RESUMO
Background: Acute pain is a common postoperative problem, especially among pediatric patients (between 1 and 6 years of age). Since children cannot report their pain to health care providers, pain needs to be promptly assessed as untreated pain may lead to sustained changes in the central neural system. Behaviour is also a useful measure and indicator of pain in children. In the Post Anesthetic Care Unit (PACU) at Srinagarind Hospital, the Face, Legs, Activities, Cry, Consolability (FLACC) scale is used for pain assessment.Objectives: To determine the proportion of pediatric patients who have undergone the FLACC pain assessment scale in the PACU and the correlation between FLACC scale and treatment.Design: Retrospective descriptive studySetting: PACU, Department of Anesthesiology, Srinagarind Hospital, Khon Kaen UniversityMaterials \& method: 180 pediatric (under 6 years of age) patients’ records in the PACU were reviewed since June 2005. Outcome measurements including sex, age, ASA status, type of operation and procedure, type of pain assessment, number of FLACC scale (0-10) used for pain assessment, causes of non-assessment and number of assessment were recorded. The results were analyzed using descriptive statistics and presented as means and percentages.Results: Among the 180 pediatric patients, 65% were male and 34% were in middle childhood. 67% of pediatric patients in the PACU were assessed by FLACC pain scale. Almost all nurses (98%) used FLACC scale to assess pain in their pediatric patients. It was found that patients’ sleep (46%) at the time of admission to the PACU was the common cause of non-assessment. In term of pain treatment, 61% of the patients were assessed for their pain before treatment, however 21% of the patients having pain (FLACC\>2) did not receive any pain treatment. The most common cause (89%) of non-assessment was due to patients’ crying. The mean of FLACC scale before and after treatment were 3.64 + 6.25 and 3.27 + 8.26, respectively.Conclusion: The pediatric pain assessment was used in the PACU more frequently than previously surveyed; however the use rate was not 100% (as expected) and some of patients having pain (FLACC\>2) did not receive any treatment. As a result, education and personnel support might be useful in order to improve the quality of pain assessment and treatment in the PACU.Key words : Pediatric pain assessment, FLACC scale, PACU
RESUMO
Background: Good perioperative analgesia especially in upper abdominal surgery may reduce the occurrence of serious postoperative complications. The efficacy and effects of continuous epidural analgesia (CEA) compared with intravenous patient-controlled analgesia (IV PCA) have not been reported in patients undergoing upper abdominal surgery.Objectives: To compare CEA with IV PCA opioid for postoperative pain control following upper abdominal surgery in cholangiocarcinoma (CHCA) patients in terms of analgesic efficacy, side effects, quality of recovery and duration of hospital stayDesign: Prospective and randomized – controlled trialSetting: Surgical ward at Srinagarind Hospital, Khon Kaen UniversityMaterials \& method: Thirty CHCA patients were randomized allocated to two groups. The patients were received the same general anesthesia plus postoperative continuous epidural morphine (0.05 mg/ml) with 0.0625% bupivacaine in CEA group or postoperative PCA using morphine sulfate (1mg/ml) in PCA group during a period of 24 hrs. Numeric Rating Scale at rest (NRS-R) and on movement (NRS-M) , Likert’s scales, ambulation scores, dosage of morphine consumption and side effects were assessed at 6 and 24 hours postoperatively. The quality of recovery scores (QoR Scores) was performed after 24 hours.Results: The demographic and surgical data were similar in both groups. The pain scores at 6 and 24 hours between two groups were not statistically significant. The ambulation scores at 24 hours was significantly greater in group CEA compared with group PCA (p=0.046). Intravenous morphine requirement at 24 hrs was significantly less in group CEA (p=0.02). The Likert’s scales, QoR Scores, side effects and duration of hospital stay were comparable for the two groups.Conclusion: Continuous epidural analgesia( CEA ) was associated with greater ambulation scores and reduced postoperative intravenous morphine requirement compared with morphine base PCA (IV PCA) in CHCA patients undergoing upper abdominal surgery.Key words: Epidural, analgesia, postoperative pain, upper abdominal surgery