ABSTRACT
Health professionals often underestimate children's pain and do not treat it as a priority. To raise awareness, the International Association for the Study of Pain has launched a campaign [Global Year against Pain in Children] in 2005, but evidence shows that the pain in children still remains undertreated. to determine the prevalence of postoperative pain and the methods for pain treatment in pediatric patients. This survey was done on a one-day period in 7 hospitals in northeastern Thailand. Participants were all in-patient children of the age <15 years old or their parents. Exclusion criteria were newborn and critically ill infants. Interesting data included; pain prevalence [pain score > 1 during the past 24 hrs], patients' perception of receiving pain treatment. Self report pain was measured with the use of either numerical rating scale [0 to 10 scales] or the Faces Pain Scale-Revised [0-5 faces]. For those who were unable to self report pain, the Neonatal Infant Pain scale was used. Types of surgery, days after surgery, prescription for pain relief and non-pharmacological measures used for pain relief were also recorded. One hundred and thirty three of 487 patients [27.3%] were surgical cases. The prevalence of postoperative pain during the past 24 hrs was 69.2%, but those who had moderate to severe pain was 43.6%. Most of children [78.2%] experienced mild or no pain at the time of interview. Almost a half [44.6%] of them perceived they had pain medication upon request and more than half of them [60.1%] used non-pharmacological methods for supplementary pain relief. Two most common prescribed medications were paracetamol [51.9%] and morphine [25.6%]. The proportion of medication administered to patients was less than those found in the prescription such as 24.8% vs 51.9% for paracetamol and 8.3% vs 25.6% for IV morphine. Only three conventional routes, oral, intravenous and intramuscular /subcutaneous routes, were found in the prescription for pain treatment. Postoperative pain remains undertreated in northeastern Thailand. We need to raise awareness level and improve the understanding and the knowledge about Postoperative pain and its management
ABSTRACT
The effectiveness of midazolam as anesthetic premedication was investigated, comparing rectal to intramuscular administration. A total of 40 children (ASA class I), varying in age from 1-5 year, were randomly allocated into two groups. Group I (N=20) was given midazolam 0.2 mg/kg intramuscularly. Group II (N=20) was given midazolam 0.3 mg/kg rectally. Induction of aneshesia was performed 30-60 minutes after the premedication. Anxiety score was objectively rated on a 5 points scale by a trained observer. Respiratory rate, pulse rate and anxiety score were recorded every 10 minutes upto 30 minutes after midazolam premedication. Acceptance of the mask for induction was assessed by the same observer. Both groups had significant (p
ABSTRACT
no abstract
ABSTRACT
We report a 61 year-old female, Jehovah’s witness patient with mitral stenosis who underwent successful surgery for mitral valve replacement. Tranexamic acid and hemodilution technique were used intraoperatively to reduce blood loss. The patient did not receive any blood or blood products while staying in the hospital.
ABSTRACT
Background : Postoperative pain remains a common complaint among PACU patients so we developed guidelines for better pain control. Patients rated their pain using a numeric rating scale (NRS, from 0 to 10). According to the guidelines, PACU nurses knew that patients with a NRS score were in severe pain and required medication.Objective : To determine the proportion of patients not receiving treatment according to the guidelines.Design : Descriptive studySetting : PACU at Srinagarind HospitalSubjects : April 2001 PACU recordsMeasurement : The PACU records were reviewed retrospectively for age, NRS score, sedation score, number of treatments given and types of medication used.Results : the PACU admitted 474 patients in the month of April and 338 them were included in our study. Pain assessment was performed on 246 of the sample (72.8%,95%Cl : 68-77%) although 92 were not documented. Most of the patients (95.5%) were able to rate their pain using the NRS. NRS scores 5 were reported by 156 patients (66.4%,95%Cl: 60-72%) but 40 of them (25.6%,95%Cl: 19-33%) did not receive any treatment because 10 refused it and 30 gave no outward sign of needing it. Prior to discharge, 54 patients (29.8%, 95% Cl: 23-37%) still had NRS score5.Conclusion : Pain assessment according to the guidelines was performed on 72.8% of the sample. About 60% of patients had a NRS score 5 but 25.6% did not receive any treatment. We concluded that the guidelines were useful for PACU pain management. For greater improvement in the quality of PACU care, a prospective study should determind provider compliance.Keywords:\ 1. Postoperative Pain\ \ 2. PACU\ \ 3. Pain algorithm
ABSTRACT
