Advances in nonpharmacologic interventions for operative puncture pain in children

Venipuncture is an indispensable nursing procedure for intravenous infusion,but it is also an invasive procedure that is highly resisted by hospitalised children due to pain or fear.Non-pharmacological interventions are widely used in clinical practice due to their low cost,low risk and simplicity.This article provides a review with the aim of providing a reference for the selection of optimal analgesic interventions in the future.

Effect of Transverse Abdominis Plane Block on Chronic Post-Operative Pain—A Review

Chronic post-operative pain is a recognized adverse consequence of surgery;managing and preventing it are always a better choice. Proper choice of Anesthetic technique, use of combined anesthesia and pre-emptive analgesia may prevent and decrease the incidence of chronic post-operative pain. Transverse abdominis plane block (TAP Block) is a regional anesthesia technique following abdominal surgeries which involve injection of a large amount of local anesthetics in TAP, an anatomical space between the internal oblique and transverse abdominis muscle. The aim of this review is to show the effect and uses of TAP block as a combined anesthesia and multimodal analgesia in preventing chronic post-operative pain.

Strengthening Post-Operative Pain Assessment in Patients with Major Abdominal Surgery, University Teaching Hospitals, Zambia

Systematic, routine pain assessment using standardized clinical guidelines is the foundation of effective pain management for patients who are unable to self-report pain. In Zambia, there are no context appropriate standardised clinical guidelines for post-operative pain observations. This study sought to develop such a clinical guideline in form of an assessment tool. The study adopted an exploratory sequential mixed method through a three-phased approach and an adapted Clinical Decision Making Survey instrument was used. Snowball sampling was employed and in phases II and III, purposive sampling was used. The study was conducted at the University Teaching Hospitals where 120 participants were enrolled in the study. Phases II and III provided preliminary internal validation processes of the developed tool, where discussions, orientation and trial implementation of the tool were done. In phase II of the study, 47 participants comprising of nurses participated while in phase III, there were 11 nurses and 32 participants. The results yielded the first ever standardised post-operative pain assessment tool for patients with major abdominal surgery in Zambia. The tool is made up of six dimensions of the identified nonverbal indicators of post-operative pain in patients with major abdominal surgery namely: facial expressions, mobility, activity intolerance, behavioural disturbance, communication ability and vital signs. The present study showed that the developed post-operative pain assessment tool for Zambia is acceptable for use among patients who have had major abdominal surgery and can facilitate improved post-operative pain management for most patients.

The Utility of Telemedicine to Manage Post-Operative Pain

Telemedicine is defined as practicing medicine via a virtual interface, including email, telephone calls, text messages, video chatting, and personalized online programs. Telemedicine has increased over the past few decades, mainly in psychology and primary care. Recently, surgical specialties have also begun to utilize telemedicine for post-operative care. There are many studies examining telemedicine’s use in managing post-operative pain. This review paper focuses on 17 on postoperative pain management. They found that telemedicine can assist physicians in managing post-operative pain remotely by increasing adherence to post-operative regimens (p < 0.001), providing greater individualized care (p = 0.01), and decreasing post-operative pain medication dependence (p = 0.04).

Persistent post-surgical pain and neuropathic pain after total knee replacement

AIM: To study the prevalence of persistent post-surgical pain(PPSP) and neuropathic pain(NP) after total knee replacement(TKR).METHODS: MEDLINE and Embase databases were searched for articles published until December 2014 in English language. Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis, and measured pain with pain specific instruments. Studies that referred to pain caused by septic reasons and implant malalignment were excluded. Both prospective and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review.RESULTS: The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP. The reported prevalence of PPSP and NP seems to be relatively high, but it varies among different studies. There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement. The prevalence of PPSP is ranging at 6 mo from 16% to 39% and at 12 mo from 13.1% to 23% and even 38% of the patients. The prevalence of NP at 6 mo post-operatively is ranging from 5.2% to13%. Pre-operative factors related to the development of PPSP also differ, including emotional functioning, such as depression and pain catastrophizing, number of comorbidities, pain problems elsewhere and operations in knees with early grade of osteoarthritis.CONCLUSION: No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies.

