The Effect of Preoperative Oral Versus Parenteral Dextrose Supplementation on Pain,Nausea, and Quality of Recovery After Laparoscopic Cholecystectomy

PurposeEarlier studies suggest that carbohydrate loading is effective in reducing preoperative nausea. This study was conducted to investigate the effect of preoperative oral versus parenteral carbohydrate loading on the postoperative pain, nausea, and quality of recovery (QoR).DesignThree-arm randomized, single-blind clinical trial.MethodsIn this study, 95 adult patients scheduled for elective laparoscopic cholecystectomy were randomly assigned into three groups of preoperative intravenous dextrose 10% infusion, oral carbohydrate (OCH)–rich drink, and control. The pain and nausea severity scores were measured during recovery, 6 hours, and 24 hours thereafter. The 40-item QoR score was evaluated the day after surgery.FindingsIn recovery, nausea severity was comparable among three groups, whereas pain score in the OCH group was significantly less than the controls (P = .009). Pain score in patients who received intravenous dextrose was mediocre and not statistically different from two other groups. Six and 24 hours after surgery, nausea and pain scores in OCH and dextrose infusion groups were significantly lower than the control group (P < .05). The 40-item QoR score was significantly higher in intervention groups than control participants (P < .05). Blood glucose levels were comparable in three groups before and after surgery.ConclusionsPreoperative carbohydrate loading significantly improves the QoR after laparoscopic cholecystectomy without significant effect on blood glucose levels. Oral route more effectively controls nausea and pain than parenteral dextrose administration.     

Microendoscopic discectomy for recurrent lumbar disc herniation*

Introduction: The purpose of this study is to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of recurrent lumbar disc herniation. Methods: Thirty‐six patients with recurrent lumbar disc herniation were treated using MED (30 men and six women; mean age: 45.7 years, range: 26–80 years; mean follow‐up: 24.4 months, range: 12–52 months; mean duration between the primary and revision surgery: 65.9 months, range: 1–320 months) (recurrent group). Sex‐ and age‐matched patients with primary lumbar disc herniation treated by MED served as the control group (primary group). The clinical outcomes were evaluated using the Japanese Orthopaedic Association score for low back pain and questionnaires regarding MED. Results: The average Japanese Orthopaedic Association scores before surgery and at the final follow‐up were significantly lower in the recurrent group than in the primary group (10.8 ± 3.4 versus 15.0 ± 4.0 before surgery, P=0.001 and 25.4 ± 2.6 versus 26.8 ± 1.9 at follow‐up, P=0.013), while the average recovery rates were not significantly different between the two groups (80.3 ± 14.1% versus 84.5 ± 14.6, P=0.22). The surgical time was significantly longer for the recurrent group than for the primary group (83.0 ± 41.8 min versus 67.1 ± 18.1 min,P=0.042). Of the 18 questionnaire respondents, 17 answered that postoperative pain was milder after MED than after a standard discectomy. Conclusion: MED is a feasible surgical option for recurrent lumbar disc herniation, yielding surgical outcomes comparable to those obtained in primary lumbar disc herniation.     

Pain,disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery

Background: Symptoms of lumbar disc herniation can be induced by both mechanical compression of the nerve roots and by biochemical irritants from the disc tissues. Proinflammatory cytokines, as well as stress are potent stimulators of the hypothalamic–pituitary–adrenal axis, reflected in enhanced release of cortisol from the adrenal cortex. Altered cortisol production is also associated to behaviour and coping patterns. The aim of the present study was to explore the relation between pain, physical function, psychosocial factors and quality of life to the diurnal cortisol variability, in patients with lumbar disc herniation. Method: This study had a cross‐sectional design. Forty‐two patients with lumbar disc herniation, verified by magnetic resonance imaging and a clinical examination by an orthopaedic surgeon, were included in the study. All patients were scheduled for disc surgery. The diurnal cortisol variability was examined before surgery. The patients were dichotomised into two groups based on low or high diurnal cortisol variability. Pain, disability, work related stress, quality of life, coping and fear avoidance beliefs, were estimated by standardised questionnaires. Results: The low diurnal cortisol variability group was distinguished by a higher median score regarding leg pain at activity and significantly more disability (p<0.05). The patients with a low diurnal cortisol variability had significantly lower coping self‐statement scores, but higher pain coping catastrophising scores (p<0.05). Conclusion: Patients with lumbar disc herniation and a low diurnal cortisol variability had lower physical function, perceived lower possibilities of influencing their pain, and were more prone to catastrophise than patients with lumbar disc herniation and a high diurnal cortisol variability.     