Background : Inappropriate medications, or doses, routs and duration of appropriate medications for control of acute postoperative pain have both physical and psychological sequelae.Objective : To survey the orders given over the first 24 hours for postoperative pain control at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.Methods: cross-sectional descriptive study.Setting: Post Anesthesia Care Unit (PACU), Srinagarind HosptialMaterials and Methods: We inventoried the orders given for the first 24 hours of postopetrative pain control for patients admintted to PACU between June 21 and 22, 2001. Excluded were patients transferred to ICU postoperatively, outpatients and those given anesthesia by local infiltration. Results: 225 patients were admitted to PACU during the sampling period. The types of pain control medication given included : Tramadol 37.4%, Pethidine 29.6% Paracetamol 22.3%, Morphine 10.2%,and Fentanyl 0.5% No jpain treatment was ordered in 8.4% of the cases. The predominant pain control orders from the Department of Surgery was Pethidine 46.4% from Orthopedics, Tramadol Tramadol 76.6%, from ENT, Paracetamol 46.4%, form OB-GYN, Pethidine Pethidine 67.6%, from Ophthalmology, Paracetamol 100%, and from Dentistry, Pethidine (100%). The most common administration routes ordered were: intravenous by the Department of Surgery (82%), intramuscular by Orthopedics (63.6%), intravenous by ENT (48%), intramuscular by OB-GYN (91%), oral by Ophthalmology (100%), and intramuscular by Dentistyr (100%). Differences in dose and duration of administration occurred when both appropriate and inappropriate orders were given.Conclusion: The postoperative pain orders at Srinagarind Hospital have many differences in medications, doses, and duration. It was up to level of pain and many factors in individual patients. This research was designed for survey of the basic information and for development of next research. Keyword: 1. Postoperative pain 2. Doctor’s order 3. Analgesic drugs
ABSTRACT
Objective: To assess the success rate of blind tracheal intubation with flexible endotracheal tube through the intubating laryngeal mask airway (ILMA) on a manikin. Design: Descriptive study.Methods: Thirty unskilled volunteers were assigned to insert a preformed flexible endotracheal tube (SheridanTM) through the inserted ILMA on the manikin which optimal positioning was already confirmed by fiberoptic bronchoscope. The success rate and time of the insertion were recorded, also difficulty of the insertion was graded by both intubator using VAS and by observer using 3- point rating scale as well.Results: Blind tracheal intubation through the ILMA was successful in all intubators. The time for intubation ranged from 7.50 to 13.28 sec. (mean 10.14 + 1.58 sec.) and the intubation was graded as easy either assessed by the observer (grade 1) or by the intubators (mean VAS =2.39+ 1.20). Conclusion: Blind tracheal intubation through the optimal position of ILMA using a preformed flexible endotracheal tube is easy to perform by unskilled personnel with high success rate. This technique may be useful for patients whose airway management is expected to be difficult. Keywords: 1. Intubating LMA, 2. Techniques, 3. Preformed endotracheal tubes, 4. Unskilled personnel, 5. Manikin
ABSTRACT
Background: Postoperative pain should be closely monitored by regular scoring and documenting it as the 5th vital sign. Objective: To evaluate the use of a revised Graphic Sheet for recording pain scores as the 5th vital sign. Design: Descriptive study.Setting: Orthopedic surgical wards at Srinagarind Hospital, Khon Kaen University, Thailand.Methods: The sequences of the study included: 1) revision of the old record form; 2) orientation of the ward nurses on how to assess and to document pain scores; and 3) the new Graphic Sheet was tested for 1 month. Pain (at rest) was assessed by nurses 4- hourly along with the other four vital signs for at least 3 days on every patient. The assessment was excepted in patients younger than 10 years or whose hospital stay was shorter than 2 days.Outcome Measures: All recorded Graphic Sheets were audited. The value of pain scores were recorded each day and the number of patients with severe pain (score \> 7) noted. A questionnaire about using the Graphic Sheet was sent to each nurse involved in recording the pain scores for practicability study.Results: A total of 121 patients, 49 from Ward #1 and 72 from Ward # 2, were operated on during the study period. Sixty-seven percent of the patients had their pain scores recorded on the Graphic Sheet and these were done between 2 and 3 times per day. The number of patients with severe pain on postoperative day 0 and day 1 was 43 and 45 percent, respectively. Most of the nurses (95%) agreed that the Graphic Sheet was useful for documenting pain scores as the 5th vital sign and in daily practice.Conclusion: The revised Graphic Sheet for documenting pain scores was tested. The pain scores were documented in 67 percent of the patients. The Graphic Sheet was useful for postoperative pain management, therefore it should be promoted for use in the other surgical wards.
