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Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double?blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 � 32.4 minutes vs. Group II: 143.2 � 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 � 47.12 minutes versus Group II: 247.00 � 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.
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Background: Access to pain management has been recognized as a fundamental human right. Inadequate pain relief hampers the quality of life and has a physiological and psychosocial impact on the patient and caregivers. Inadequate pain relief remains the leading cause of suffering in hospitalized patients worldwide. Objective: The objective of this article is to provide adequate pain relief to hospitalized patients through proper assessment, treatment, and monitoring of pain by the trained health-care workers through a sustainable and effective institutional pain management policy. Methods: The formulation of pain management policy at a tertiary care teaching institute was conducted in three phases – Phase 1: need assessment by an open?label, uncontrolled, prospective observational study over 1 month period, Phase 2: teaching, training, and awareness of health?care workers, and Phase 3: constitution of the committee at the institute level with the formation of pain resource teams. Results: An open?label, prospective observational study conducted over 1 month revealed that among 814 hospitalized patients, 108 out of 235 (46%) patients in medical and 385 out of 579 (66.5%) patients in the surgical cohort had NRS score of ?3, implying an inadequate pain relief even at 24 h following medical or surgical intervention, respectively. Conclusion: The provision of effective and adequate pain relief to hospitalized patients requires trained health-care workers and a uniform and structured pain management policy at the institutional level. Recognition and addressal of the barriers and challenges while framing an institutional pain policy is of utmost importance.
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Background & objectives: High mortality has been observed in the cancer population affected with COVID-19 during this pandemic. We undertook this study to determine the characteristics and outcomes of cancer patients with COVID-19 and assessed the factors predicting outcome. Methods: Patients of all age groups with a proven history of malignancy and a recent diagnosis of SARS-CoV-2 infection based on nasal/nasopharyngeal reverse transcriptase (RT)-PCR tests were included. Demographic, clinical and laboratory variables were compared between survivors and non-survivors groups, with respect to observed mortality. Results: Between May 11 and August 10, 2020, 134 patients were included from the three centres and observed mortality was 17.1 per cent. The median age was 53 yr (interquartile range 39-61 yr) and thirty four patients (25%) were asymptomatic. Solid tumours accounted for 69.1 per cent and breast cancer was the most common tumour type (20%). One hundred and five patients (70.5%) had received chemotherapy within the past four weeks and 25 patients (19.3%) had neutropenia at presentation. On multivariate analysis, age [odds ratio (OR) 7.99 (95% confidence interval [CI] 1.18-54.00); P=0.033], haemoglobin [OR 6.28 (95% CI 1.07-37.04); P=0.042] neutrophil–lymphocyte ratio [OR 12.02 (95% CI 2.08-69.51); P=0.005] and baseline serum albumin [OR 18.52 (95% CI 2.80-122.27); P=0.002], were associated with higher mortality. Recent chemotherapy, haematological tumours type and baseline neutropenia did not affect the outcome. Interpretation & conclusions: Higher mortality in moderate and severe infections was associated with baseline organ dysfunction and elderly age. Significant proportion of patients were asymptomatic and might remain undetected
ABSTRACT
India has a high share in the global burden of chronic terminal illnesses. However, there is a lack of a uniform system in providing better end-of-life care (EOLC) for large patients in their terminal stage of life. Institutional policies can be a good alternative as there is no national level policy for EOLC. This article describes the important aspects of the EOLC policy at one of the tertiary care institutes of India. A 15 member institutional committee including representatives from various departments was formed to develop this institutional policy. This policy document is aimed at helping to recognize the potentially non-beneficial or harmful treatments and provide transparency and accountability of the process of limitation of treatment through proper documentation that closely reflects the Indian legal viewpoint on this matter. Four steps are proposed in this direction: (i) recognition of a potentially non-beneficial or harmful treatment by the physicians, (ii) consensus among all the caregivers on a potentially non-beneficial or harmful treatment and initiation of the best supportive care pathway, (iii) initiation of EOLC pathways, and (iv) symptom management and ongoing supportive care till death. The article also focuses on the step-by-step process of formulation of this institutional policy, so that it can work as a blueprint for other institutions of our country to identify the infrastructural needs and resources and to formulate their own policies.