自我效能干预对腰椎间盘突出症康复治疗患者负性情绪及疼痛程度的影响

目的:探讨增强自我效能干预对腰椎间盘突出症康复治疗患者负性情绪及疼痛程度的影响。方法:将我院收治的60例腰椎间盘突出症康复治疗患者随机等分为对照组和观察组,对照组给予常规护理干预,观察组给予强化自我效能干预。结果:观察组自我效能评分、自我管理能力评分显著高于对照组,观察组疼痛程度显著低于对照组,两组比较差异有统计学意义(P0.05)。结论:对腰椎间盘突出症康复治疗患者进行自我效能干预,可提高患者自我效能及自我管理能力,改善患者焦虑、抑郁的情绪,有效缓解其疼痛程度。     

How Can we Improve the Comfort Level and Sleep Quality After Surgery?

PurposeThe aim of this study was to determine the effect of progressive relaxation exercises on the comfort level and sleep quality of patients undergoing lumbar disc herniation surgery.MethodsThe study was conducted between July 2015 and October 2016 in the neurosurgery clinic. The sample consisted of 96 patients (n = 56, experimental patients; n = 40 control patients) randomized into groups. The data was collected by using the personal information form, The Perianesthesia Comfort Questionnaire, The General Comfort Questionnaire and Visual Analog Sleep Scale.FindingsIn the postoperative General Comfort Scale that there was a statistically significant difference between the mean of the control group and experimental group on the final test (P < .05). When the Visual Analog Sleep Scale mean of the experimental and control group patients were compared between the groups, there was a statistically significant difference on the postoperative 2nd day and 3rd day (P < .05).ConclusionThis study supports previous work that progressive relaxation exercises are feasible and effective to improve patient comfort levels after lumbar disc surgery.     

腕踝针缓解老年腰椎间盘突出症患者疼痛的效果研究

目的：探讨腕踝针对老年腰椎间盘突出症患者疼痛的治疗效果,并且与非甾体抗炎药物以及传统针刺治疗进行对比,比较三种治疗方法对疼痛的治疗效果是否存在差异。方法：选取2019年1月-2021年6月收治的慢性腰椎间盘突出症/腰椎退行性病变伴腰痛急性发作的老年患者90例,随机分为三组,每组各30例,分别给予腕踝针治疗、非甾体抗炎药物治疗、传统针刺治疗,观察评估患者治疗30分钟后的疼痛VAS评分以及评估治疗1疗程（6天）后的腰椎疾患治疗成绩评分。结果：三组治疗后的VAS评分均有降低（P值均＜0.05）,表明三组治疗均可缓解疼痛,并且三组治疗30分钟后VAS评分之间有差异,两两对比后西药组与腕踝针组治疗30分钟后VAS评分无差异,但均低于传统针刺组（P＜0.05）,表明疼痛改善程度较传统针刺组大;三组治疗1个疗程后的腰椎疾患治疗成绩评分有差异,两两对比后传统针刺组与腕踝针组均高于西药组（P＜0.05）,而传统针刺组与腕踝针组之间无差异。结论：本文证实了腕踝针对老年患者腰椎间盘突出症并发急性疼痛有效,并且在即时止痛以及远期镇痛疗效上均有优势。     

