The Effect of Endotracheal Suctioning on Pain in Conscious Adult Patients in Intensive Care Unit.

BACKGROUND AND PURPOSE: Pain assessment and management are an important issue to ensure the comfort of patients in the intensive care unit, and reducing pain is an important nursing intervention. Therefore, it is important to evaluate pain correctly. For correct pain management, it is necessary to correctly determine the presence and severity of pain. The study was conducted to determine whether endotracheal suctioning was painless and whether the Behavioral Pain Scale (BPS) was an accurate assessment tool to assess pain during endotracheal suctioning. METHODS: This study is a prospective clinical study. Thirty-two patients were endotracheal suctioned using the same technique by the same person, and their before-procedure BPS and visual analog scale (VAS) scores were recorded. The study was conducted in the anesthesia and reanimation intensive care unit of a university hospital between December 12, 2020, and April 14, 2021. RESULTS: The before-procedure BPS and VAS scores indicated no pain. There was an increase in the procedure BPS score, whereas the VAS score did not change. CONCLUSIONS: Endotracheal suctioning did not cause pain in conscious patients when the procedure was performed with the correct catheter in accordance with the guideline. In addition, it can be said that BPS is not sufficient to evaluate pain, but the reason for its high level is because endotracheal suctioning is an uncomfortable procedure. Of course, more studies and further studies are needed for a clear result.It is important for health care professionals to relieve or reduce the pain of patients during the endotracheal aspiration procedure. In addition, the presence and severity of pain associated with the endotracheal aspiration procedure should be accurately measured. This study is registered in ClinicalTrials.gov with the IDNCT04634474.The data that support the findings of this study are available from the corresponding author upon reasonable request.

Evaluation of Reasons for Not Giving Donor Consent by Families of Patients With Brain Death: A Retrospective, Mixed-Method Study.

OBJECTIVES: The number of patients with organ failure is increasing day by day; today, the numbers of organs and tissues for transplant remain inadequate. This study, which was carried out in a hospital of Sivas Cumhuriyet University in Turkey, aimed to determine reasons for not giving consent for organ donation after brain death and to clarify the familial causes listed among these reasons. MATERIALS AND METHODS: This study was a retrospective, mixed-method study. Records of patients diagnosed with brain death and patient relatives who stated that they did not donate organs and who agreed to participate were included in the study. RESULTS: Of 48 patients diagnosed with brain death, 39 (81.3%) did not donate organs. Reasons for not donating could be grouped under 5 themes: distrust (communication defects, frustration, anger, not meeting expectations), thoughts that the procedure would not provide benefits, fear (not accepting death, not understanding brain death, and experiencing loss), unwillingness to impair body integrity, and phobia of social reactions. CONCLUSIONS: We found that some patient relatives who were not against and even supported organ donation decided not to donate organs at the last minute. Reasons for not giving donation consent included distrust, anger, and frustration resulting from communication problems with health professionals, making the candidate donor feel valueless, previous bad experiences and prejudgments about the institution, and not providing the appropriate physical conditions related to the comfort of the patient relative during the process. It is important to keep in mind that the organ donation process begins with the patient's admission to the hospital; if managed correctly, the process can affect the decision of relatives in a positive way. Identifying and preventing potential obstacles that could affect decisions may increase donation rates. Health professionals with special training on this subject are needed for these situations.

Effect of adding dexmedetomidine to intra-articular levobupivacaine on postoperative pain following arthroscopic meniscus surgery: A prospective, double-blind, randomized, placebo- controlled, clinical trial.

