Association of the knowledge of nurses about the pain management with their attitude towards cancer patients

Objective: Proper training and knowledge about pain and pain management can help nurses during their task of active management to relieve pain, but it also builds positive attitude towards patients. We aimed to determine the association between knowledge and attitudes of the nurses about pain management of cancer patients and the relationship to different demographic and educational factors

Methodology: This cross-sectional study was conducted in four hospitals of Lahore, [Pakistan] from 1st July 2013 to 1st July 2014. A self-administered questionnaire was used to collect data. 100 nurses working in cancer units [both medical and surgical oncology wards] were included in the study using convenient sampling technique. Nurses not working in cancer units, high positioned [head nurses] and nurses with higher education [e.g. MSc [N], post RN-BSc [N], other courses] were excluded from the study. Questionnaire used based upon the "Knowledge and Attitudes Survey Regarding Pain [KASRP]" for knowledge and attitude. Data was collected and analyzed using SPSS version 21.0

Results: Out of one hundred nurses 90% were females while 10% were males. The mean age of participants was 30.88 +/- 8.91 years. Majority of the nurses i.e., 59% had inadequate knowledge. Attitude score regarding the cancer pain management was 60%. Knowledge of pain management was significantly associated with nurses attitude towards pain management [p = .001]

Conclusion: There is positive association between the knowledge and attitude towards cancer pain management. Thus, by showing good attitude, the nurses, who spend most of their time with patients can help to minimize their pain. This is only possible if the nurses have proper knowledge and education in this field

Frequency of headache with 25G or 27G quincke needles after spinal anesthesia in patients undergoing elective cesarean section

Objectives: Post-dural puncture headache [PDPH] is an iatrogenic complication of spinal anesthesia which results from puncture of the dura mater. The signs and symptoms of PDPH are thought to be caused due to loss of cerebrospinal fluid, traction on the cranial contents and reflex cerebral vasodilation. The patient's age, sex and the size of the dural perforation are the two most important factors affecting the frequency and severity of PDPH. We aimed to compare the frequency of post-dural puncture headache [PDPH] with 25G quincke needle and 27G quincke needle in spinal anesthesia in patients undergoing elective cesarean section

Methodology: This randomized controlled trial was carried out in our anesthesiology department over a period of six months from 1st December 2014 to 30th May 2015. A total of 124 parturients, ASA physical status I to II undergoing cesarean section were included in this study. Patients with infection at the site of injection, severe hypovolemia, coagulopathy, raised intracranial pressure, severe aortic and mitral stenosis, severe preeclampsia, placenta previa grade II-IV, placenta accreta and twin pregnancy were excluded from the study. Enrolled parturients were divided into two groups A and B, with 62 patients in each group. In Group-A and Group-B, Quincke spinal needles 25G and 27 G were used respectively to administer spinal anesthesia in the sitting position at the L3-4 or L4-5 intervertebral spaces. PDPH was assessed after 6, 12, 24 and 48 hours of surgery. Qualitative variable are presented as frequency and percentages while quantitative variable like age was presented as mean +/- SD. Sample t-test was applied on quantitative variable age. Chi-square test was applied for comparison of PDPH. A P- value < 0.05 was considered statistically significant

Results: The ages of patients were between 18 to 40 years. Mean age of the patients in Group-A was 27.77 +/- 4.82 y and 27.74 +/- 4.30 y in Group-B. Nine patients [14.5%] of Group-A experienced PDPH as compared to 2 patients [3.2%] of Group-B. There was statistically significant difference [p = 0. 027] between the groups

Conclusion: We conclude that 27G quincke spinal needle has definite advantage over 25G quincke spinal needle in terms of frequency of PDPH in spinal anesthesia for cesarean sections

Positive end expiratory pressure [PEEP]; comparison different values during one lung ventilation, for its effects on blood arterial oxygenation and carbon dioxide levels