经皮椎间孔镜技术与显微镜辅助治疗腰椎间盘突出症的临床疗效分析

目的 对比分析经皮椎间孔镜技术与显微镜辅助治疗腰椎间盘突出症的临床效果。方法 采用随机数表法,将2017年10月-2019年12月该院收治的60例腰椎间盘突出症患者随机分为：采用经皮椎间孔镜治疗的试验组和采用显微镜辅助治疗的对照组,每组30例。术后分析两组患者的临床治疗效果。结果试验组手术时间和住院时间均短于对照组,切口长度短于对照组,术中出血量少于对照组（P <0.05）;术后1周,试验组视觉模拟评分（VAS）低于对照组,日本骨科学会（JOA）评分高于对照组（P <0.05）;两组患者临床优良率、术后1和3个月VAS和JOA评分比较,差异均无统计学意义（P> 0.05）;对照组术中发生1例硬膜囊撕裂,采用可吸收线修补。其余患者术中及术后均无并发症发生。结论 经皮椎间孔镜技术可有效缩小手术切口,减少术中失血量,减轻短期疼痛,促进患者腰椎功能恢复,且不增加患者并发症发生率,值得临床推广应用。     

腰椎间盘突出症患者出院准备度与疼痛程度的相关性分析

目的探讨腰椎间盘突出症患者出院准备度现状、疼痛程度及其相关性。方法对2019年3月—9月河南省某三甲医院收治的196例腰椎间盘突出症患者采用出院准备度量表(RHDS)和疼痛数字分级法(NRS)进行问卷调查,并用Pearson相关分析法进行分析。结果腰椎间盘突出症患者RHDS总分为(94.17±8.56)分,处于偏高水平,3个维度中得分最高的是个人状态,其次是预期性支持,最后是适应能力。腰椎间盘突出症患者入院时NRS评分为(6.10±0.30)分,为中度疼痛;出院前4 h NRS评分为(1.70±0.50)分,为轻度疼痛;出院前4 h患者疼痛评分明显降低,差异有统计学意义(t=1.892,P<0.05)。腰椎间盘突出症患者的RHDS总分及3个维度得分均与患者出院前4 h的NRS评分呈负相关(P<0.05)。结论腰椎间盘突出症患者出院准备度处于较高水平,出院前疼痛程度明显减轻处于较低水平,两者呈负相关。医护人员应积极关注腰椎间盘突出症患者的出院准备度,帮助其减轻疼痛,促进患者康复。     

Widespread Proprioceptive Acuity Impairment in Chronic Back Pain: A Cross-sectional Study

ObjectiveTo investigate whether proprioceptive accuracy measured with the Joint Position Sense (JPS) in patients with chronic neck and low back pain is impaired exclusively in affected areas or also in distant areas, not affected by pain.DesignCross-sectional study.SettingInterdisciplinary outpatient rehabilitation clinic for back and neck pain.ParticipantsPatients with chronic neck pain (n=30), patients with chronic low back pain (n=30), and age- and sex-matched asymptomatic control subjects (n=30; N=90).InterventionsNot applicable.Main Outcome MeasuresPatients and asymptomatic control subjects completed a test procedure for the JPS of the cervical spine, lumbar spine, and ankle in a randomized order. Between group differences were analyzed with the univariate analysis of variance and associations of the JPS with clinical features using the Pearson's correlation coefficient.ResultsBoth patients with chronic neck pain (P<.001) and patients with chronic low back pain (P<.01) differed significantly from asymptomatic controls in the JPS of the cervical spine, lumbar spine and ankle joint, regardless of the painful area. No difference was shown between patient groups (P>.05). An association of the JPS with clinical characteristics, however, could not be shown.ConclusionThese results suggest widespread impairment of proprioceptive accuracy in patients with chronic and low back pain and a role for central sensorimotor processes in musculoskeletal pain conditions.     