The Impact on the Level of Anxiety and Pain of the Training before Operation Given to Adult Patients

Aim: The aim oh this study was to detrmine the effects of different training programs implemented before inguinal hernia operation on the pre- and post-operation anxiety level of and pain level the patient. Material and method: This quasi experimental study was carried out with inguinal hernia patients 18 - 60 years who were hospitalized in the General Surgery Clinic of Hospital of Atatürk University and Süleyman Demirel Medical Centre in Erzurum for inguinal hernia operation. The study data were collected between November 2007-May 2008 from a total of 90 patients. 30 patients were in the control group, 30 were in the video (VCD) training group, and 30 were in the booklet training group. Data were collected by means of a questionnaire about the patients and the inventory of state anxiety fort he adult. In collecting data, patient introduction form and Spielberger’in State-Trait Anxiety Inventory, and visual analogue scale (VAS) were used. In data assessment, T-test, Pearson correlation test, Mauchly’s variance analysis, Anova for repeated measures tests and Bonferroni Correction Analysisi were used. Results: In control, booklet and VCD groups, In group Situational Constant Anxiety score average was found significant in each three time periods (p < 0.001). When the pain situations of the patients after operation was considered, the distinction in Visual Analogue Scale and Verbal Rating Scala values of two groups in all measurement times was found significant (p<0.001). Conclusion: In the conclusion of the study, it was found out that the given education effective on level of pain and anxiety score for experimental groups of patients.

OBSERVATION ON THERAPEUTIC EFFECTS OF ACUPUNCTURE IN 206 CASES WITH POSTOPERATIVE COMPLICATION OF ANUS AND INTESTINE

The authors have treated postoperative complication of anus and intestine by usingacupuncture at main point Chengshan(BL 57) with cool-producing needling manipulation. Therapeuticeffects of the treatment on postoperative severe pain, retention of urine, constipation, and bleedingwere observed clinically. Results indicated that the cure rate was 97. 6 % and the total effective ratewas 100%. Strong stimulation of Chengshan(BL 57) point improved mainly postoperative edema,spasm, local edema. The improvement of hyperemia and spasm is a ma jor factor of curing various postoperative complication of the anus and intestine. The therapeutic method has advantages of using lesspoints, rapidly producing effects, shorter therapeutic course, suffering little for patients, and no sideeffect.

Effect of hyperthermia combined with opioids on cancer pain control and surgical stress in patients with gastrointestinal cancer

BACKGROUND Surgical palliative surgery is a common method for treating patients with middle and late stage gastrointestinal tumors.However,these patients generally expe-rience high levels of cancer pain,which can in turn stimulate the body’s stress and undermine the effect of external surgery.Although opioid drugs have a signifi-cantly positive effect on controlling cancer pain,they can induce adverse drug reactions and potential damage to the body’s immune function.Hyperthermia therapy produces a thermal effect that shrinks tumor tissues.However,its effect on relieving the pain of middle and late stage gastrointestinal tumors but also the stress of surgical palliative surgery remains unclear.AIM To investigate the effect of hyperthermia combined with opioids on controlling cancer pain in patients with middle and late stage gastrointestinal cancer and evaluate its impact on surgical palliative surgical stress.METHODS This was a retrospective study using the data of 70 patients with middle and late stage gastrointestinal tumors who underwent cancer pain treatment and surgical palliative surgery in the Ninth People’s Hospital of Suzhou,China from January 2021 to June 2024.Patients were grouped according to different cancer pain control regimens before surgical palliative surgery,with n=35 cases in each group,as follows:Patients who solely used opioid drugs to control cancer pain were included in Group S,while patients who received hyperthermia treatment combined with opioid drugs were included in Group L.In both groups,we compared the effectiveness of cancer pain control(pain score,burst pain score,24-hour burst pain frequency,immune function,daily dosage of opioid drugs,and adverse reactions),surgical palliative indicators(surgery time,intraoperative bleeding,stress response),and postoperative recovery time,including first oral feeding time,postoperative hospital stay).RESULTS Analgesic treatment resulted in a significant decrease in the average pain score,burst pain score,and 24-hour burst pain frequency in both Groups L and S;however,these scores were statistically significantly lower in Group L than in Group S group(P<0.001).Analgesic treatment also resulted in significant differences,namely serum CD4+(29.18±5.64 vs 26.05±4.76,P=0.014),CD8+(26.28±3.75 vs 29.23±3.89,P=0.002),CD4+/CD8+(0.97±0.12 vs 0.83±0.17,P<0.001),between Group L and Group S,respectively.The daily dosage of opioid drugs incidence of adverse reactions such as nausea,vomiting,constipation,and difficulty urinating were statistically significantly lower in Group L than those in group S(P<0.05).Furthermore,palliative surgery time and intraoperative blood loss in Group L were slightly lower than those in Group S;however,the difference was not statistically significant(P>0.05).On the first day after surgery,serum cortisol and C-reactive protein levels of patients in group L and group S were 161.43±21.07 vs 179.35±27.86 ug/L(P=0.003)and 10.51±2.05 vs 13.49±2.17 mg/L(P<0.001),respectively.Finally,the first oral feeding time and hospitalization time after surgery in group L were statistically significantly shorter than those in group S(P<0.05).CONCLUSION Our findings showed that hyperthermia combined with opioids is effective in controlling cancer pain in patients with middle and late stage gastrointestinal tumors.Furthermore,this method can reduce the dosage of opioids used and minimize potential adverse drug reactions,reduce the patient’s surgical palliative surgical stress response,and shorten the overall postoperative recovery time required.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