Thoracic surgeries and aesthesia for lung resection has presented anaesthesiologists with certain unique physiological problems. These include placing [lateral decubitus position] in order to obtain optimal access for most operations on lungs, pleura, esophagus, and great vessels, opening the chest wall [open pneumothorax] and one lung ventilation anaesthesia. One lung ventilation anaesthesia and lateral decubitus position produces decrease in functional residual capacity and an obligatory right to left shunt that ranges from 15% to 40% leading to increase in ventilation perfusion [V/Q] mismatch thus causing hypoxia and or hypoxemia. An optimal level of positive end expiratory pressure of 5cmH O when added to dependent lung is known to improve arterial oxygenation and improve ventilator 2 efficiency. To compare different values of positive end expiratory pressure [PEEP] during one lung ventilation, for its effects on blood arterial oxygenation and carbon dioxide levels. Study Randomized controlled trial [RCT]. Conducted in surgical Unit-III and Department of anaesthesia and Intensive Care, Combined Military Hospital, Rawalpindi. Duration of study with dates: Ten months from 25-12-2008 to 01-10-2009, Additional quantum of Data was collected from 01-01-2011 to 25-01-2011. The patients were divided into two equal groups of 100 patients each, by random allocation of patients to either in-group A [subjected to zero PEEP] or group-B [subjected to PEEP 5cm of water]. At induction and start of two lung ventilation 14 [14.0%] of the patients from group-A and 16 [16.0%] from group-B had normal PaCO. At initiation of one lung ventilation 25 [25.0%] of the patients from group-A and 80 [80.0%] from group-2 B had normal PaO. At initiation of one lung ventilation 26 [26.0%] of the patients from group-A and 80 [80.0%] from group-B had normal PaCO 2 2 with p<0.001. At end of procedure one lung ventilation 30 [30.0%] of the patients from group-A and 90 [90.0%] from group-B had normal PaO. 2 At end of procedure one lung ventilation 32 [32.0%] of the patients from group-A and 91 [91.0%] from group-B had normal PaCO. 2 The execution of one-lung ventilation still constitutes a challenge in clinical and surgical practice

Local analgesia comparison of premixed lignocaine and adrenaline with freshly prepared lignocaine and adrenaline

To compare the analgesic effect of commercially available premixed injection of lignocaine 2% and adrenaline in 1:100,000 dilution with that of freshly prepared solution by mixing adrenaline in suitable quantity to 2% plain lignocaine just before the time of injection for tooth extraction in patients of dental caries. Descriptive Interventional Study. Armed Forces Institute of Dentistry [AFID] Rawalpindi from March 2006 to August 2006. Patients and A total of 50 patients of dental caries, who were scheduled for tooth extraction, were divided into 2 groups of 25 each. Group A was provided analgesia with commercially available premixed injection of lignocaine and adrenaline and group B was provided analgesia with freshly prepared solution of plain lignocaine and adrenaline. In group A, good quality analgesia sufficient enough for tooth extraction, was achieved in 19 patients whereas in group B good quality analgesia was achieved in 23 patients. Freshly prepared mixture of plain lignocaine and adrenaline gives better analgesic effect than that of commercially available solution of lignocaine with adrenaline

Surgery in a temporary setup- sharing an experience of 16 months

Sharing an experience of surgery in a temporary set up. Descriptive study. This study was carried out at Combined Military Hospital Muzaffarabad after the earthquake of October 2005 over a period of 16 months. The workload that this hospital has managed over the period despite running under tents. The hospital was functioning under the temporary set up. Patients were earth quake victims requiring different surgical procedure. A total of 2887 major and 7471 minor surgical procedures pertaining to the specialty of General Surgery, Orthopedics, ENT, EYE and Gynecology were carried out over a period of 16 months. Though the load was comparable to any [C] class and most of the [B] class hospitals, despite being under tents, there was not a single case of post operative infection. The importance of single-use-only surgical disposables in the good management of surgical patients has also been highlighted. The basic sterilization techniques, if followed religiously stand good in preventing postoperative infection, even in compromised working condition

Moderate acute normovolaemic haemodilution - a limited experience with autologous blood transfusion

Blood is transfused to increase the oxygen carrying capacity and the intravascular volume. The requirement of blood transfusion is not simply dependent upon the haemoglobin or haematocrit values but the emphasis is also placed upon the age and health of the patient. The potential risks of blood transfusion have necessitated finding alternatives to allogeneic blood transfusion. This study was conducted to determine the efficacy and safety of moderate acute normovolemic hemodilution to reduce allogeneic red blood cells transfusion in operations in which blood transfusion was otherwise required. It is an interventional clinical trial. The study was carried out in the department of anaesthesia, operation theatre and intensive therapy care unit, Combined Military Hospital, Okara Cantt, during the period from January 2003 to October 2003. Twenty five patients of ASA-I and II status, who were undergoing elective surgical procedures, were subjected to the technique of moderate acute normovolaemic haemodilution. The intravascular volume of the patients was maintained with lactated Ringer's solution and 6% hexaethyl starch solution. Autologous blood was reinfused after the operation. All patients in this study remained haemodynamically stable. No patient required any homologous blood transfusion. Moderate ANH was found a useful, safe and economical technique. It can be used as an alternative technique in operations in which homologous blood is otherwise required

comparison of sevoflurane with midazolam to provide sedation to patients for surgery under locoregional anaesthesia