The Effect of Patient Education Prior to Rhinoplasty Surgery on Anxiety,Pain, and Satisfaction Levels

PurposeThis study aimed to evaluate the effect of education before rhinoplasty surgery on patients’ anxiety, pain, and satisfaction levels.DesignThis was a randomized controlled experimental study.MethodsOf the 90 patients who underwent rhinoplasty surgery at Kayseri City Hospital, Turkey between October 2017 and December 2018, 79 were included in the study. The patients were assigned to an experimental or control group according to a computer-generated randomization list. The experimental group (n = 36) was educated using a rhinoplasty training guide prior to routine plastic surgery procedures. The control group (n = 35) received only routine plastic surgery procedures. A patient identification form, State-Trait Anxiety Inventory, Newcastle Satisfaction with Nursing Care Scale, and Visual Analog Scale were used to collect data. Data analysis included the Shapiro–Wilk normality test, Q-Q plot, two-way analysis of variance, Friedman and Mann-Whitney U tests, and Pearson's chi-square.FindingsIn the postoperative period, the mean state anxiety inventory score of the experimental group (36.25 ± 9.78) was found to be significantly lower than that of the control group (42.28 ± 9.42) (P < .05). There was no statistically significant difference between the trait anxiety inventory scores of the experimental (39.63 ± 10.20) and control (38.77 ± 6.16) (P > .05) groups. The mean Newcastle Satisfaction with Nursing Care Scale score of the experimental group (71.01 ± 14.65) was significantly higher than the control group (62.93 ± 16.36) (P < .05). There was no significant difference between the pain scores of experimental and control groups postoperatively at 6, 12, and 24 hours (P > .05).ConclusionsBased on the results of our study, we conclude that it would be beneficial to educate patients before rhinoplasty surgery in line with their needs and aesthetic concerns.     

Construction and Application of Chain Management Information System for Cancer Pain

BackgroundWith the rapid development of information technology, hospital information systems (HISs) have been deeply applied in the medical field and have shown broad application prospects. There are still some noninteroperable clinical information systems that pose an obstacle to the effective coordination of care, such as cancer pain management.AimTo construct a chain management information system for cancer pain and explore its clinical application effect.MethodsA quasiexperimental study was conducted in the inpatient department of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. A total of 259 patients were nonrandomly divided into two groups: the experimental group (after the system was applied, n = 123) and the control group (before the system was applied, n = 136). The cancer pain management evaluation form score, patient satisfaction with pain control, pain score at admission and discharge, and the worst pain score during hospitalization were compared between the two groups.ResultsCompared with the control group, the score of the cancer pain management evaluation form was significantly higher (p < .05). There were no statistically significant differences in worst pain intensity, pain score at admission and discharge, and patients’ satisfaction with pain control between the two groups.ConclusionsThe cancer pain chain management information system can enable nurses to evaluate and record pain in a more standardized way, but it has no significant effect on the pain intensity of cancer patients.     

Arteriovenous Graft for Hemodialysis: Effect of Cryotherapy on Postoperative Pain and Edema

BackgroundArteriovenous grafting offers an alternative for patients whose vessels are unsuitable for arteriovenous fistula. However, as a result of subcutaneous tunnel dissection, postoperative pain and edema of the operated limb present early after surgery. As a traditional therapeutic approach, cryotherapy has the ability to suppress postoperative pain and edema.AimsThe purpose of the study was to investigate the feasibility of cryotherapy after arteriovenous graft surgery to decrease perioperative medication usage.DesignThis study was a randomized controlled trial.SettingA large integrated health care facility in South China.Participants/SubjectsA total of 85 hemodialysis patients who received arteriovenous graft surgery from March 2011 to February 2017 were enrolled.MethodsThe participants were divided into an intervention group and a control group according to the postoperative management. Ice packs were applied covering the operative forearm for 120 minutes after wound closure in the intervention group. General information, pain score, analgesic consumption, wound inflammation, forearm edema, and participant satisfaction were compared between the two groups.ResultsCryotherapy-treated patients required less analgesia (26.19% vs. 48.84%, p < .05), reported lower pain score from 30 minutes to 48 hours postoperative (p < .05), less wound inflammation (11.90% vs. 25.58%, p < .05), and higher participant satisfaction (8.92 ± 0.57 vs. 6.52 ± 0.63, p < .05), whereas the incidence of forearm edema was equivalent (p > .05). No adverse events were reported in either group.ConclusionsCryotherapy is a preferable intervention for patients after arteriovenous graft implantation as a result of its favorable cost, convenience, and fewer side effects.     