ABSTRACT
Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients’ lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO’s three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients.
Subject(s)
Air , Anesthesia, Closed-Circuit , Gastroscopy/adverse effects , Gastrostomy/adverse effects , Humans , Intestines/physiology , Male , Middle AgedABSTRACT
PURPOSE: The purpose of this study was to explore the psychological and social problems the terminally ill are facing in India. Another objective of this study was to explore the Locus of Control and Depression. AIMS: The study was conducted on an incidentally available sample of fifteen terminally ill patients at the Pain Clinic, I.R.C.H., AIIMS, ranging from young adults (30-35 years), to middle aged (40-50 years), to the elderly (55-65 years). MATERIALS AND METHODS: A thematic and narrative analysis was done using semi-structured interview. After the semi-structured interview, two standardized inventories were administered. The two inventories used were Multidimensional Health Locus of Control, and Beck's Depression Inventory. The statements from the two inventories were translated into Hindi and then asked. The inventories were not given as a questionnaire to be filled; rather they were asked orally and marked by the investigator. RESULTS: The co-relation between Internal Health Locus of Control and Depression was found to be significant below the 0.05 level. Statistics also revealed that a large number of participants were either severely depressed (33.33%) or extremely depressed (20%). The seven common themes running through all the narratives were identified; Concern for physical pain; Anxiety and Depression; Body-image problems; Social withdrawal; Disease viewed as bad 'karma'; Desire for hastened death; and lastly Hope. CONCLUSION: This article would create greater awareness among all the concerned people working with cancer patients on what intervention strategies should be utilized to help the patients, as well as, how the belief in karma can help gain a more positivistic outlook towards death and the core role spirituality and the belief in karma can play in the counseling of the patients and their families.
Subject(s)
Adult , Aged , Anxiety/etiology , Body Image , Counseling , Depression/etiology , Female , Humans , Male , Middle Aged , Neoplasms/psychology , Pain, Intractable/therapy , Social Isolation , Spiritual Therapies , Terminally IllABSTRACT
OBJECTIVE: Pediatric radiotherapy is a day care procedure. In children, anaesthesia is necessary to prevent movement during the therapy. Traditionally intramuscular ketamine is used for these procedure because of its inherent safety in a child who used to be left alone in the cobalt room. METHODS: This study was designed to explore the efficacy of propofol and ketamine in pediatric radiotherapy in nineteen children. The inclusion criteria was a child fasting for six hours with no fever or URTI in the past week. A child coming to the radiotherapy (RT) unit without an intravenous cannula was given intramuscular ketamine 10 mg/kg and taken for the procedure. Before the child recovered from anaesthesia an intravenous cannula, 20-22G, Vasofix was inserted for subsequent sittings of RT. The child coming with an intravenous cannula was given propofol 2.5 mg/kg with xylocaine (0.1 mg/kg) without adrenaline. The parameters recorded were pulse rate, oxygen saturation and respiratory rate-baseline to every 30 seconds till five minutes. Onset time, recovery time, oral feeding time and any untoward effects like nausea, vomiting, nystagmus were also noted. RESULT: The drug was graded on a scale of 0-10 according to parental acceptability where 0 is the worst and 10 is the best acceptability. The mean (+/-SD) of all the measured parameters were calculated and compared between the two groups. CONCLUSION: Propofol was associated with faster onset, better recovery, early oral feeding time, no nausea and vomiting and better parental acceptability. There was no hypotension, bradycardia and oxygen saturation at 60 seconds, which was between 94-95%, was easily treatable with supplementation of oxygen by face mask.