基于肌肉激活的斜方肌平衡训练对偏瘫肩痛患者上肢运功功能及神经电生理的影响

目的:本研究探讨斜方肌平衡训练对卒中偏瘫后肩痛患者上肢运动功能及神经电生理的影响。方法:选取2021年10月~202 3年11月在广东省第二中医院康复科住院且符合纳入标准的卒中偏瘫后肩痛患者144例,随机分为对照组和观察组各72例。两组患者均采用常规用药及神经发育学治疗,对照组在此基础上采用肩胛带的稳定性训练,观察组在对照组的基础上采用斜方肌平衡训练(侧卧位肩外旋、侧卧位外旋、俯卧位水平外展、俯卧位水平后伸),两组患者训练均30min/次,1次/d,5次/周,连续训练6周;分别在治疗前和治疗6周后,对两组患者分别进行Fugl-Meycr上肢运动功能评分和VAS视觉模拟评分,以及上肢静息运动阈值(rMT)、中枢运动传导时间(CMCT)检测。结果:观察组9例及对照组7例患者因提前出院中途退出被剔除,最终观察组63例,对照组65例。治疗后,两组患者的VAS评分均较治疗前降低(P<0.05),FMA-UE评分均较治疗前升高(P<0.05),且观察组治疗后的VAS评分低于对照组(P<0.05),FMA-UE评分高于对照组(P<0.05)。治疗后,两组患者的rMT和CMCT均较治疗前降低(P<0.05),且观察组治疗后的rMT和CMCT均低于对照组(P<0.05)。结论:在肩胛带的稳定性训练基础上,斜方肌平衡训练能更好的改善偏瘫后肩痛患者的疼痛、运动功能及神经电生理。

桂枝芍药知母汤治疗膝骨性关节炎关节镜清理术后肿痛临床观察

目的探究桂枝芍药知母汤治疗膝骨性关节炎关节镜清理术后肿痛的临床效果。方法选取南昌市洪都中医院收治的膝骨性关节炎关节镜清理术后肿痛患者69例作为研究对象,按随机数字表法分为对照组(34例)和观察组(35例)。对照组予常规治疗,观察组在对照组基础上予桂枝芍药知母汤治疗,比较两组术前及术后1 d、3 d、7 d、14 d视觉模拟量表(VAS)评分、膝关节肿胀值并评估临床疗效。结果术前,两组VAS评分、膝关节肿胀值比较,差异无统计学意义(P>0.05);术后1 d、3 d、7 d、14 d,观察组VAS评分、膝关节肿胀值均低于对照组(P<0.05)。观察组临床治疗总有效率为97.14%(34/35),高于对照组的82.35%(28/34),差异有统计学意义(P<0.05)。结论对膝骨性关节炎关节镜清理术后肿痛患者实施桂枝芍药知母汤治疗,可有效缓解疼痛、消除肿胀,提高临床效果。

Pain Management and Factors Associated with Its Severity among Post Surgical Patients Admitted in the Intensive Care Unit at Muhimbili National Hospital, Tanzania

Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR;7.42, CI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain. Pethidine and paracetamol were the most prescribed drugs, however the prescription pattern used was inadequate to control pain.

A Longitudinal Study of Patient Reported Positioning-Related Discomfort and Pain after Laparoscopic Surgery in the Lithotomy Position

Background: Our hypothesis was that only established and persistent injuries and complications after positioning in the Trendelenburg position are reported and detected, despite that patients may have great discomfort after surgery. Aim: The aim of this study was to explore patient reported discomfort, pain and functional decrease two hours, 24 hours and four weeks after laparoscopic resection of the colon in the prone lithotomy position, as well as factors potentially associated with reported pain. Methods: A longitudinal self-report questionnaire study was conducted at three time-points. Results: A total of 37 patients responded. Findings show that patients mostly reported pain in relation to the surgical area, but also related to other areas that may be linked to positioning. Conclusion: Even though patients reported mild pain, several of the patients still reported this, four weeks postoperatively, as well as some functional decrease. Our findings support the need to focus on preventing positioning injuries.