Patient Perceptions of Pain Management Therapy: A Comparison of Real-Time Assessment of Patient Education and Satisfaction and Registered Nurse Perceptions

Nurses must have an understanding of their patients' perception to assist in meeting analgesic goals. Adequate patient teaching is essential. The value of a simplified tool to assess patients' satisfaction has not been widely examined. This study examined if nurses' perceptions of their patients' satisfaction with pain management are congruent with patients' self-report, and if patients' level of satisfaction corresponds with the type of therapy used and adequacy of teaching related to their pain management plan. Data were collected though a survey in a community hospital. It was designed as an evaluative study of the variables in two nursing units and as a pilot study of the survey tool. Ratings of patient satisfaction by nurses (3.8 ± 0.88 [mean ± SD]) were similar to patients' self-ratings (4.08 ± 1.06). Higher self-report of pain (visual analog scale 4.00 ± 2.22) was associated with lower levels of satisfaction (3.80 ± 0.881). Patients reporting adequate teaching rated a higher satisfaction score (4.46) than patients reporting inadequate teaching [3.59; t (48) = ?3.12; p = .003]. Patients receiving intravenous analgesia as needed had higher pain VAS scores (4.74) than patients receiving other analgesia protocols [3.37; t(48) = ?2.26; p = .028]. Measuring patient satisfaction has become critical in evaluating adequacy of treatment. Factors that affect patients' satisfaction with pain management include the adequacy of teaching they receive and the type of therapy they are provided. A simple survey can be a useful tool in measuring satisfaction.     

Effects of Pain Education Program on Pain Intensity,Pain Treatment Satisfaction,and Barriers in Turkish Cancer Patients

The purpose of this randomized controlled study was to investigate the effect of a pain education program (PEP) on pain intensity, patients' satisfaction with pain treatment, and patient-related barriers to pain management among Turkish patients with cancer. The study was conducted in a sample of 40 patients who were hospitalized for cancer and experiencing pain. The patients were equally randomized to either a PEP or a control group. The data were collected by means of the McGill Pain Questionnaire, the Numeric Rating Scale, and the Barrier Questionnaire–Revised. After the completion of the questionnaires at the first interview, patients in the PEP group received pain education using a pain educational booklet and an explanatory slide program that discussed the booklet's content with the patients. Patients in the control group received routine clinical care. The questionnaires were reapplied to the patients in both groups after 2, 4, and 8 weeks. Participation in a PEP was associated with decreased pain intensity scores for “present” and “least pain” during weeks 2, 4, and 8 (p < .05). Similarly, there were significant differences between the groups with respect to weeks 2, 4, and 8 satisfaction with pain treatment (p < .05). At the end of second week, the total BQ-r score decreased significantly in the PEP group from 2.12 to 1.29 compared with 2.30 to 2.28 in the control group (p < .001). The findings suggest that the PEP decreases pain intensity, improves satisfaction with treatment, and decreases barriers about cancer pain management in cancer patients. Incorparation of PEP into the standard of care for cancer patients with pain may improve the quality of pain management.     

The 5% Lidocaine Patch for Decreasing Postoperative Pain and Rescue Opioid Use in Sternotomy: A Prospective,Randomized, Double-blind Trial

