Meme küçültme cerrahisinde preoperatif oral yoldan uygulanan pregabalin ve tramadol kombinasyonu ile parasetamol ve tramadol kombinasyonu tek başına tramadole göre postoperatif ağrı skorları, 24 saatlik total tramadol tüketimi ve yan etkiler açısından farklılığa yol açmamıştır.

Abstract Introduction Complete and accurate documentation of opioids administered by patient-controlled analgesia (PCA) pumps is critical for ensuring a high-quality medication record and an accurate conversion of the intravenous (IV) regimen to oral therapy. Incomplete charting of PCA usage through a manual process may be associated with fragmented documentation of delivered therapy affecting the completeness of the medical record and the IV to oral dose conversion. This study is the first to evaluate the association between auto-documentation of opioid administration provided by PCA smart pump—electronic health record (EHR) interoperability and the completion of PCA opioid administration charting tasks. Methods This retrospective cohort study was conducted at Lancaster General Hospital, Lancaster, Pennsylvania. Patients were assigned to pre-auto-documentation (n = 55) or post-auto-documentation groups (n = 58) based on whether they received PCA therapy prior to or after PCA-EHR interoperability was implemented. Charting of PCA therapy included documentation of the number of patient attempts, number of doses given, and total volume infused for both pre- and post-auto-documentation groups. In addition, total dose delivered was documented for the post-auto-documentation group. The overall chart-field completion rate was evaluated as the primary outcome. Individual chart completion percentages were assessed by stratified groups as secondary outcomes. Results PCA smart pump—EHR interoperability with auto-documentation was associated with an increase in overall chart-field completion rate from 69.9 to 97.0% (p

Background: Perioperative pain can negatively impact patient recovery after spine surgery and be a contributing factor to increased hospital length of stay and cost. Most data currently available is extrapolated from adolescent idiopathic cases and may not apply to adult and geriatric populations with thoracolumbar spine degeneration.Purpose: Study the impact of epidural analgesia on pain control and outcomes after adult degenerative scoliosis surgery in a large single-institution series of adult patients undergoing thoraco-lumbar-pelvic fusion.Study Design/setting: Retrospective single-center review of prospectively collected data.Patient Sample: Patients undergoing thoracolumbar fusion with pelvic fixation.Outcome Measures: Self-reported measures: Visual analog scale for pain. Physiologic Measures: Oral pain control requirements converted into daily morphine equivalents. Functional Measures: Ambulation perimeter after surgery, urinary retention and constipation rates.Methods: We retrospectively reviewed patient data for the years 2016 and 2017 before the use of patient controlled epidural analgesia (PCEA), and then 2018 and 2019 after its implementation, for all thoracolumbar degenerative procedures, and compared their postoperative outcomes measures.Results: There were 46 patients in the PCEA group and 37 patients in the intravenous PCA (IVPCA) groups. All patients underwent long segment posterolateral thoracolumbar spinal fusion with pelvic fixation. Patients in the PCEA group had lower pain scores and ambulated greater distances compared with those in the IVPCA group. PCEA patients also had lower urinary retention and constipation rates, but no increased intraoperative or postoperative complications related to catheter placement.Conclusions: PCEA can provide optimal pain control after adult degenerative scoliosis spine surgery, and may promote greater early ambulation, while decreasing postoperative constipation and urinary retention rates. [ABSTRACT FROM AUTHOR]

Background: Nefopam is a non-opioid, non-steroidal, central acting drug used effectively for postoperative pain. The efficacy of nefopam for cancer pain remains unclear. We aimed to evaluate the analgesic efficacy of nefopam for cancer pain in a randomized controlled trial. Methods: Patients with moderate to severe cancer pain (n=40) were randomly divided into two groups. The nefopam group (n=20) received three 20 mg doses of nefopam every 8 hours. The placebo group (n=20) received normal saline. Intravenous patient-controlled analgesia with morphine was given for breakthrough pain for 48 hours. The primary outcome was significant pain reduction. Secondary outcomes were morphine consumption over 48 hours and incidence of side effects. Results: The nefopam group showed pain reduction at 12 hours (65% of patients), 24 hours (80%), 36 hours (85%), and 48 hours (65%). The placebo group showed pain reduction at 12 hours (70%), 24 hours (75%), 36 hours (80%), and 48 hours (60%). However, there were no statistically significant differences between the groups (p>0.05). The median dosage of morphine consumption in 48 hours was lower in the nefopam group (25.5 mg) compared with the placebo group (37 mg), but this was not statistically significant (p=0.499). There were no statistically significant differences in blood pressure and heart rate between the groups. Side effects in both groups were comparable. Conclusions: At dosage of 60 mg in 24 hours, nefopam did not provide significant pain reduction in moderate to severe cancer pain patients. However, there was a trend of reduced opioid consumption. Further studies with larger sample sizes, longer duration, or higher doses of nefopam are warranted. Registration: Thai Clinical Trail Registry (TCTR) ID TCTR20181016001; registered on 12 October 2018.

