Impact of Optimizing Emergency Nursing Processes on Resuscitation Success in Patients with Acute Chest Pain

Objective:To analyze the effect of optimizing the emergency nursing process in the resuscitation of patients with acute chest pain and the impact on the resuscitation success rate.Methods:66 patients with acute chest pain received by the emergency department of our hospital from January 2022 to December 2023 were selected as the study subjects and divided into two groups according to the differences in the emergency nursing process,i.e.,33 patients receiving routine emergency care were included in the control group,and 33 patients receiving the optimization of emergency nursing process intervention were included in the observation group.Patients’resuscitation effect and satisfaction with nursing care in the two groups were compared.Results:The observation group’s consultation assessment time,reception time,admission to the start of resuscitation time,and resuscitation time were shorter than that of the control group,the resuscitation success rate was higher than that of the control group,and the incidence of adverse events was lower than that of the control group,with statistically significant differences(P<0.05);and the observation group’s satisfaction with nursing care was higher than that of the control group,with statistically significant differences(P<0.05).Conclusion:Optimization of emergency nursing process intervention in the resuscitation of acute chest pain patients can greatly shorten the rescue time and improve the success rate of resuscitation,with higher patient satisfaction.

The Safety and Efficacy of Transcutaneous Nerve Stimulation (TENS) in Reducing Vaginal Delivery Labor Pain: Randomized Controlled Clinical Trial

Background: Labor analgesia remains the center of interest for both obstetricians and women. The safety of the traditional pharmacologic analgesics remains questionable due to their potential fetal and maternal complications. Therefore, several non-pharmacological modalities were evaluated for their safety and efficacy to relieve labor pain. Among these methods, transcutaneous nerve stimulation (TENS) gained much concern due to ease of use, low cost and high capacity for women self-titration. The study aims to investigate the efficacy of TENS in reducing labor pain associated with vaginal deliveries, and to determine the factors controlling the response to TENS. Methods: The study was a randomized, controlled clinical trial. A total of 390 women candidates for vaginal delivery were randomly allocated to 3 groups of intervention: paracetamol infusion, TENS, and intramuscular pethidine (130 women per group). The primary endpoint was pain intensity assessed on 10-point VAS scale and women satisfaction. Secondary endpoints included maternal or fetal complications. Results: VAS scores recorded during vaginal deliveries demonstrated a statistically significant reduction in TENS group compared to paracetamol at 15, 30 minutes, 1 and 2 hours, while pethidine arm demonstrated lower scores than TENS group (p < 0.001). The intermediate analgesic efficacy of TENS was preserved when evaluating episiotomy related pain scores. Analysis of differences between good and poor responders to TENS indicated that weight, BMI, education level and the stimulation characteristics were statistically different between the two subgroups (p < 0.001). Adverse maternal and fetal outcomes in TENS arm were comparable to paracetamol and significantly less than pethidine. Conclusion: TENS is a reliable labor pain analgesic with comparable efficacy and superior safety relative to pethidine. Clinicians should personalize TENS therapy according to women’s BMI and education level for optimized pain control.

Labor Pain through the Eyes of Brazilian Women and Delivery Nurses

Objective: Understanding the perception of women who have recently given birth in a Brazilian hospital regarding labor pain and nursing involvement in the labor process. Methodology: exploratory, descriptive and qualitative study carried out in a Maternity part of the supplementary health system in the Federal District (DF). Data were collected between May and July 2015 through interviews using a semi-structured questionnaire. The sample consisted of 16 mothers and data analysis followed Bardin methodology in three phases. Results: The pain experienced during labor is surrounded by feelings and expectations. Both positive and negative feelings experienced by mothers were identified in the interviews and unanimous opinion was the fact that the second stage is the most painful period as continuous pain is experienced. Some of the participants compared pain with strong menstrual cramps, renal colic and back pain;others, said labor pain was the strongest ever experienced. The immediate contact with the newborn was referred to as a reward for coping with breast pain and suffering. Other factors such as the importance of follow-up, support and coping with the pain and care provided by health staff were also highlighted. Conclusion: empowerment of the mother and family through knowledge is considered an important tool to fight pain and cope with the birth process in a positive and physiological way, which in the long run promotes a cultural change in the population regarding the importance of vaginal birth.