ABSTRACT
Background: Most of gynecological patients were encourage to ambulate after 24 hr of surgery. For this reason, after a total abdominal hysterectomy, care providers are reluctant to give a strong analgesic after the first postoperative day, except oral acetaminophen. Pain patients are experiencing the second postoperative day at our hospital has not been graded. Objective: To determine the incidence and magnitude of pain during the second post-operative day after total abdominal hysterectomy.Design: Descriptive study.Setting: Gynecological Ward at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University between October 4 and December 7, 2004.Method: The patients were interviewed on the second post-operative day after total abdominal hysterectomy.Outcome Measures: Pain and suffering scores were evaluated both at rest and during ambulation (both using a numeric rating scale 0-10, scores \> 5 defined moderate to severe pain). We recorded pain intensity and relief before and after taking oral acetaminophen, numbers of analgesic injection(s) during the 24 hours after surgery, the time between the last analgesic injection and the first oral acetaminophen, the need for analgesic injection(s)during the second post-operative day, and patients' satisfaction with pain relief.Results: Forty-five patients were interviewed: 69% (95% CI 51–79%) had moderate to severe pain and 67% suffering while ambulating. Before receiving the first oral acetaminophen, 86% had moderate to severe pain and 84% suffering; afterward the pain and suffering were reduced to 38 and 37%, respectively. Twenty-eight percent of the participants felt that oral acetaminophen provided modest pain relief, while 42% needed more analgesic on the second post-operative day. Most of the patients (92%) were satisfied with the pain relief given even though they still experienced pain.Conclusion: On the second post-operative day after a total abdominal hysterectomy, 69% of women had moderate to severe pain and 67% suffering while ambulating: 28% reported oral acetaminophen produced modest pain relief. Although most of the patients were satisfied with the received treatment, alternative methods should be used for greater reduction of pain and suffering.Key words: Pain, suffering, total abdominal hysterectomy, ambulation.
ABSTRACT
Blackground : A mother should have contact with, and take care of, her newborn as early as possible. For this reason, after a cesarean section, care providers are reluctant to give a strong analgesic after the first postoperative day, except oral acetaminophen: as some analgesics are contraindicated for breastfeeding mothers. Pain mothers are experiencing the second postoperative day at our hospital has not been graded. Objective: To determine the incidence and magnitude of pain the second day after cesarean section.Design: Descriptive study. Setting: Postpartum Ward at Srinagarind Hospital between August 1 and October 31, 2004.Method: Interview mothers in the second day after cesarean section.Measurement: Pain and suffering scores were evaluated both at rest and duringambulation (both using a numeric rating scale 0-10, scores \> 5 defined moderate to severe pain). We recorded pain intensity and relief before and after taking oral acetaminophen, numbers of analgesic injection(s) during the 24 hours after surgery, the time between the last analgesic injection and the first oral acetaminophen, the need for analgesic injection(s) the second day, and mothers' satisfaction with pain relief. Results: One-hundred mothers were interviewed: 78% (95% CI 69 – 86%) had moderate to severe pain and 66% suffering while ambulating. Before receiving the first oral acetaminophen, 96% had moderate to severe pain and 94% suffering; afterward the pain and suffering were reduced to 43 and 55%, respectively. Thirty-nine percent of the participants felt that oral acetaminophen provided modest pain relief, while 20% needed more parenteral analgesic in the second day. All of the mothers were satisfied with the pain relief given even though they still experienced pain.Conclusion: The second day after a cesarean section, 78% of women had moderate to severe pain and 66% suffering while ambulating: 39% reported oral acetaminophen produced modest pain relief. Although all of the mothers were satisfied with the received treatment, alternative methods should be used for greater reduction of pain and suffering.Key words: Pain, suffering, cesarean section, ambulation.