Context: Good quality analgesia posttotal knee arthroplasty (TKA) contributes majorly to early mobilization and shorter hospital stay. Aim: To compare adductor canal block (ACB) versus local infiltration analgesia (LIA) for postoperative pain relief in patients undergoing TKA. Settings and Design: This prospective, single-blind, randomized controlled trial was undertaken at a tertiary care university hospital. Materials and Methods: Sixty patients of American Society of Anesthesiologists physical status Classes I, II, and III, who received spinal anesthesia for TKA were randomly allocated to two groups. Group A patients had LIA of the knee joint using a mixture of 50 mL of 0.25% bupivacaine, 10 mg morphine (1 mL) and 99 mL of normal saline. Group B patients received ACB using 25 mL of 0.5% bupivacaine under ultrasound guidance. All patients received multimodal analgesia comprising of paracetamol, diclofenac, and patient controlled analgesia with morphine in the first 24 h' postoperative period. The primary outcome measures were first 24 h' morphine consumption and pain scores at 4, 6, 8, 12, and 24 h. The secondary outcome measures were nausea/vomiting, sedation, and patient satisfaction scores. Statistical Analysis: Statistical analysis was performed using the Student's t-test, Mann–Whitney test, and Chi-square test. Results: The 24 h morphine consumption was 11.97 ± 7.97 and 10.83 ± 6.41 mg in the LIA group and ACB group, respectively (P = 0.54). No significant differences were noted either in the pain scores at rest and flexion or secondary outcome measures between both groups in the first 24 h. Conclusion: Single-shot ACB is equally effective as LIA as postoperative analgesia for TKA. [ABSTRACT FROM AUTHOR]

Background and Aims: Our aim was to assess the postoperative analgesia after ultrasound-guided transmuscular "Quadratus lumborum block" (QLB) and lumbar "Erector spinae plane block" (ESPB) in hip surgeries postoperatively. Design: Double-blinded, randomized prospective study. Materials and Methods: Sixty-three patients who underwent hip surgeries were divided into three groups, with 21 patients each. Each group was given spinal anesthesia using 30 ml of 0.5% hyperbaric bupivacaine. After the completion of the surgery, Group I patients were given ipsilateral transmuscular QLB and Group II patients were given ipsilateral lumbar ESPB. No block was given in Group III. In the postanesthesia care unit (PACU), pain was assessed using the Numeric Rating Scale (NRS) scoring. The time of first analgesic requirement and the total postoperatively tramadol consumption in first 24 h was recorded. Results: No significant difference was seen between the three groups pertaining to patient's demographic data, type, and duration of surgery. Statistically significant lower NRS scores were present in QLB group and ESPB group than the control group in the first 24 h (P < 0.001). The total tramadol consumption was significantly more in the control group (346.67 ± 71.37) mg than QLB group (159.05 ± 39.74) mg and ESPB group (190.48 ± 33.83) mg with P < 0.001. Time duration of first analgesic requirement in PACU was 344.05 min, 267.86 min, and 105.24 min for QLB, ESPB, and control group, respectively. Conclusion: In conclusion, both QLB and ESPB provide good postoperative pain control in hip surgeries with QLB providing a better analgesic profile when compared to ESPB. [ABSTRACT FROM AUTHOR]

To determine the efficacy of paracetamol and tramadol analgesia via patient controlled pump and intermittent administration using the Short-Form McGill Pain Questionnaire after L4/L5 discectomy in neurosurgical patients. Fourteen months prospective quantitative study with 200 neurosurgical patients' participation who underwent elective discectomy of the L4/L5 intervertebral disc extrusion. The study was conducted due to a patient-controlled analgesia pump and intermittent analgesia application. Pain was assessed using the Short-Form McGill Pain Questionnaire in the Croatian language during the zero, first, and second postoperative day. Perception of pain was reduced in patient controlled analgesia pump groups after the second measurement during the first postoperative day [95% CI: −3.89, −0.76], regardless of administered analgesic (p< 0.001). After the final measurement, at 7 PM on the second postoperative day, the differences were not significant (p= 0.070). This study results are registered and allocated in the Australian New Zealand Clinical Trials Registry (ANZCTR). Analgesia administration via patient-controlled pump contributes to the alleviation of postoperative pain after L4/L5 disc extrusion surgery regardless of administered analgesic. [ABSTRACT FROM AUTHOR]