OBJECTIVE: The aim of this study was to determine the effect of adding dexmedetomidine to intra-articular levobupivacaine on postoperative pain levels and analgesic requirements following arthroscopic meniscectomy. METHODS: A total of 60 American Society of Anesthesiologist physical status I-II patients, aged 20 to 62 years, and scheduled for arthroscopic partial meniscectomy under general anesthesia were included in this study. All the patients were randomly assigned to one of four groups (15 patients in each group): Group 1 (8 male, 7 female; mean age = 46.70 ± 13.13 years; 0.9% isotonic 20 ml), group 2 (7 male, 8 female; mean age = 42.60 ± 12.18 years; levobupivacaine 0.5 mg/kg plus 0.9% isotonic), group 3 (8 male, 7 female; mean age = 43.80 ± 12.63 years; 1µg/kg dexmedetomidine plus 0.9% isotonic), and group 4 (7 female, 8 male; mean age = 40.40 ± 11.79 years; levobupivacaine 0.5 mg/kg plus 1µg/kg dexmedetomidine and 0.9% isotonic). All medications were administered at the end of arthroscopic surgery. Pain levels were measured using a Visual Analogous Scale (VAS) and Verbal Rating Scale (VRS) at postoperative 1, 2, 4, 6, 12, and 24 hours. RESULTS: VAS scores at rest were significantly lower in Group 4 at postoperative 1th, 2nd, 4th, 6th,12th, and 24th hours than in other groups. The time to take the first analgesic was significantly higher in Group4 (964 ± 288 min), and total analgesic consumption was significantly lower in Group 4 compared to those of other groups. CONCLUSION: Although administration of intra-articular dexmedetomidine alone may have a weaker effect than intra-articular levobupivacaine on postoperative pain relief after arthroscopic partial meniscectomy, adding dexmedetomidine to intra-articular levobupivacaine may increase the durationand quality of postoperative analgesia without any side effect. LEVEL OF EVIDENCE: Level I, Therapeutic Study.

The effect of postoperative serratus anterior plane block on postoperative analgesia in patients undergoing breast surgery.

OBJECTIVES: This study aimed to evaluate the effect of serratus anterior plane block (SAP) on postoperative morphine consumption. We aimed to determine the differences between both similar blocks and evaluate the effect of the methods of application of this block on patients' postoperative pain scores and morphine consumption. MATERIAL AND METHODS: This study is a single-center, prospective and observational study performed with 40 volunteer patients with American Society of Anesthesiologists (ASA) I-III, who were 18-70 years of age, scheduled for breast surgery. A total of 40 patients who underwent general anesthesia were divided into two groups each with 20 patients. While SAP block was applied to the study group, no block was applied to the control group. SAP block was made by injecting a total of 40 ml of 0.25% bupivacaine between 2 muscles after the test dose was injected with saline. All patients were followed up for 12 hours postoperatively with patient-controlled analgesia (PCA) pump. Morphine consumption, visual analogue score (VAS) values and side effects were recorded at the postoperative 1st, 6th and 12th hours. RESULTS: There was no significant difference between the two groups in terms of hemodynamic parameters and demographic data. Postoperative morphine consumption and postoperative analgesic requirement were significantly lower in the SAP block group (p <0.001). Postoperative VAS values were significantly lower in the SAP block group (p <0.001). No complication was observed related to the block. CONCLUSION: It was found that the SAP block reduced morphine consumption, significantly decreased VAS values, and reduced side effects due to opioids postoperatively.

Views of algology inpatients about ethical issues related to pain.

OBJECTIVES: To determine the views of patients hospitalized in the algology clinic about ethical issues related to pain. METHODS: A total of 135 patients admitted to the algology clinic comprised the population of this descriptive study. Data were collected using the visual analogue scale (VAS) and the questionnaire on ethical issues related to pain. To evaluate the data, percentage distribution and the Tukey test of variance were used. RESULTS: Of the patients, 92.6% believed that they had the right to pain relief, and 94.8% believed that they should be consulted when decisions about them were made. It was determined that 43.0% of the patients disagreed with Proposition 1, 'When a terminal-stage cancer patient with unrelievable pain requests an overdose of pain medication, possibly to cause death, the physician must prescribe it,' while 51.9% of the participants disagreed with Proposition 2, 'When a terminal-stage cancer patient with unrelievable pain and his or her family request an overdose of pain medication, possibly to cause death, the physician must prescribe it,' and 44.4% of them disagreed with Proposition 3, 'When a terminal-stage cancer patient with unrelievable pain requests an overdose of pain medication, possibly to cause death even though his or her family refuses, the physician must prescribe it.' A statistically significant relationship (p<0.05) was found between the mean VAS scores and Propositions 1 and 3. CONCLUSION: The patients were willing to be informed and to be asked about their views regarding the issue, but they did not want to be prescribed a high dose of pain medication, possibly to cause overdose and death.