Level of Labor Pain, Level of Labor Pain Behaviors, and Cultural Pain Behaviors among First-Time Indonesian Muslim Mothers

Background: Many factors influence the expressions of pain in primiparous women aside from contractions of the uterus. Objective: This study aimed to describe the level labor pain, level of labor pain behaviors based on cultural pain behaviors at 3 - 4 cm of cervical dilation or the beginning of the active phase of labor among primiparous Muslim women in Indonesia. Methods: This was a study with 42 primiparous Muslim women who gave birth in the labor room at Bhinneka Bhakti Husada Hospital and Community Health Center Pamulang, Indonesia from June until January 2017. The women were asked to describe on a 100 mm Visual Analogue Scale the intensity of level of labor pain in their abdomen during the last contractions at 3 - 4 cm of cervical dilation, and Pain Behaviors Observation Scale to observe pain behaviors. Descriptive statistics were used to analyze the data. Results: The findings showed that the mean score of level of labor pain at 3 - 4 cm of cervical dilation was 86.38 (SD = 4.47) and most participants experienced high level of labor pain (97.6%). The expression of cultural labor pain behaviors including saying praises to Allah, Asma’aul husna, reciting the Qur’an, sholawat.

Butorphanol in epidural:Could this be the breakthrough solution for safe and effective labor analgesia that we've been waiting for?

The authors have conducted a comprehensive investigation into the safety and effectiveness of butorphanol for epidural analgesia during labor.Their critical analysis of the paper and discussion of the technique's advantages and disadvantages provide a thorough understanding of the topic.

Advances in epidural labor analgesia:Effectiveness and treatment strategies of butorphanol

In this editorial,we provide a critical review of the article by Tang et al published in the World J Clin Cases,focusing on the utilization of butorphanol for epidural analgesia during labor.Our discussion encompasses recent research developments in epidural labor analgesia,specifically highlighting the current status of clinical applications of butorphanol and associated treatment approaches.Epidural analgesia is widely acknowledged as the primary method for pain management during labor,offering effective and prolonged pain relief while allowing mothers to remain alert and actively participate in the delivery process.Among the various drugs utilized for epidural labor analgesia,butorphanol has received increasing attention due to its potential efficacy and distinctive pharmacological properties.As a synthetic opioid analgesic,butorphanol exhibits both agonistic and antagonistic activity on opioid receptors,striking a balance between analgesia and minimizing side effects.Nevertheless,the safety and efficacy of butorphanol in epidural labor analgesia remains controversial.While certain studies have reported positive outcomes with butorphanol,including effective pain relief and a reduced incidence of side effects,others have raised concerns about its safety and efficacy compared to traditional opioids or alternative analgesics.In addition,the optimal dosing strategy and regimen of butorphanol as an adjuvant in epidural labor analgesia still need to be verified.Through comprehensive synthesis and analysis of existing literature,we aim to evaluate the current evidence regarding the use of butorphanol for epidural labor analgesia,delineate areas of consensus and controversy,and propose future avenues for research and clinical practice in this domain.

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.

Women with Fear of Childbirth Perceived Large Accumulated Labor Pain in Japan

Background: To improve negative birth experiences among women who experience intense labor pain during labor, it is important to examine the relationship between fear of childbirth immediately after vaginal delivery and the actual intensity of labor pain. However, previous studies have generally evaluated labor pain in a retrospective setting. Purpose: This study examined the relationship between fear of childbirth immediately after vaginal delivery and the actual labor pain intensity and accumulated labor pain intensity without pharmacological pain relief during labor in Japan. Methods: A prospective observational study was conducted between July 2015 and April 2016. Forty-seven pregnant Japanese women were available for analysis. Fear of childbirth was measured by the Japanese version of the Wijma Delivery Expectancy/Experience Questionnaire (JW-DEQ) version B on the third day after vaginal delivery. Participants with scores of 85 or higher were categorized in the high JW-DEQ group, having severe fear of childbirth. Labor pain intensity was examined chronologically in real time with stepwise usage of two types of Numeric Rating Scale (NRS). Accumulated labor pain intensity was calculated using the area under the curve (AUC). Results: Nine participants were in the high JW-DEQ group and eight of the nine were primiparae. Primiparae in the high JW-DEQ group experienced significantly longer duration and larger accumulated labor pain intensity between the onset of labor and 4 to 6 cm of cervical dilatation than those in the low JW-DEQ group (P = 0.024 and P = 0.021, respectively). Conclusions/Implications for Practice: The latent phase of labor was a key stage to improve fear of childbirth immediately after vaginal delivery without pharmacological pain relief among Japanese primiparae. Midwives should give assistance in the latent phase of labor by focusing on progressing labor smoothly and relieving labor pain to improve negative birth experiences.