ABSTRACT
Background: Nursing care in the orthopedic surgical wards have in place a policy for quality improvement, which is emphasized by use of pain score recording.Objective: To audit pain score records for the first 72 hours after surgeryDesign: Descriptive study with retrospective data collectionSetting: Orthopedic Surgical Wards at Srinagarind Hospital, Khon Kaen University, ThailandMethods: Between March and April 2005, we extracted data from the Graphic Sheets for patients ³ 10 years of age.Outcome Measures: 1) All records were audited and the values for pain scores recorded each day including the operative day (Day 0 – assessed by a nurse every 4 hours) and two days post-op (Days 1 and 2 – assessed every 8 hours). Good quality records had regularly recorded pain scores. An improvement in quality was acknowledged if the proportion of quality records was ³80%. 2) The percentage of patients having two-consecutive severe pain recordings (i.e. score ³ 7) on each Day. 3) Mean pain score each time. 4) Patient-satisfaction before discharge.Results: A total of 94 patients were included. On Day 0, 98% of the assessment and recording of pain scores occurred, on Day 1 it was 95% and on Day 2 it was 89%. The highest post-operative pain was 5.5 ± 2.5, 4.0 ± 2.5 and 3.1 ± 2.7 on Day 0, 1 and 2; while the lowest pain score was 4.2 ± 2.8, 2.9 ± 2.7 and 2.1 ± 2.1 on Day 0, 1 and 2, respectively. Percentages of the patients having two-consecutive severe pain were 19%, 5% and 1%, respectively. All of the patients were satisfied with the pain relief offered.Conclusion: Completion of the assessment and pain score records at the orthopedic surgical wards were high and all of the patients indicated that they were satisfied with the pain service.Keywords: Audit Recording, Orthopedic Wards, Pain Scores, Postoperative
ABSTRACT
Background: The Faculty of Medicine annually allocates its own budget for research grant but the numbers of research publication each year in the previous study was only 21.5%Objective: To study and improve the supportive system for research publication within the Faculty of Medicine, Khon Kaen University.Setting: The Faculty of Medicine, Khon Kaen University.Design: Descriptive studyMethods: The sequences of the study included; phase 1) reviewed proposals granted by the Faculty of Medicine between the years 2002- 2004 and then a structured questionnaire was sent to all principal investigators; phase 2) problems related to research publication were analyzed after discussed with a focus group who were involved in research activities; phase 3) reported the problems to the Faculty’s administrative board; and phase 4) Post-evaluation after supportive system changed. Outcome measures: Numbers of proposal granted, total amount of the budget funded, numbers and factors related to research publication were recorded.Results: During the studied period there were 204 proposals granted with amounted to 11,567,715 Baht. Only 71 proposals (34.8%) of the researcher could finish their work within 1- 3 years after granting and made the final report to the Faculty. Thirty –six out of 71 proposals (17.6% of granted proposal) were submitted for publication, where 32 have not prepared the manuscript. Most of non-publication (75%) grants were done by postgraduate students. The existing supportive system for publication within the faculty includes; institutional journal (in Thai), English consultant, page charge fee, and reward prize for index journal publication. The administrative board of the Faculty responded to the reported problems by improving the supportive system, however, changing for research publication may take times.Conclusion: The Faculty of Medicine has a completed supportive system for publication but only 17.6% of granted proposals were submitted for publication. Most of non-publication was postgraduate students. The Faculty now is doing some changes of supportive system that might raise the number of publication.Keyword: research funding system, research utilization, publication