Background: Standard protocols or algorithms are considered essential to ensure adequate analgesia. Germany has widely adopted postoperative protocols for pain management including oral opioids for rescue medication, but the effectiveness of such protocols has only been evaluated longitudinally in a before and after setting. The aim of this cohort analysis was to compare the effectiveness of an oral opioid rescue medication algorithm for postoperative management of pain to the gold standard of patient-controlled intravenous analgesia (PCIA). Material and methods: This study compared cohorts of patients of two prospective observational studies undergoing elective total hip replacement. After surgery patients received piritramide to achieve a pain score of ≤3 on the numeric rating scale (NRS 0–10). A protocol was started consisting of oral long-acting oxycodone and ibuprofen (basic analgesia). Cohort 1 (C1, 126 patients) additionally received an oral opioid rescue medication (hydromorphone) when reporting pain >3 on the NRS. Cohort 2 (C2, 88 patients) was provided with an opioid by PCIA (piritramide) for opioid rescue medication. Primary endpoints were pain intensity at rest, during movement, and maximum pain intensity within the first 24 h postoperative. Secondary endpoints were opioid consumption, functional outcome and patient satisfaction with pain management. Results: Pain during movement and maximum pain intensity were higher in C1 compared to C2: pain on movement median 1st–3rd quartile: 6 (3.75–8) vs. 5 (3–7), p = 0.023; maximum pain intensity: 7 (5–9) vs. 5 (3–8), p = 0.008. There were no differences in pain intensity at rest or between women and men in either group. The mean opioid consumption in all patients (combined PACU, baseline, and rescue medication; mean ± SD mg ME) was 126.6 ± 51.8 mg oral ME (median 120 (87.47–154.25) mg ME). Total opioid consumption was lower in C1 than C2 (117 ± 46 mg vs 140 ± 56 mg, p = 0.002) due to differences in rescue opioids (C1: 57 ± 37 mg ME, C2: 73 ± 43 mg ME, p = 0.006, Z = −2.730). Basic analgesia opioid use was comparable (C1: 54 ± 31 mg ME, C2: 60 ± 36 mg ME, p = 0.288, Z = −1.063). There were no differences in respect to the addition of non-opioids and reported quality of mobilization, sleep, frequency of nausea and vomiting, or general satisfaction with pain management. Conclusion: In this study PCIA provided a better reduction of pain intensity, when compared to a standardized protocol with oral opioid rescue medication. This effect was associated with increased opioid consumption. There were no differences in frequencies of opioid side effects. This study was a retrospective analysis of two cohorts of a major project. As with all retrospective studies, our analysis has several limitations to consider. Data can only represent the observation of clinical practice. It cannot reflect the quality of a statement of a randomized controlled trial. Observational studies do not permit conclusions on causal relationships. [ABSTRACT FROM AUTHOR]

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Introduction: Complete and accurate documentation of opioids administered by patient-controlled analgesia (PCA) pumps is critical for ensuring a high-quality medication record and an accurate conversion of the intravenous (IV) regimen to oral therapy. Incomplete charting of PCA usage through a manual process may be associated with fragmented documentation of delivered therapy affecting the completeness of the medical record and the IV to oral dose conversion. This study is the first to evaluate the association between auto-documentation of opioid administration provided by PCA smart pump—electronic health record (EHR) interoperability and the completion of PCA opioid administration charting tasks. Methods: This retrospective cohort study was conducted at Lancaster General Hospital, Lancaster, Pennsylvania. Patients were assigned to pre-auto-documentation (n = 55) or post-auto-documentation groups (n = 58) based on whether they received PCA therapy prior to or after PCA-EHR interoperability was implemented. Charting of PCA therapy included documentation of the number of patient attempts, number of doses given, and total volume infused for both pre- and post-auto-documentation groups. In addition, total dose delivered was documented for the post-auto-documentation group. The overall chart-field completion rate was evaluated as the primary outcome. Individual chart completion percentages were assessed by stratified groups as secondary outcomes. Results: PCA smart pump—EHR interoperability with auto-documentation was associated with an increase in overall chart-field completion rate from 69.9 to 97.0% (p < 0.001). Auto-documentation was also associated with an increase in fully completed charts from 38 to 91% (139.3% increase, p < 0.001) and reductions of incomplete records in each stratified group (p < 0.001). Conclusions: PCA smart pump—EHR interoperability with auto-documentation is associated with significant improvements in the completion of opioid administration chart-fields. Improved documentation of PCA administered opioids may have implications for the safety of opioid administration. Additional studies will be needed to assess the potential clinical impact of these results. Funding: ICU Medical, Inc. [ABSTRACT FROM AUTHOR]

Jae Chul Koh, Young Song, So Yeon Kim, Sooyeun Park, Seo Hee Ko, Dong Woo Han Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Abstract: In this retrospective study, data of 2,435 patients who received fentanyl and ropivacaine-based patient-controlled epidural analgesia (PCEA) for pain relief after elective surgery under general or spinal anesthesia were reviewed. Differences in postoperative pain, incidence of patient-controlled analgesia (PCA)-related adverse effects, and risk factors for the need for rescue analgesics for 48 hours postsurgery in young (age 20–39 years) and elderly (age ≥70 years) patients were evaluated. Although there were no significant differences in postoperative pain intensity between the two groups until 6 hours postsurgery, younger patients experienced greater postoperative pain intensity compared with older patients 6–48 hours postsurgery. While younger patients exhibited greater incidence of numbness, motor weakness, and discontinuation of PCA postsurgery, elderly patients exhibited greater incidence of hypotension, nausea/vomiting, rescue analgesia, and antiemetic administration. Upon multivariate analysis, low fentanyl dosage and history of smoking were found to be associated with an increased need for rescue analgesia among younger patients, while physical status classification III/IV and thoracic surgery were associated with a decreased need for rescue analgesia among the elderly. Discontinuation of PCA was more frequent among younger patients than the elderly (18.5% vs 13.5%, P=0.001). Reasons for discontinuation of PCA among young and elderly patients, respectively, were nausea and vomiting (6.8% vs 26.6%), numbness or motor weakness (67.8% vs 11.5%), urinary retention (7.4% vs 8.7%), dizziness (2.2% vs 5.2%), and hypotension (3.1% vs 20.3%). In conclusion, PCEA was more frequently associated with numbness, motor weakness, and discontinuation of PCA in younger patients and with hypotension, nausea/vomiting, and a greater need for rescue analgesics/antiemetics among elderly patients. Therefore, in order to minimize the adverse effects of PCEA and enhance pain relief, different PCEA regimens and administration/prevention strategies should be considered for young and elderly patients. Keywords: adverse effect, age, elderly, epidural analgesia, pain management, patient-controlled analgesia

Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.