Introduction of a New Concept of Pain Management during Labor and a Novel Technique for Pain Free Labor

Traditional labor epidural techniques have not been proven to be sufficient to cover the second stage of labor. We have developed a new concept of pain management during labor and a new technique that provides sufficient analgesia for second stage of labor. Combined Spinal Epidural with long lasting saddle block (with hyperbaric tetracaine) was used. Potentially pain free labor could be achieved by using this method. Utilizing hyperbaric Tetracaine intrathecally may provide a long lasting sensory sacral blockade. Primary outcome measure was absence of pain during pushing (2nd stage of labor). Patients received additional comfort during 1st stage of labor. Sample size included all patients that requested labor epidurals since 12/22/11 when this new technique was introduced.

Midwives’ utilization of nonpharmacological pain relief measures for labor pain management: A descriptive cross-sectional study

Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar,Cross River State,Nigeria.Materials and Methods:A descriptive cross-sectional design was used for the study.The study was rooted in Katherine Kolcaba’s Comfort theory.Totally,67 participants were recruited for the study using the purposive sampling technique.A self-made structured questionnaire was used to obtain participants’information on knowledge,utilization,and predictors of nonpharmacological pain relief measures.Results:Although 41(61.2%)of the participants had knowledge about nonpharmacological pain relief measures,few did not know some of the cognitive-behavioral and environmental measures in labor pain management.There was 35.8%(24/67)for utilization of cognitive-behavioral measures and 55.2%(37/67)for psychological/emotional measures for labor pain management by respondents,respectively.Fifty(74.6%)of respondents agreed that predictors such as lack of knowledge,lack of updates and training,work experience,best practice guidelines,and equipment were hindrances to utilization.There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures(r=0.6,P<0.05).Conclusion:The utilization of nonpharmacological measures for labor pain management is low,thus it is recommended that frequent education,training updates on effective labor pain management,provision of clinical guidelines on labor pain management,and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.

Psychiatric disorders and pain:The recurrence of a comorbidity

Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance.Although pain is a common complaint among psychiatric patients,clinicians generally separate its presence from the background mental disorder and downplay its importance,trying primarily to control the psychiatric symptomatology.As a sensory modality,the presence of pain and its importance account for an impressive body of scholarly research.Cartesian methodology considered sensations of all modalities in a mechanistic form,which actually sounds obsolete.However,authors have continuously been faced with the same dilemmas plaguing scholars for centuries.We assume that a large portion of the sensory inputs might be generators of distorted perceptions,which subsequently lead to psychopathology.Auditory and visual hallucinations are incontestable examples.Somaesthetic hallucinations also exist,but pain hardly deserves such a denomination.Nevertheless,chronic pain and psychiatric comorbidity is a reality that needs explanation.Painkillers are not effective in treating psychiatric disorders,and antipsychotics do very little,perhaps nothing,to relieve pain.The pharmacological approach opens one door on the horizon and closes many others,while clinicians continue to face a high prevalence of comorbid pain and mental health issues.However,attempts to correlate altered body schemata(as distorted as it may be,for example,in phantom limb pain) with somatic delusions can simplify all these dilemmas,and the basket of psychophysiology,in fact,might be bigger than presumed.

A qualitative study of the psychological processes in patients with post-herpetic neuralgia

Objective:To understand the psychological process of patients with post-herpetic neuralgia(PHN)and provide references for the psychological management of PHN.Methods:The objective sampling method was used to conduct semi-structural in-depth interviews on 10 PHN patients,and Colaizzi’s phenomenological analysis method was used for data analysis.Results:According to the different pain durations of PHN patients,the patients were divided into three stages and five themes were extracted:the need for strong pain relief,the helpless tolerance of pain,the self-feeling burden,the need for health education,and the positive response to pain.Conclusions:PHN has complex psychological activities,so it is necessary to pay attention to the psychological process of patients and take effective psychological measures to intervene negative psychology so that patients can actively cope with the pain.