ABSTRACT
Background: Pain assessment and documentation can be used as vital sign for the improvement of postoperative pain management; however, these systems have never been adopted for use at Srinagarind Hospital.Objectives:1. To develop a systematic postoperative pain assessment and documentation as the fifth vital sign; and,2. To implement a revised graphic sheet for pain documentation at Srinagarind Hospital.Design: Descriptive studySetting: Srinagarind Hospital, Faculty of Medicine, Khon Kaen UniversityMethods: Researchers explored the ward nurses’ attitudes and practices vis-à-vis the pain assessment and documentation in a pilot ward. Subsequently, systematic pain assessment and documentation using the old graphic sheet, originally developed for recording four other vital signs, were re-designed to include the new sign, tested and revised for its practicality. The revised graphic sheet was re-tested in two other wards and finally the system was implemented throughout the hospital.Measurement: Pain assessment tools, frequency of pain documentation and the number of patients assessed before and after the study were recorded. The ward nurses were asked to give their comments on the practicality of the new system for pain assessment and documentation.Results: In the pilot ward, misunderstanding regarding the pain assessment tools was found among some ward nurses. The frequency of pain assessment and documentation significantly increased after using the revised graphic sheet (43.2% vs. 57.3%, p=0.039). The prevalence of no pain assessment also decreased significantly (12.1 vs. 2.2%, p=0.008). Most of the nurses (87.5%) could complete the pain record form within one minute. The new system, as reported by 62.5% of the ward nurses, nominally increased their workload. Re-testing this system in the other two wards increased the number of pain assessments and documentations on the first post-operative day from 67% to 98 %. The revised graphic sheet was then accepted by the policy makers for use throughout the hospital.Conclusion: The system of post-operative pain assessment as the fifth vital sign was developed. A revised graphic sheet was used for pain documentation and accepted for routine use. The new system increased the number of pain assessments and documentations of post-operative patients.
ABSTRACT
Introduction: Doing research about routine patient care, so-called Routine to Research or R2R, can increase both the quantity of articles and quality of care. Objective: To determine the number of R2R-related articles by anesthesia providers at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, and their utilization.Study Design: descriptive studyMethods: Questionnaires to the corresponding authors of papers published between 2002 and 2005. We excluded case reports from the study and focused on basic data of researchers, number of articles that received funding, the number of R2R-related articles and their utilization. The data were analyzed and presented using descriptive statistics.Results: All 40 questionnaires were returned, representing 22 anesthesiologists’ articles (55%) and 18 nurse anesthetists’ articles (45%). Eighteen articles (45%) received funding. Thirty-six articles (90%) were classified as R2R-related articles: 12% have already been applied to routine patient care; 6 had potential for application provided they received suitable encouragement; 10% had less potential for application; and, 8% were non-applicable because of an unavailability of medications or equipment.Conclusion: Based on articles published by anesthesia providers at the Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, between 2002 and 2005, R2R-related articles comprised 90%, but only one-third have been applied to routine patient care while another 16.7% (or 15% of all articles) have potential for applications were they to receive suitable encouragement.