Yao Tsung Lin,1 Kuo Mao Lan,1 Li-Kai Wang,1 Chin-Chen Chu,1 Su-Zhen Wu,1 Chia-Yu Chang,2 Jen-Yin Chen1,3 1Department of Anesthesiology, 2Department of Neurology, Chi Mei Medical Center, 3Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Background: Intravenous patient-controlled analgesia (IVPCA) is a common method of relieving pain which is a risk factor of postoperative delirium (POD). However, research concerning POD in IVPCA patients is limited. Objective: We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. Methods: A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0–10). Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS) (0–10). An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1) is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required. Results: In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, P

Background Penthrox is a handheld inhaler that administers methoxyflurane. Its use is approved for analgesia in moderate-to-severe trauma-related pain in adults in the ED. The literature currently lacks methodologically robust qualitative data on individual patient experiences. Using a structured qualitative study, we set out to address this shortcoming. Methods Five patients were selected as a focus group to identify key themes they felt were important to explore, and these were included in the questionnaire design. We retrospectively identified all uses of Penthrox in the ED from June to August 2021. Qualitative data was gathered using the Trickett short interview method, and responses were grouped into positive and negative descriptors. In addition, quantitative data concerning their experience using the 5-point Likert scale was also gathered. Results A total of 101 participants responded to the questionnaire. Penthrox was utilised mainly for the manipulation of fractures, most commonly those of the ankle and wrist. Around 90% reported an overall satisfaction of ≥ good, and 97% reported the ease of use to be ≥ good. Its analgesic effectiveness was rated as excellent by 52%, and ≥ good by 89%. The most reported side effects were drowsiness (13%) and nausea (7%). The majority reported no side effects (74%). About 94% of the participants said they would take it again if required. An NVivo word cloud (Lumivero, Denver, CO, USA) was created visually, confirming an overall positive experience amongst the patients. Conclusions This study shows that Penthrox is a well-tolerated and user-friendly means of alleviating trauma-related pain in the ED. It highlights the importance of taking into consideration the individual patient journey alongside robust evidence-based data on safety and efficacy for the development of a holistic treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Dias et al.)

Background: Several randomised controlled trials show that maintenance of labour epidural analgesia with programmed intermittent epidural bolus reduces the maternal motor block compared with maintenance with a continuous infusion. However, these trials were usually restricted to healthy nulliparous parturients. To assess the generalisability of these randomised controlled trials to 'real-world' conditions, we compared maternal motor function (modified Bromage score) over time between healthy nulliparous and parous women using routinely collected quality-control data.Methods: After ethical approval, all parturients receiving programmed intermittent epidural bolus labour analgesia between June 2013 and October 2014 were included in this prospective cohort study. Bupivacaine 0.1% with fentanyl 2 μg ml-1 was used allowing for patient-controlled bolus every 20 min. The maternal motor function (primary outcome) was regularly assessed from insertion of the epidural catheter until delivery.Results: Of the 839 parturients included, 553 (66%) were nulliparous and 286 (34%) were parous. The parous women had a shorter median duration of epidural analgesia (3 h 59 min vs 5 h 45 min) and a higher incidence of spontaneous delivery (66% vs 37%). The probability of being in a certain Bromage category at birth was similar in nulliparous and parous women in a general additive model adjusting for duration of epidural analgesia, number of rescue top-ups, and number of catheter manipulations (cumulative odds ratio: 1.18; 95% confidence interval: 0.98-1.41). Parous women required a higher time-weighted number and volume of rescue top-ups.Conclusions: The results of the randomised controlled trials on a reduced motor block with programmed intermittent epidural bolus seem generalisable to parturients typically not included in these trials. [ABSTRACT FROM AUTHOR]

Background: The RemiPCA SAFE Network was established to set standards and monitor maternal and neonatal outcomes when using remifentanil for labour analgesia. The aim of this analysis was to describe the development of the network standard and to report maternal and neonatal outcome data, including severe adverse events.Methods: Data sets of the RemiPCA SAFE Network database from the initial six consecutive years (2010-2015) were retrospectively analysed. The data were analysed on an annual basis and set in context with changes of the network standard, i.e. adaptations of the network's standard operating procedure. Main outcomes reported are maternal and neonatal data regarding effectiveness and safety, such as satisfaction, need for bag/mask ventilation and/or cardiopulmonary resuscitation.Results: Among 5740 data sets, no need for maternal ventilation or cardiopulmonary resuscitation was registered. Neonatal cardiopulmonary resuscitations, potentially related to remifentanil, occurred in 0.3%. In parallel with adaptations of the network standard, a moderate rate of maternal hypoxia (oxygen saturation <94% in 24.7%) was found, together with a low rate of supplemental oxygen requirement in neonates (5.0%).Conclusion: The RemiPCA SAFE Network data show that remifentanil patient-controlled analgesia can be applied safely. There is bias when data from real clinical settings are analysed retrospectively. Notwithstanding, the approach taken by the RemiPCA SAFE Network, with constant, systematic and standardised evaluation of multiple parameters during the course of labour, might identify trends and anomalies and guide the development and application of safety standards, when translating knowledge from scientific trials into clinical practice. [ABSTRACT FROM AUTHOR]