Effects of electroacupuncture at Chéngshān (承山 BL 57) on postoperative pain of mixed hemorrhoids

ABSTRACT Objective To discuss the effect of electroacupuncture at Chengshan （承山 BL 57） on postoperative pain of mixed hemorrhoids. Methods One hundred and twenty cases with postoperative pain of mixed hemorrhoids were divided into an electroacupuncture group （60 cases） and a medication group （60 cases） randomly. In electroacupuncture group disperse-dense wave in frequency of 2 Hz/100 Hz was adopted at Chengshan （承山 BL 57）, the first treatment was given within 30 min after the operation, from the second day on electroacupuncture treatment was applied once a day and each time after hip bath in the morning. While in medication group 2 tablets of Naproxen Sunstained Release Capsule were administered orally within 30 min after operation, later on 2 tablets were taken before dressing change in the day. After 4 times of treatment, evaluate the changed condition of Visual Analogue Scale （VAS） at 5 h, 24 h, 48 h and 72 b after operation. Results In electroacupuncture group all tested pain scores at 5 h, 24 h, 48 h and 72 h after operation （6.78±2.12, 5.56±1.87, 4.34±2.23 and 3.15±2.11） were lower than those in the medication group （7.56±2.01, 6.23±1.15, 5.57±2.21 and 4.34±2.12）, and the difference was statistically significant （all P〈0.05）. Conclusion Electroacupuncture at Chengshan （承山 BL 57） can reduce the postoperative oain of mixed hemorrhoids.

感觉饱和疗法对缓解重症监护病房患儿操作性疼痛的效果研究

目的探讨感觉饱和疗法对缓解新生儿重症监护病房(neonatal intensive care unit,NICU)患儿操作性疼痛的效果。方法选取2022年7月-2023年7月NICU收治的104例患儿为研究对象,采用随机数表法将其分为对照组及观察组,各52例,对照组采用静脉穿刺常规护理,观察组在对照组的基础上实施感觉饱和疗法,比较两组疼痛评分及生理指标。结果观察组操作时及操作后5 min疼痛评分均低于对照组(t=11.421,P<0.001;t=25.490,P<0.001),操作后观察组心率、呼吸及血氧饱和度均优于对照组(t=8.471,P<0.001;t=2.590,P=0.011;t=12.120,P<0.001)。结论感觉饱和疗法能有效缓解NICU患儿静脉穿刺的疼痛感,并维持患儿生理指标的稳定。

腰椎融合术后患者急性疼痛发展轨迹及影响因素

目的探讨开放性腰椎融合术患者急性术后疼痛轨迹的潜在类别,分析不同潜在类别的影响因素,为不同类别患者制定针对性镇痛措施提供依据。方法使用便利抽样法,选取择期开放性腰椎融合术患者251例,在术前1 d收集患者一般资料、疼痛评分及睡眠质量资料。术后分别于全麻清醒并拔除气管导管的0 h、6 h、12 h、1 d、2 d、3 d、4 d、5 d、6 d 9个时间点评估患者疼痛程度。采用潜类别增长模型识别急性术后疼痛轨迹的潜在类别,采用无序多分类logistic回归分析急性术后疼痛轨迹潜在类别的影响因素。结果识别出3种急性术后疼痛轨迹,分别为疼痛加剧后缓解组(83例,33.0%),疼痛加剧稳定后反弹组(30例,12.0%),轻度疼痛组(138例,55.0%)。回归分析显示,相对于轻度疼痛组,病程≥10年、高中以下文化程度、手术时间>240 min的患者更容易进入疼痛加剧稳定后反弹组;年龄≤50岁、存在睡眠障碍、术后未使用镇痛泵的患者更容易进入疼痛加剧后缓解组(均P<0.05)。结论开放性腰椎融合手术患者急性术后疼痛呈现不同的发展轨迹,医护人员应根据不同发展轨迹重视年龄≤50岁、病程≥10年、高中以下文化程度、术前有睡眠障碍、手术时间>240 min、术后未使用镇痛泵的患者,给予及时的疼痛评估及针对性干预措施,改善患者术后疼痛程度。