Effects of high-frequency bio-oxidative ozone therapy in temporomandibular disorder-related pain.

OBJECTIVE: It was the aim of this study to compare the efficacy of ozone therapy and drug treatment in patients with painful temporomandibular joint (TMJ) disorder (TMD). SUBJECTS AND METHODS: A total of 63 patients with TMD were enrolled; 33 were treated with bio-oxidative therapy and 30 with a ketoprofen tablet thiocolchicoside capsule 2 × 1 for 7 days. Maximum voluntary interincisal mouth opening (MMO) was measured in millimeters using a scale and recorded during the pre- and posttreatment periods. The patients evaluated their subjective pain using a visual analogue scale (VAS). Data were analyzed using the Mann-Whitney U test, the Kolmogorov-Smirnov test, and the independent t test. RESULTS: The mean MMO of the group that received ozone therapy during the pretreatment period was 46.51 ± 8.2 mm, and it immediately increased to 48.78 ± 7.5 mm after 1 week of ozone therapy, which was statistically significant (p = 0.04). For those who received medication, the mean MMO during the pretreatment period was 46.30 mm, and at the end of 1 week it was 46.9 mm. In the ozone group, 29% of patients showed a gradual decrease in their VAS pain scores compared to pretreatment values (6.3 ± 2.1 to 3.0 ± 2.2). In the medication group, 24% of patients showed a significant decrease in VAS pain scores during the follow-up period (6.9 ± 1.4 to 5.0 ± 1.5). CONCLUSION: This study showed that bio-oxidative therapy was a more effective treatment than medication therapy for relieving TMJ pain.

Comparison of the effects of desflurane and sevoflurane on middle ear pressure: a randomized controlled clinical trial.

OBJECTIVE: The aim of the present study was to compare the effects of two inhalation anesthetics, desflurane and sevoflurane, on middle ear pressure. METHODS: After we obtained written consent from the patients and the approval from our institutional ethical committee, we included 56 ASA I-II patients aged between 18 and 60 years in this study. They were randomly divided into two groups of 28 patients each. Desflurane 4-6% (Group D) or sevoflurane 1-2% (Group S) were used for anesthesia management in patients. Baseline tympanometry was carried out and recorded before the induction of anesthesia on both ears, and 3 more measurements were done and recorded 5, 15 and 30 min after induction. RESULTS: In both groups, middle ear pressure values were found to be significantly elevated when compared to baseline measurements (p < 0.05). When middle ear pressure was compared between the groups, no difference was found between the values obtained at baseline and at 5 min in Group S, while especially the values obtained at 15 min revealed significantly higher middle ear pressures in Group D. CONCLUSION: It was observed that the increase in middle ear pressure caused by sevoflurane was significantly lower than that caused by desflurane.

The importance of needle echogenity in ultrasound guided axillary brachial plexus block: a randomized controlled clinical study.