Background: The adductor canal block (ACB) is an effective intervention for postoperative analgesia following total knee arthroplasty (TKA). However, the ideal ACB regimen has not yet been established. We compared the analgesic effects between a continuous ACB group and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) with a single-shot ACB group. Methods: Patients who underwent TKA were randomly allocated to either a continuous ACB group (Group CACB) or IV-PCA with a single-shot ACB group (Group IVACB). Before the surgery, ultrasound guided ACB with 0.5% ropivacaine 20 cc was provided to all patients. Before skin incision, the infusion system (0.2% ropivacaine through an adductor canal catheter in group CACB vs. intravenous fentanyl in group IVACB) was connected. The postoperative pain severity; the side effects of local anesthetics and opioids; administration of rescue analgesics and anti-emetics; and sensorimotor deficits were measured. Results: Postoperative pain severity was significantly higher in the IVACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The averages and standard deviations (SD) of the NRS score of postoperative pain were 0.14 ± 0.37, 4.57 ± 2.37, 6.00 ± 1.63, and 4.28 ± 1.49, respectively in the IVACB group. Rescue analgesic requirements and quadriceps muscle strength were not statistically different between the groups throughout the postoperative period. Moreover, rescue antiemetic requirements were higher in group IVACB than group CACB. Conclusions: In this study, the continuous ACB provided superior analgesia and fewer side effects without any significant motor deficit than the IV-PCA with a single-shot ACB. [ABSTRACT FROM AUTHOR]

Background: The adductor canal block (ACB) is an effective intervention for postoperative analgesia following total knee arthroplasty (TKA). However, the ideal ACB regimen has not yet been established. We compared the analgesic effects between a continuous ACB group and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) with a single-shot ACB group. Methods: Patients who underwent TKA were randomly allocated to either a continuous ACB group (Group CACB) or IV-PCA with a single-shot ACB group (Group IVACB). Before the surgery, ultrasound guided ACB with 0.5% ropivacaine 20 cc was provided to all patients. Before skin incision, the infusion system (0.2% ropivacaine through an adductor canal catheter in group CACB vs. intravenous fentanyl in group IVACB) was connected. The postoperative pain severity; the side effects of local anesthetics and opioids; administration of rescue analgesics and anti-emetics; and sensorimotor deficits were measured. Results: Postoperative pain severity was significantly higher in the IVACB group at 30 min, 4 h, 24 h, and 48 h after surgery. The averages and standard deviations (SD) of the NRS score of postoperative pain were 0.14 ± 0.37, 4.57 ± 2.37, 6.00 ± 1.63, and 4.28 ± 1.49, respectively in the IVACB group. Rescue analgesic requirements and quadriceps muscle strength were not statistically different between the groups throughout the postoperative period. Moreover, rescue antiemetic requirements were higher in group IVACB than group CACB. Conclusions: In this study, the continuous ACB provided superior analgesia and fewer side effects without any significant motor deficit than the IV-PCA with a single-shot ACB. [ABSTRACT FROM AUTHOR]

Introduction: Pain is one of the most dreaded side effects of surgery for the patient during as well as after the surgery. Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control may result in increased morbidity or mortality. Aim: To compare Thoracic Para Vertebral Block (TPVB) and IV PCA (fentanyl) and with IV PCA alone, for postoperative analgesia and also to compare intraoperative and postoperative haemodynamic changes and side effects in patients undergoing open nephrectomy. Materials and Methods: Patients were randomised into two groups, 30 patients in each group. GROUP A: Received preoperative single thoracic paravertebral block (20 mL 0.25% bupivacaine) + General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose -12 microgm, Lockout interval- 20 minutes. GROUP B: Received General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose-12 microgm, Lockout interval-20 minutes. Postoperative pain score, amount of fentanyl consumption, Demand dose and haemodynamic stability was assessed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software. The values were represented in Number (%) and Mean±SD. Results: Group A which received preoperative TPVB and IV PCA showed less analgesia, less fentanyl consumption, less demand dose and better haemodynamic stability in comparison to the Group B which received IV PCA alone (p

Objective: Morphine is commonly used in post-operative analgesia, but opioid-related respiratory depression causes a general reluctance for its use. The "Integrated Pulmonary Index" is a tool calculated from non-invasively obtained respiratory and hemodynamic parameters. The aim of this prospective, randomized, double blind, and placebo-controlled study is to determine a more safe and effective dose for morphine in patient-controlled analgesia following supratentorial craniotomy using the "Integrated Pulmonary Index".Methods: This study included 60 patients (ASA I, II, and III). All patients used iv PCA for 24 h following supratentorial craniotomy. The PCA was set to administer a bolus dose of 1 mg morphine in Group 1 and 0.5 mg morphine in Group 2. The PCA contained placebo in Group 3 and patients received dexketoprofen 50 mg iv after awakening, repeated every 8 h. The IPI and NRS scores, total morphine consumption, and morphine related side-effects were recorded at 10 min, 1, 2, 6, 12, and 24 h post-operatively. The lowest IPI score, count of apnea, and desaturation events were recorded during the study period.Results: The IPI scores were similar among the groups. Although a statistically significant difference was not observed among the groups the lowest IPI scores were observed in Group 1; apnea and desaturation counts were also higher in Group 1. Statistically significant differences were not observed among the groups in terms of pain scores, but were lower in Groups 1 and 2 compared to Group 3.Conclusion: Patient controlled analgesia with 0.5 mg morphine may be safe and effective for pain management following supratentorial craniotomies. Integrated pulmonary index can be used for detecting opioid-induced respiratory depression. Clinical Trials registration number: NCT02929147. [ABSTRACT FROM AUTHOR]