ABSTRACT
Background: Currently, post-operative pain management is considered an integral part of recovering and reducing complications related to pain. Acute pain service (APS) has been established worldwide in order to improve the effectiveness of patient care. The Departments of Anesthesia at Khon Kaen and Chiang Mai Universities (KKU and CMU, respectively) developed an APS system each at approximately the same time. Collaboration of the two institutions to benchmark their APS data will help them move forward vis-à-vis post-operative pain management.Objectives: Comparing the results of the respective APS systems between Khon Kaen and Chiang Mai Universities.Design: Retrospective, descriptive studyMethods: The 2005 calendar year data, from the respective APS databases, were reviewed, allowing a comparison of post-operative pain management at KKU and CMU hospitals. We focused on the percentage of post-operative orthopedic patients care through the APS system compared with (1) APS service, (2) days of service, (3) method of pain management, (4) pain assessment, (5) complications, (6) the APS system and (7) patient satisfaction. The data were analyzed using descriptive statistics.Results: Patients who received APS accounted for 12.3 and 7.2 percent of KKU and CMU patients, respectively. The greatest proportion of patients at KKU receiving APS was for intra-abdominal surgery (60%) while at CMU it was for cardiovascular and thoracic surgery (76%). Both institutions provided an average 2.0+1.0 days of service. Surgery on extremities (orthopedics) ranked second at both institutions (26.8 and 20.7 percent, respectively). KKU used variety techniques for controlling pain among orthopedic patients: viz., IV PCA (59%), IV opioid infusion (30%), epidural (6.8%) and spinal morphine with PCA (5.2%), while the primary modality for pain control at CMU was IV PCA (97%). Resting pain for CMU patients was less than that reported by KKU patients (6 vs. 9.5 percent, respectively); however, dynamic pain was not assessed at CMU. Serious complication was not found and patient rated satisfy with APS approximately 94% and 97% (CMU, KKU).Conclusion: The delivery of APS for orthopedic surgery patients at two regional university hospitals in Thailand were studied and benchmarked. There was some difference in the strengths of the APS system between the two institutions; such as, techniques of pain treatment, pain scores and system for pain management. Strengths and weaknesses observed during this benchmarking exercise will be used to improve the delivery of APS at both institutions.Keywords: Acute Pain Service; Benchmark; Post-Operative Pain; University Hospital
ABSTRACT
Introduction: The adequate treatment of acute pain after surgery is a humanitarian obligation for heath care professionals. Analgesia plays an important role in speeding the patient’s recovery, in reducing and limiting morbidity, as well as probably improving clinical outcomes. Significant knowledge deficit regarding currently accepted principles of pain management practice as well as beliefs that could interfere with optimal care, mandate a need for educational interventions.Objective: To assess the pain knowledge and attitudes toward postoperative pain management by acute pain service (APS) of healthcare providers in Srinagarind HospitalDesign: Descriptive \& prospective research Setting: The surgical, obstetrics \& gynecological, orthopaedics and otorhinolaryngology wards in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University Population: All physicians and nurses work at those wards in Srinagarind Hospital Material and methods: The total 286 questionnaires from physicians and nurses were collected during August to October 2005. The informed consents were obtainedfrom all subjects. The demographic data, previous pain education, clinical experience, pain knowledge scores, level of satisfaction to APS and other variables were analysed. The data were analyzed using, and presented as, descriptive statistics. The Chi-square test was used to test for significant difference variables. A p-value of less than 0.05 was considered statistically significant.Results: The response rate of questionnaire in physicians and nurses were 99.2% and 77.5%, respectively. The physicians’ knowledge scores were moderate to high and higher in nurse groups. The level of physicians’ knowledge significantly associated with previous pain education (p= 0.001). Attitudes toward postoperative pain management by APS of healthcare providers in term of physicians and nurses on satisfaction level were satisfied and highly satisfied, respectively. This survey suggests that our healthcare providers need the continuing organization and education in pain management and consultation system.Conclusion: Most physicians and nurses were satisfactory in attitudes towards postoperative pain management by APS. Practical recommendations are presented for increasing physicians and nurses’ knowledge about pain management. The continuing education and good consultation system might be useful in order to improve the quality of postoperative pain management in our hospital.Keywords: knowledge, Attitude, Acute pain service
ABSTRACT
Background: The Royal College of Anesthesiologists of Thailand arranged the first national incident reports of anesthesia-related adverse events in 2007 on an anonymous and voluntary basis. Objective: To identify the incidence of perioperative non-hypoxic bradycardia in pediatric patients’ clinical course, outcome, contributing factors and its preventive strategies in the database of the Thai anesthesia incidents monitoring study (Thai AIMS). Methods: As part of the Thai AIMS, perioperative anesthesia incident reports of adverse events were collected from 51 participating hospitals across Thailand between January to June 2007. Three anesthesiologists reviewed relevant data of perioperative non-hypoxic bradycardia in pediatric patients. A descriptive statistical method was used. Results: There were 49 cases of perioperative non-hypoxic bradycardia in pediatric patients (2.4% of all 1996 incident reports or 13.4% of all incident reports from pediatric patients). Anesthesia (71%) was a major factor that related to the bradycardia, wheareas 19% and 10% were surgical and patient factors, respectively. Sixty percent of cases occurred during induction, of which 80% (24 out of 30 cases) and 10% were considered as anesthesia-related or combination of anesthesia and patient factors. Sixty percent (9 out of 15 cases) of bradycardia during the maintenance phase was surgery-related particularly in ophthalmologic surgery. Four cases (8.1%) of all bradycardia occurred during the emergence and recovery phase of which 78% was considered anesthesia-related. All bradycardia had complete recovery. Sixty-three percent of events were preventable. Major contributing factors were lack of adequate knowledge (55%) and inappropriate decision-making (22%). Conclusion: Most perioperative non-hypoxic bradycardia incidences were anesthesia-related and most common during the induction phase. Improved supervision, additional training and vigilance were suggested corrective strategies.