消胀止痛锭治疗混合痔术后肛门坠胀疼痛的临床疗效观察

目的:观察消胀止痛锭治疗混合痔术后肛门坠胀疼痛的临床疗效。方法:选取2021年1月到2022年8月住院患者。将符合纳入标准的120例混合痔术后患者进行随机分组,分为治疗组和对照组,两组患者各60例。治疗组给予消胀止痛锭直肠给药,对照组给予复方角菜酸脂酸直肠给药。比较两组患者术后肛门坠胀、水肿、疼痛、抑郁、焦虑评分,住院时间、手术创面愈合时间、肛门直肠测压、盆底表面肌电图等指标。结果:治疗组术后3、5、7天的肛门水肿、坠胀、疼痛、抑郁、焦虑评分均较对照组明显缓解(P<0.01),治疗组的住院时间较对照组减少(P<0.05),治疗组的伤口愈合时间较对照组明显缩短(P<0.01),治疗组患者术前与术后盆底肌电图和肛门直肠压力未发生明显变化(P>0.05),其中对照组在术后的初始感觉、最大耐受以及排便感觉阈值较术前增高(P<0.01),肛管长度增加(P<0.05),力排时直肠收缩压明显降低(P<0.01)。表面肌电图测量中,治疗组患者术后7天与术前相比较差异无统计学意义(P>0.05),对照组术后7天盆底肌力较术前比较则有明显的降低(P<0.01)。结论:消胀止痛锭直肠给药对混合痔术后肛门坠胀疼痛有明显疗效,能缓解混合痔术后患者焦虑紧张的情绪,缩短了住院时间,促进了术后创面的愈合,未见明显不良反应,操作简便,值得临床推广应用。

白噪声对新生儿操作性疼痛影响的系统评价

目的:系统评价白噪声对缓解新生儿操作性疼痛的影响。方法:计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、PubMed、EMbase、Web of Science、the Cochrane Library数据库,检索时限从建库至2023年5月31日,由2名研究人员独立筛选文献,并使用Cochrane系统评价的偏倚风险评价工具对纳入研究进行方法学质量评价。结果:共纳入23篇文献,涉及2 014例新生儿。结果显示,白噪声对致痛性操作中新生儿的疼痛、生理及行为指标均有不同程度的影响。结论:现有证据表明,白噪声能够缓解新生儿操作性疼痛,但对新生儿哭泣等的行为指标以及心率、血氧饱和度、呼吸频率的改善仍有争议;今后仍需开展高质量、大样本的原始研究,以进一步确认白噪声对新生儿操作性疼痛的效果。

术中心理暗示疗法对腹腔镜术后患者疼痛和睡眠质量的影响

目的探讨术中心理暗示疗法对术后疼痛和睡眠质量的影响。方法选取2023年1—12月甘肃省中医院手术室行腹腔镜手术患者62例,采用随机数表法分为观察组(31例)与对照组(31例)。对照组接受标准手术程序和护理,观察组除了标准护理外,还接受术中心理暗示疗法。术后,使用视觉模拟评分、匹兹堡睡眠质量指数(PSQI)对患者进行评价,并使用生活质量综合评定问卷(GQOLI-74)评价患者的生活质量。结果接受心理暗示疗法的患者在术后的疼痛程度有显著的降低,差异有统计学意义(P<0.05)。在PSQI评分中,除了睡眠入睡时间、睡眠质量和日间补充睡眠障碍外,其他方面与对照组相比,差异无统计学意义(P<0.05)。此外,接受心理暗示疗法的患者在GQOLI-74的各个维度上的得分都比对照组高,这表明他们的生活质量得到了提升,差异有统计学意义(P<0.05)。结论与术中接受常规操作及护理相比,术中心理暗示疗法有助于减轻术后疼痛,能够有效改善患者的术后睡眠质量,提升生活质量,具有积极意义,值得临床推广。

不同时期腹腔镜胆囊切除术治疗轻度急性胆管炎的应用分析

目的:分析不同时期腹腔镜胆囊切除术治疗轻度急性胆管炎的应用效果。方法:选取2018年1月—2021年12月天津市公安医院收治的60例轻度急性胆管炎患者作为研究对象,按照手术时期分为早期组30例和延期组30例。早期组于入院后行腹腔镜胆囊切除术,延期组于炎症控制后行腹腔镜胆囊切除术。比较两组患者疗效相关指标;肝功能指标包括:丙氨酸氨基转移酶(ALT)、总胆红素(TBIL);术后视觉模拟疼痛(VAS)评分。结果:早期组患者首次排气时间、术后住院时间长于延期组,差异有统计学意义(χ^(2)=3.475,P<0.05;t=3.107,P<0.05);术后3 d,两组患者ALT、TBIL水平比较,差异无统计学意义(t=0.853、0.361,P>0.05);术后1 h、12 h,早期组患者VAS评分明显低于延期组,差异有统计学意义(t=3.417、5.068,P<0.05)。结论:与早期腹腔镜胆囊切除术比较,延期腹腔镜胆囊切除术更有利于轻度急性胆管炎患者术后恢复,但术后12 h内的疼痛更明显。