PurposePoststernotomy pain (PSP), a primary concern after sternotomy, can negatively affect patients' satisfaction with surgery and quality of life. Many clinical trials have been conducted to examine the usefulness of lidocaine patches (LPs) for postoperative pain control for multiple types of surgery; however, the results of these trials are inconsistent. In addition, little is known about the use of LPs after cardiac procedures that require sternotomy. This prospective, double-blind, placebo-controlled trial aimed to determine the efficacy of the 5% LP application at the sternotomy site for reducing PSP and rescue opioid consumption.MethodsThe patients were randomly assigned to receive either the 5% LP or the placebo patch on each side of the incision site immediately after the surgery. The intensity of pain at 6, 12, 24, and 48 h after the patch application; the total dose of rescue opioids; incidence of nausea, vomiting, and sleep disturbance; and use of antiemetics were compared between the 2 groups.FindingsFifty-seven (31 in the LP group and 26 in the placebo group) patients were included. The pain intensity was significantly lower in the LP group at each time point (66%–68% pain reduction, P < 0.001, interaction of time × treatment P = 0.69). In addition, the total dose of rescue opioids used for 48 h was significantly lower in the L group (27.2% reduction, P = 0.008). No significant differences were found in other outcome variables between the 2 groups.ImplicationsThe application of a 5% LP on each side of the sternotomy site can reduce PSP and additional opioid use without significant adverse effects in patients undergoing sternotomy. Thus, it can be considered as a standard and routine modality along with other analgesic medications for the management of PSP. Clinical Trial Registry in South Korea identifier: KCT0000476.     

A Pilot Randomized Controlled Trial of Outcomes Associated with Parent-Nurse Controlled Analgesia vs. Continuous Opioid Infusion in the Neonatal Intensive Care Unit

PurposeProspectively compare parent/nurse controlled analgesia (PNCA) to continuous opioid infusion (COI) in the post-operative neonatal intensive care unit (NICU) population.Design/MethodsA randomized controlled trial compared neonates treated with morphine PNCA to those treated with morphine COI. The primary outcome was average opioid consumption up to 3 post-operative days. Secondary outcomes included 1) pain intensity, 2) adverse events that may be directly related to opioid consumption, and 3) parent and nurse satisfaction.ResultsThe sample consisted of 25 post-operative neonates and young infants randomized to either morphine PNCA (n = 16) or COI (n = 9). Groups differed significantly on daily opioid consumption, with the PNCA group receiving significantly less opioid (P = .02). Groups did not differ on average pain score or frequency of adverse events (P values > .05). Parents in both groups were satisfied with their infant's pain management and parents in the PNCA group were slightly more satisfied with their level of involvement (P = .03). Groups did not differ in nursing satisfaction.ConclusionsPNCA may be an effective alternative to COI for pain management in the NICU population. This method may also substantially reduce opioid consumption, provide more individualized care, and improve parent satisfaction with their level of participation.Clinical ImplicationsPatients in the NICU represent one of our most vulnerable patient populations. As nurses strive to provide safe and effective pain management, results of this study suggest PNCA may allow nurses to maintain their patients' comfort while providing less opioid and potentially improving parental perception of involvement.Study TypeTreatment study.Level of EvidenceI.     

The Use of a Nurse-Initiated Pain Protocol in the Emergency Department for Patients with Musculoskeletal Injury: A Pre-Post Intervention Study

Background and Aim: As a common complaint of patients with traumatic injuries, pain remains undermanaged in emergency departments (EDs). Our aim was to evaluate the effects of a nurse-initiated pain management protocol in patients with musculoskeletal injuries in an ED in Iran.Material and MethodsThis pre-post intervention design study was conducted on 240 patients with orthopedic injuries selected through sequential sampling over two phases. The intervention consisted of case study sessions and the implementation of the nurse-initiated pain management protocol. The outcomes were assessed based on the Numeric Rating Scale (NRS) pain scores, the pain management satisfaction questionnaire, the nursing performance checklist and the waiting time evaluation form.ResultsThe mean pain intensity 30 and 60 min after triage and at discharge decreased significantly in the post-intervention group (p < .001). The patients' satisfaction with pain management (p < .01) and the nurses’ performance (p < .001) improved in the post-intervention group. Waiting time: there was a significant reduction in the post-intervention group from the end of triage by the nurse to the visit by the physician, and from patient’s arrival in ED to discharge or transferring, and also the time to initial analgesic.ConclusionsEducation based on case study and the implementation of the nurse-initiated pain management protocol resulted in a significant increase in multimodal analgesia administration and a reduction in pain intensity, an increase in patient satisfaction, an improvement in the triage nurses’ performance and the reduction of potential delays in pain management while maintaining the safety of patients with musculoskeletal trauma.