Evaluation of the efficacy of ropivacaine combined with sufentanil and ropivacaine alone for epidural labor analgesia

Objective: To study the efficacy of ropivacaine combined with sufentanil and ropivacaine alone for epidural labor analgesia. Methods: Primiparae who received vaginal delivery under epidural analgesia in Ankang People's Hospital between March 2015 and February 2017 were selected and randomly divided into accepting the group A who received ropivacaine combined with sufentanil for epidural analgesia and the group B who received ropivacaine alone for epidural analgesia. During the first, the second and the third stage of labor, the serum was collected to determine the levels of pain mediators SP, 5-HT and PGE2 as well as stress hormones NE, E, F-C, AT-II and INS;after delivery, the placenta tissue was collected to determine the expression of stress molecules GRP78, CHOP, Nrf-2 and ARE. Results: Serum SP, 5-HT, PGE2, NE, E, F-C, AT-II and INS levels of group A during the first, the second and the third stage of labor were significantly lower than those of group B;GRP78, CHOP, Nrf-2 and ARE mRNA expression in placental tissue of group A after delivery were significantly lower than those of group B. Conclusion: ropivacaine combined with sufentanil for epidural labor analgesia is more effective than ropivacaine alone in reducing pain and inhibiting stress response.

Effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion

Objective: To discuss the effect of ropivacaine combined with sufentanil epidural labor analgesia on pain neurotransmitters as well as cytokine production and stress hormone secretion. Methods: A total of 218 cases of puerperae who received caesarean section in the hospital between January 2015 and January 2017 were divided into control group (n=109) and observation group (n=109) by random table method. Control group received postpartum ropivacaine epidural analgesia alone, and observation group received postpartum ropivacaine combined with sufentanil epidural analgesia. The differences in serum levels of pain neurotransmitters, inflammatory factors and stress hormones were compared between the two groups immediately after childbirth (T0), 6 h after delivery (T1), 12 h after delivery (T2) and 24 h after delivery (T3). Results: At T0, the differences in serum levels of pain neurotransmitters, inflammatory factors and stress hormones were not statistically significant between the two groups. At T1, T2 and T3, serum NPY, β-EP and SP levels of observation group were lower than those of control group at corresponding points in time;serum IL-1β, hs-CRP and IL-6 levels of observation group were lower than those of control group at corresponding points in time;serum Cor, AngⅠ, AngⅡ and NE levels of observation group were lower than those of control group at corresponding points in time. Conclusion:Ropivacaine combined with sufentanil epidural analgesia after caesarean section can effectively inhibit the pain neurotransmitter expression and relieve the systemic inflammatory stress response in puerperae.

Giant cystic lymphangioma originating from the lesser curvature of the stomach

Cystic lymphangiomas are rare benign tumors.Most frequently occurring in children and involving the neck or axilla,these tumors are much less common in adults and very rarely involve the abdomen.The known congenital and acquired(traumatic)etiologies result in failure of the lymphatic channels and consequent proliferation of lymphatic spaces.This case report describes a very rare case of a giant mesenteric cystic lymphangioma in an adult male with no clear etiology and successful resolution by standard radical resection.A previously healthy 44-year-old male presented with a 6-wk history of progressive upper abdominal pain,vomiting,anorexia and unintentional weight loss accompanied by rapid abdominal distension.A palpable mass was detected upon physical examination of the distended abdomen and abdominal computed tomography scan showed a giant multilobulated cystic process,measuring 40 cm in diameter.Exploratory laparotomy revealed an enormous cystic mass containing 6 L of serous fluid.The process appeared to originate from the lesser omentum and the lesser curvature of the stomach.Radical resection of the tumor was performed along with a partial gastrectomy to address potential invasion into the adjacent tissues.Histological analysis confirmed the diagnosis of a multicystic lymphangioma.The postoperative recovery was uneventful and the patient was discharged after 6 d.At 3-mo follow-up,the patient was in good health with no signs of recurrence.

Midpoint transverse process to pleura block for postoperative analgesia following laparoscopic renal cyst decortication:Two case reports

BACKGROUND The midpoint transverse process to pleura(MTP)block,a novel technique for thoracic paravertebral block(TPVB),was first employed in laparoscopic renal cyst decortication.CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication.To address safety concerns associated with TPVBs,we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication.The MTP block was performed at the T9 level under ultrasound guidance,with 20 mL of 0.5%ropivacaine injected.Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels.Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement,with none exceeding a mean 24 h numeric rating scale>3.CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.