To compare the quality, speed of recovery, and side effects of sevoflurane sedation compared with intravenous midazolam. Quasi experimental, double-blind, comparative study. Operation theatre complex, Combined Military Hospital Rawalpindi from 1st June 2006 to 31st Dec 2006. Total of sixty patients, American Society of Anaesthesiology I-III aged 18-70 years undergoing surgery under locoregional anaesthesia were divided into two equal groups by convenient sampling. Group A: [n=30] received Sevoflurane sedation. Group B: [n=30] received Midazolam sedation. The patients were sedated gradually during the procedure and maintained at Observer`s assessment of alertness and sedation [OAAS] score of 3. At recovery the OAAS score was measured at 5, 10 and 30 minutes after stopping the drug administration. Subjective assessment of quality of recovery was measured by visual analog scale [VAS] determined at baseline and 5, 10, and 30 min of recovery. On observer`s assessment of alertness and sedation score no significant difference was observed between the two groups in the first 10 min after drug discontinuation but after 30 min allpatientsin group A and 26 out of 30 patients in group B had returned to an OAAS of 5 [p= 0.039]. Subjective recovery as assessed by VAS scores showed that patients were more awake, had higher energy level, were less confused and better coordinated in group A sedation at 10 and 30 min post-procedure as compared to midazolam group B. Sevoflurane for sedation produced faster recovery as compared to intravenous midazolam measured by OAAS score and subjective assessment on VAS scale. However, sevoflurane is complicated by a high incidence of intra-operative excitement

Stellate ganglion block for the immediate treatment of frostbite of upper limb

The purpose of performing early sympathectomy at high altitude was to get relief of vasoconstriction of frostbitten part so that the progression of the disease might be arrested immediately. Descriptive Interventional Study. This study was done in Northern area from December 1997 to December 1998. In this interventional clinical trial, 23 young soldiers who were the victims of frostbite of upper extremity, were given stellate ganglion block with local anesthetic at army field hospital Goma, situated at altitude of 10,800 feet. All the patients were referred back from the posts at forward areas in high mountains, during one year [Dec 1997-Dec 1998]. The results of the study were very encouraging. Patients having mild to moderate form of disease recovered fully whereas disease progression was arrested in patients with severe form and later on they required less reconstructive surgery. The results noted in this study mandate the purpose of more research in this field so that the morbidity caused by the frostbite may be further decreased

Intubation; comparison of glyceryl trinitrate with plain lignocaine in attenuating the hypertensive response

Endo-tracheal intubation causes hypertensive stress response and increase in blood pressure and heart rate. This increase in systolic blood pressure causes myocardial ischemia and dysrythmias in vulnerable patient. Different drugs are used intravenously to attenuate this hypertensive response during intubation. I compared glyceryl trinitrate with plain Lignocaine intravenous to obtund this hypertensive stress response. In a randomized, double blind study, 60 patients were selected for this study and divided into two equal groups of I and II based on receiving intravenous glyceryl trinitate and plain lignocaine respectively. A bolus dose of Glyceryl trinitrate [Nitronal] 200 mcg, 20 seconds before intubation. And then titration at a rate of 2 pgm/kg/minute was started. Group II was given plain lignocaine 1.5 mg/kg body weight. The comparative study was carried out to know the effectiveness of each drug to blunt the hypertensive stress response and Heart Rate Variability [HRV] during intubation. Blood pressure and heart rate variability [HRV] immediately after intubation was assessed. Blood pressure fall was more marked in patient receiving Glyceryl trinitrate [Nitronal] then those of receiving plain Lignocaine, but heart rate variability [HRV] was greater in patient receiving Glyceryl trinitrate [Nitronal]. Glyceryltrinitrate [Nitronal] is more effective than plain lignocaine in blunting the hypertensive stress response of intubation

Pattern of maxillofacial injuries in the earthquake victims

To observe the pattern of Maxillofacial injuries in Earthquake victims and to discuss their management. Descriptive Study. This study was conducted at the Maxillofacial Surgery Department, Armed Forces Institute of Dentistry [AFID], Rawalpindi over a period of six months following the 8[th] October, 2005 Earthquake. 176 patients who sustained maxillofacial injuries during the earthquake were included in this study. The pattern of maxillofacial injuries and their management was documented. Out of the 176 patients, 141 [80.11%] had fractures of the maxillofacial bones. The remaining 35 [19.89%] patients sustained minor maxillofacial injuries e.g. soft tissue injuries, dentoalveolar fractures and temporomandibular joint arthritis / dislocation. Isolated mandibular fractures were seen in 64 [36.4%] patients. Fifty-seven [32.4%] patients had multiple fractures of the facial bones. Zygomatic bone was fractured in 18 [10.2%] patients whereas 02 [1.1%] patients had isolated fracture of the maxilla. Fifty-nine [41.8%] patients were treated by closed reduction and IMF, 55 [39%] patients by open reduction and transosseous wire fixation in addition to IMF and 27 [19.1%] cases by open reduction and miniplate osteosynthesis. Postoperative complications were noticed in 18 [10.2%] of the patients. Multiple fractures of the facial bones were far more common than the routine trauma cases. The magnitude of the disaster dictated simple and timesaving conventional methods of management in majority of the cases