ABSTRACT
Background: Recently, the proportion of elderly persons is rising worldwide leading to increase amount of surgical patients of this age group. The evidences about pain control clearly supported that elderly persons received under-treatment. Whatever, data from our institute is limited and needs to be determined.Objective: To survey postoperative pain management and its outcomes in elderly patients at Srinagarind Hospital. Study design: Cross-sectional descriptive study.Setting: Post anesthesia care unit (PACU) and surgical wards, Srinagarind Hospital.Materials and Methods: Pain management and its outcomes were evaluated in patients over 65 years old underwent elective general surgery for a two months period. Data were collected from medical records and from patient assessment including method of pain treatment, pain intensity (at rest), pain relief, patient’s satisfaction and side effects of the treatment.Results: Ninety-one patients with the mean age of 72.0 + 5.7 years were evaluated. Most of them (72.5%) received general anesthesia and 56.1% underwent intra-abdominal surgery. Intravenous injection was the most common technique used for pain control (63.8%) while PCA pump was used about 20.9%. Pain assessment usingNRS was achieved in between 62-95.6% (average 75.5%). The proportion of patients experienced moderate to severe pain during arrival at the PACU, at discharged from the PACU and at 24 hours after operation were 29.4%, 23.1% and 18.8%, respectively. The most common side effect was nausea and vomiting (12.2%). Only 8.9% of patients reported that pain was not relief and 1.1% of patients unsatisfied with the treatment received. Conclusion: About 29.4% of the elderly patients experienced moderate to severe pain after surgery. Most of them received pain treatment by intravenous injection while only 20.9% received acute pain service from the acute pain unit of Anesthesiology department.Keyword: older patients, postoperative pain management
ABSTRACT
Background and Objectives: Effective pain control can minimize post operative complications especially for pulmonary complications. Previous reports showed pain management using combined spinal morphine (spinal MO) plus patient-controlled analgesia (IV PCA) was more effective than either intravenous or PCA alone. This technique had been conducted in our institute since 2004 but its effect on postoperative pain control was not reported. Aim is study the effect of spinal morphine plus IV PCA on postoperative pain control. Methods: The author conducted this descriptive study at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, by retrospectively reviewing all medical record of surgical patients who received spinal morphine plus PCA for postoperative analgesia between January 2005 and December 2006. Data extracted were age, gender, types of operation, dosage of spinal morphine, pain scores (both at rest and during movement) on the first post operative day, adverse effects, and patient’s satisfaction. Effect of the pain control were classified as; effective (pain score 0-4) and ineffective (pain score 5-10)Results: Two hundred and sixty two records were analyzed. There were 63% female with a mean age of 49.6+10.5 years. Most of patients (69%) underwent abdominal surgery (excluded cesarean section and kidney surgery). Median dosage of spinal morphine was 0.3 mg depending on types of surgery. There were 62% of cases received effective analgesia at rest whereas 35.4% received while movement. No respiratory depression was reported but 1.5% of patients experienced severe nausea and vomiting. However, 92% of patients were satisfied with the treatment received.Conclusion: Spinal morphine plus PCA is effective for pain control in the first postoperative day only for at rest, but not during movement. Keywords: postoperative pain, spinal morphine, patient-controlled analgesia