Efficacy and safety of different doses of ropivacaine + sufentanil for epidural labor analgesia

Objective:To study the efficacy and safety of different doses of ropivacaine and sufentanil for epidural labor analgesia.Methods: The primiparae with single birth and cephalic presentation who underwent vaginal delivery in Chengde Maternal and Child Health Hospital between March 2015 and February 2018 were selected and randomly divided into the group A who received subarachnoid injection of sufentanil 4 μg, the group B who received injection of sufentanil 4 μg + ropivacaine 2 mg and the group C who received injection of sufentanil 4 μg+ ropivacaine 3 mg. During childbirth, serum was collected at the first, second and third stages of labor respectively to detect the secretion of pain mediators and oxidative stress mediators;after childbirth, the placenta was collected to determine the expression of stress molecules. Results: At first, second and third stages of labor, serum SP, DYN, NE, PGE2, TNF-α, COR, AT-II and MDA secretion of group B and group C were significantly lower than those of group A whereas SOD and GSH-Px secretion were significantly higher than those of group A, and serum SP, DYN, NE, PGE2, TNF-α, COR, AT-II and MDA secretion of group C were significantly lower than those of group B whereas SOD and GSH-Px secretion were significantly higher than those of group B;after childbirth, GRP78, CHOP, Bax and Caspase-3 mRNA expression in placenta of group B and group C were significantly lower than those of group A whereas Bcl-2 mRNA expression were significantly higher than that of group A, and GRP78, CHOP, Bax and Caspase-3 mRNA expression in placenta of group C were significantly lower than those of group B whereas Bcl-2 mRNA expression was significantly higher than that of group B.Conclusion: The analgesic effect of sufentanil 4 μg + ropivacaine 3 mg for epidural labor analgesia is the most significant.

The mechanism and research progress of non-drug analgesic labor

Non-drug analgesic labor is of great significance to protect,promote and support natural labor.The purpose of this paper is to review the mechanism of non-drug analgesia,the significance of non-drug analgesia delivery,and the methods of non-drug analgesia delivery,so as to provide reference for the research of clinical non-drug analgesia delivery and promote the development of non-drug analgesia delivery.

Labor Pain Treated with Acupuncture or Acupressure

Opioid-dependent women have an 80% to 90% unintended pregnancy rate, almost double the overall unintended pregnancy rate: 40% globally and 51% in north America. The prescription drug abuse milieu increases the possibility opioid abusing laboring patients. In 2012, neonatal abstinence syndrome occurred in 5.8 per 1000 hospital births. Non-pharmacological labor pain management (NPLPM) is especially recommended for laboring patients with a history of substance abuse. Therefore, literature review was performed to elucidate the efficacy and safety of acupuncture, noninvasive electro-acupuncture (EA), and acupressure in labor pain management. Compared to standard intrapartum controls, bilateral EA at JiaJin or Sanyinjiao significantly reduced visual analog scale (VAS) pain scores 30-minutes post intervention (p < 0.01) and Stage 1 active phase labor length (p < 0.05). EA achieves shorter Stage 2 labor than patient-controlled epidural analgesia (p = 0.05);and 10-point lower VAS pain scores and reduced cesarean delivery rate than no-analgesia controls, p < 0.05. Current evidence indicates that EA should have a role in NPLPM, and that acupressure may have a role in NPLPM. Nevertheless, future RCTs could strengthen the argument for increased EA and acupressure use in NPLPM.

Baastrup's disease: The kissing spine

A 67-year-old male presented with a gradually progressive low back pain of 2 years duration. The patient was leading a retired life and there was no history of chronic fever or significant trauma. There was no radiation of pain or any features suggestive of claudication. There was no history of any comorbidity. The pain was aggravated with extension of the spine and relieved with flexion. There was no swelling or neurological deficit, but muscle spasm was present. Radiographs of the spine revealed degenerative changes in the lumbosacral spine, along with articulation of spinous processes at in lumbar spine at all levels level suggestive of Baastrup's disease, commonly known as "kissing spine". Routine blood investigations were within normal limits. The patient was managed conservatively. He was given a week's course of analgesics and muscle relaxants and then started on spinal flexion exercises, with significant improvement being noted at 6 months follow up.