Introduction: Pain is one of the most dreaded side effects of surgery for the patient during as well as after the surgery. Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control may result in increased morbidity or mortality. Aim: To compare Thoracic Para Vertebral Block (TPVB) and IV PCA (fentanyl) and with IV PCA alone, for postoperative analgesia and also to compare intraoperative and postoperative haemodynamic changes and side effects in patients undergoing open nephrectomy. Materials and Methods: Patients were randomised into two groups, 30 patients in each group. GROUP A: Received preoperative single thoracic paravertebral block (20 mL 0.25% bupivacaine) + General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose -12 microgm, Lockout interval- 20 minutes. GROUP B: Received General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose-12 microgm, Lockout interval-20 minutes. Postoperative pain score, amount of fentanyl consumption, Demand dose and haemodynamic stability was assessed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software. The values were represented in Number (%) and Mean±SD. Results: Group A which received preoperative TPVB and IV PCA showed less analgesia, less fentanyl consumption, less demand dose and better haemodynamic stability in comparison to the Group B which received IV PCA alone (p<0.001). Conclusion: TPVB provide excellent and prolonged postoperative analgesia, significantly reduced consumption of rescue analgesia and less demand dose in the postoperative period, good opioid sparing and pre-emptive effect in patients undergoing nephrectomy as compared to iv PCA alone. [ABSTRACT FROM AUTHOR]

Background: supraclavicular Brachial plexus block is an excellent method for attaining optimal operating conditions for upper limb surgeries by producing complete muscular relaxation, maintaining haemodynamic stability and the associated sympathetic block. Aim of the Work: the purpose of this study was to compare Supraclavicular Brachial plexus nerve block to patient controlled analgesia for postoperative pain management in forearm surgeries. Therefore, we performed a randomized study to compare the efficacy of Supraclavicular Brachial plexus nerve block with that of patient controlled analgesia. Patients and Methods: sixty-four patients presenting to Ain Shams University hospitals for forearm surgeries were enrolled in this prospective randomized study after providing written consents. Participants were instructed about the study protocol and visual analogue scale (VAS). Approval was obtained from the research ethics committee of anesthesia and intensive care department, at Ain Shams University. Results: the results of the study revealed that there is significant difference between supraclvicular brachial plexus block and patient controlled analgesia regarding the postoperative analgesia after forearm surgery. Conclusion: there is significant difference between supraclvicular brachial plexus block and patient controlled analgesia regarding the postoperative analgesia after forearm surgery. Significantly better pain control was observed in the supraclvicular brachial plexus block group. Patient satisfaction was greater in the supraclvicular brachial plexus block group. Nausea and vomiting were observed more frequently in patient controlled analgesia group. [ABSTRACT FROM AUTHOR]

PURPOSE: This study was to investigate the effects of the provision of concrete information about patient-controlled analgesia (PCA) in hysterectomy patients. METHODS: Study design was a nonequivalent control group non-synchronized pre- and post-test design. Sixty subjects participated were assigned to experimental group (30 patients) or control group (30 patients) at one university hospital. Concrete information about PCA was composed of three sections: explanation with a leaflet, practice of using PCA, and question and answer session. RESULTS: The experimental group who received concrete information about PCA before surgery had statistically higher knowledge level about PCA, more positive attitude toward pain control analgesia, a lower pain score, and a higher satisfaction level of the use of PCA post-surgery compared to the control group who received general information before surgery. CONCLUSION: Provision of concrete information about PCA was an effective nursing intervention that reduced post-operative pain for patients and increased their satisfaction with using PCA. It is recommended that concrete information about PCA be provided by nurses to promote the use of PCA and consequently reduce patient's pain post-surgery.

Amaç: Bu çalışmada meme kanseri nedeniyle opere olacak olgularda preemptif amaçlı uygulanan oral gabapentinin preoperatif anksiyete ve postoperatif ağrı kontrolü üzerindeki etkilerinin karşılaştırılması amaçlanmıştır. Materyal ve Metod: Çalışmaya yaşları 18-60 yaş arasında değişen ASA I-II grubu toplam 62 meme kanserli olgu alınmış olup çalışma prospektif, randomize ve çift kör olarak yürütülmüştür. Olgular iki gruba ayrılmış ve hepsine preoperatif Sürekli Kaygı Ölçeği uygulanmıştır. Birinci gruptaki olgulara operasyondan bir saat öncesi gabapentin 600 mg tablet oral yoldan verilmiş, cerrahiden hemen önce Durumluluk Kaygı Ölçeği uygulanırken 2. gruptaki olgulara yalnızca operasyon öncesi Durumluluk Kaygı Ölçeği uygulanmıştır. Her iki gruba da postoperatif analjezi amacıyla operasyon bitiminden 30 dk önce 1mg/kg i.v. tramadol uygulanmıştır. Postoperatif ağrıyı değerlendirmek amacıyla postoperatif Vizüel Analog Skala değerleri ile total tramadol tüketimi değerlendirilmiştir. Bulgular: Her iki grubun demografik özellikleri, operasyon süreleri, hemodinamik değerleri ve anksiyete skorları birbirine benzer olup intraoperatif 10. ve 60. dakikalarda ölçülen kalp atım hızı değerleri, postoperatif 24 saatte toplam tramadol tüketimi, postoperatif 5., 10. dk ve 6. saat dışındaki VAS değerleri gabapentin verilen grupta kontrol grubuna göre anlamlı düzeyde düşük bulunmuştur (p

Purpose: The goal of this study was to evaluate the effect of pre-emptive gabapentin administration on anxiety and on postoperative tramadol requirement in patients undergoing breast cancer surgery. Material and Methods: After obtaining the local ethics committee approval and written informed consent, sixty-two patients with ASA physical status I-II aged 18-60 years and scheduled for breast cancer surgery were included into our study. They were randomly allocated into two groups. As control group did not receive premedication, the other group received 600 mg gabapentin per orally. We performed STAI-2 (The State-Trait Anxiety Inventory-2) and preoperatively STAI-1 (The State-Trait Anxiety Inventory-1) in both groups. Heart rate, systolic and diastolic blood pressure were recorded intraoperatively. 30 minutes before the end of surgery, 1mg.kg-1 tramadol was administered intravenously for postoperative analgesia. Patient controlled analgesia device was used intravenously to provide postoperative analgesia. Postoperative VAS scores and postoperative tramadol requirement at 5, 10, 15, 30, 45th and 60th minutes and at 4, 8, 12, 24th hours were recorded. Results: Demographic data, hemodynamic values during the surgery, and anxiety scores were not different between two groups. Heart rate at 10th and 60th minutes intraoperatively, tramadol requirement and VAS scores postoperatively were significantly reduced in gabapentin group compared with control group (p

Opiate concentration in the effect compartment of the brain (OCEC) determines both, the pain control and the side effects. This concentration can be estimated using pharmacodynamics models; however, these models do not predict OCEC when delivery of the drug is random. We are proposing to use stochastic hybrid automata for the verification of individualized model of patient's drug demands and model of patient's pharmacokinetics for the estimation of OCEC, and to express results as the probability of falling below the minimum effective analgesic concentration (MEAC) and/or probability of exceeding toxic concentration threshold. Patient controlled analgesia (PCA) model was based on the stochastic hybrid automata, while the verification of the model was done using UPPALL-SMC tool. The suggested approach allowed for quantitative prediction of the OCEC. [ABSTRACT FROM AUTHOR]

Study objective: The aim of this article is to highlight the rare serious complication of labour analgesia with remifentanil, describe its solution and provide an overview of the efficacy and safety of remifentanil in 2012−2014 in the hospital, where the use of remifentanil in childbirth is a the analgesic method of choice. Study design: Case report and retrospective audit. Setting: Regional Hospital. Material and methods: With the approval of the Ethics Committee Karlovy Vary Regional Hospital we aimed to enroll parturients who laboured in the Sokolov Hospital and their labour pain was relieved with remifentanil. The objective was to verify whether the application of labour analgesia with remifentanil will decrease pain intensity by 2 or more based on the visual analogue scale. Maternal satisfaction with the analgesic method was evaluated by five-percentile range. All complications associated with the analgesia were recorded.Results: We enrolled 66 parturients (13−39 years) in the period 2012−2014. There was a statistically significant difference in pain intensity after the remifentanil administration (decrease VAS ≥ 2, p = 0.006). Satisfaction with the analgesic method was 82.4%. Except of described case report of cardiac arrest with successful administration of naloxone during resuscitation, there were no serious complications associated with the application of remifentanil labour analgesia. Conclusion: Introduced regimen of obstetric analgesia with remifentanil led to the reduction in the intensity of labour pain at a high rate of maternal satisfaction. Case report pointed out the need for availability of remifentanil antidote in the delivery room and on the importance of rapid availability of anaesthesia team. [ABSTRACT FROM AUTHOR]

Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search. [ABSTRACT FROM AUTHOR]

Introduction:Sufentanil is a highly selective µ-opioid agonist commonly used by intravenous and intrathecal routes for acute pain. Sublingual sufentanil formulation for patient controlled analgesia (PCA) uses an innovative administration device that suspends a 15 µg nanotablet with a fixed lockout interval. The system is a non-invasive, less burdensome method of opioid delivery compared to intravenous and intrathecal routes. Sublingual nanotablet PCA transmucosal bioavailability is 59% and the meaningful analgesic onset time is 60 minutes. Areas covered:This paper focuses on the effectiveness, safety and feasibility of sufentanil PCA sublingual formulation for the management of postoperative pain. The paper is based on PubMed searches and the European Medicine Agency assessment report. Expert commentary:Under-treatment of acute pain is a substantial clinical problem. The initial experiences with the sublingual delivery system are encouraging. Sufentanil sublingual nanotablets intended for PCA device use are approved in Europe, and approval is pending in the United States. [ABSTRACT FROM PUBLISHER]

Amaç: Meme küçültme operasyonlarında postoperatif ağrı kontrolünde rutin uygulanan yöntemlerden birisi intravenöz yoldan hasta kontrollü analjezi (HKA) ile tramadol uygulamasıdır. Biz bu çalışmada meme küçültme operasyonu uygulanan hastalarda preemptif oral gabapentin/tramadol ile parasetamol/tramadol kullanımının postoperatif tramadol tüketimi üzerindeki etkilerinin karşılaştırılmasını amaçladık. Materyal ve Metod: Çalışma yaşları 18 - 65 arasında, ASA I-III grubu 54 hastada yapıldı. Hastalar rastgele üç gruba ayrıldı. I.Gruba; operasyondan bir saat önce gabapentin 600mg tablet ve tramadol 35mg damla, II. Gruba; operasyondan bir saat önce parasetamol 500mg tablet ve tramadol 35mg damla, III. Gruba (Kontrol grubu); operasyondan bir saat önce tramadol 35mg damla verildi. Her üç gruba da operasyon bitiminden 30 dakika önce 1mg/kg iv tramadol ve 10mg metoklopramid HCl, operasyon bitiminde postoperatif hasta kontrollü analjezi (HKA) uygulaması ile tramadol (100cc %0,09 serum fizyolojik içerisine 300mg konulup, 0,2mg/kg HKA doz, 15 dk kilitli kalma süresi) infüzyonuna başlandı. Grupların peroperatif SpO2, KH, SKB, DKB, ekstübasyon, göz açma, sözlü uyaranlara yanıt süreleri, postoperatif ağrı skorları(VRS, VAS), toplam tramadol tüketimi, ek analjezik ihtiyacı ve yan etkileri (bulantı, kusma, çift görme, sersemlik) not edilerek değerlendirildi. Bulgular: Grupların demografik özellikleri, operasyon süreleri, ekstübasyon, göz açma, sözlü uyaranlara yanıt süreleri, peroperatif SpO2, KH, SKB değerleri postoperatif ağrı skorları (VRS, VAS), toplam tramadol tüketimi birbirine benzerdi. Peroperatif 2. saatteki DKB değerlerinin ve postoperatif 12. saatteki ek analjezik gereksiniminin II. Grupta diğer gruplar ile karşılaştırıldığında daha yüksek olduğu bulundu. Yan etkiler karşılaştırıldığında gruplar arasında çift görme dışında anlamlı fark yoktu. Çift görme sıklığı I. Grupta daha yüksek bulundu. Sonuç: Meme küçültme operasyonlarında preemptif oral yoldan uygulanan tramadol/gabapentin, tramadol/parasetamol ve düşük doz tramadolün (35mg) intraoperatif hemodinamiyi etkilemediği, postoperatif HKA ile kombine edildiğinde postoperatif ağrı skorlarının ve 24 saatlik total tramadol tüketiminin ve 12. saat dışında ek analjezik gereksiniminin fark göstermediği, gabapentin grubundaki çift görme dışında yan etkilerin benzer olduğu kanısına varılmıştır. Anahtar Kelimeler:

Purpose: Application of tramadol by intravenous patient controlled analgesia (PCA) is a routine method for controlling postoperative pain in the breast reduction operations. It was aimed to compare the efficacy of preemptive oral gabapentin/tramadol and parasetamol/tramadol combination usage on the postoperatif tramadol consumption in patients undergoing breast reduction operation. Material and Methods: Our study was held on 54 patients (ASA I-III, aged between 18-65 yr) undergoing breast reduction operation. Patients randomly divided into three groups. Group I were received 600mg tablet gabapentin and 35mg drop tramadol one hour before the operation. Group II were received 500mg tablet parasetamol and 35mg drop tramadol one hour before the operation. Group III (Control group) were received 35mg drop tramadol one hour before the operation. 30 minutes before the end of operation, 1mg/kg i.v. tramadol and 10mg metoklopramid HCL three groups were administred. After the end of operation, three groups were started to receive tramadol infusion and intravenous patient controlled analgesia (PCA) application (300 mg diluated with 0,09% 100cc SF, 0,2 mg/kg PCA, 15 min locked in time). Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects (nausea and vomiting, diplopia, dizziness) were recorded and evaluated. Results: Peroperative SpO2, KH, SKB, DKB, extubation, disillusion, response time to the verbal stimuli, postoperative pain scores (VRS, VAS), total tramadol consumption, additional analgesic need and side effects of groups were similar to each other. Peroperative second hour DKB values and postoperative twelfth hour additional analgesic need of second group was found higher compared to other groups. There were no significantly differences in the groups except diplopia. It was found higher in favour of the first group. Conclusion: Application of tramadol/gabapentin, tramadol/parasetamol and low dose tramadol (35mg) in patients undergoing breast reduction operation did not affect intraoperative hemodinami. The tramadol combined with postoperatif HKA also does not cause any differences among postoperative pain scores, 24 hours total tramadol consumption and additional analgesia need except twelfth hour. It was concluded that the side effects in group applied gabapentin were similar except diplopia. [Cukurova Med J 2013; 38(3.000): 417-425]