OBJECTIVE: In this study we aimed to compare the echogenic needles and the nerve stimulation addition to non-echogenic needles in ultrasound guided axillary brachial plexus block for upper extremity surgery. METHODS: 90 patients were enrolled to the study. The patients were allocated into three groups randomly: Group E (n=30): ultrasound guided axillary block using echogenic needle, Group N (n=30): ultrasound guided axillary block using non-echogenic needle, Group NS (n=30): ultrasound guided axillary block using non-echogenic needle with nerve stimulator assistance. Duration of block procedure, mean arterial pressure, heart rate, pulse-oximetry, onset time of sensory and motor block, duration of sensory and motor block, time to first analgesic use, total need for analgesics, postoperative pain scores, patient and surgeon satisfaction scores were recorded. RESULTS: Duration of block procedure values were lower in group E and NS, sensory and motor block durations, were significantly lower in group N. Sensorial and motor block onset time values were found lower in group NS but higher in group N. Patient and surgeon satisfaction scores were found lower in group N. CONCLUSION: We conclude that ultrasound guided axillary block may be performed successfully using both echogenic needles and nerve stimulation assisted non-echogenic needles.

Efficacy of preventive analgesia with tramadol or lornoxicam for percutaneous nephrolithotomy: a prospective, randomized, double-blind, placebo-controlled study.

BACKGROUND: Prevention of postoperative pain provides better and more rapid convalescence for patients. OBJECTIVE: The aim of this study was to compare the preventive analgesic effect of tramadol and lornoxicam in the early postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS: Patients who were scheduled for elective PCNL at the Cumhuriyet University Hospital, Sivas, Turkey, were enrolled in this prospective, double-blind, placebo-controlled study. The patients were randomly assigned to 1 of 3 groups: tramadol, lornoxicam, and normal saline (NS). Ten minutes before induction of anesthesia, the tramadol group received tramadol 100 mg IV, the lornoxicam group received lornoxicam 8 mg IV, and the NS group received NS 2 mL IV. Anesthesia was induced using fentanyl 1 µg/kg and thiopental sodium 4 to 7 mg/kg. Vecuronium 0.1 mg/kg was used for muscle relaxation. Desflurane 4% to 6% and 50%:50% oxygen/nitrous oxide were used for maintenance. Oxygen saturation, heart rate, and mean blood pressure were recorded before induction and during the postoperative period. During the postoperative period, visual analogue scale O/AS) scores, time to first analgesic (TFA), total analgesic consumption (TAC), and patient satisfaction scores were determined. Data about postoperative nausea and vomiting and other adverse events and complications were also collected. RESULTS: Seventy-three patients were assessed for enrollment and 60 (33 women, 27 men; mean [SD] age, 44.69 [11.27] years; age range, 20-62 years) were included in the study. The baseline demographic characteristics and duration of surgery were similar in all 3 groups. The mean (SD) VAS scores in the tramadol group were significantly lower than in the NS group at 15 and 30 minutes and 1, 2, 4, and 12 hours after surgery (all, P < 0.05). The VAS scores in the lornoxicam group were significantly lower than in the NS group at 15 and 30 minutes and 1 hour (all, P < 0.05). The VAS score at 1 hour after surgery was significantly lower in the tramadol group than in the lornoxicam group (18 [8] vs 32 [16]; P < 0.05); however, there were no other significant differences in VAS scores between the active groups. A significantly shorter TFA was associated with the NS group when compared with the tramadol and lornoxicam groups (46 [27] vs 354 [187] and 180 [118], respectively; both, P < 0.05). TFA was significantly shorter in the lornoxicam group when compared with the tramadol roup (180 [118] vs 354 [187]; P < 0.05). TAC was significantly higher in the NS group than in the tramadol and lornoxicam groups (270 [47] vs 115 [74] and 145 [72], respectively; both, P < 0.05). Patient satisfaction score (range) was significantly lower in the NS group when compared with the tramadol and lornoxicam groups (0 [0-1] vs 3 [0-3] and 2 [0-3], respectively; both, P < 0.05). There were no other significant between-group differences observed. CONCLUSIONS: Tramadol and lornoxicam were more effective than NS in preventing early postoperative pain. The preventive analgesic effect of tramadol was comparable with that of lornoxicam, except at 1 hour when tramadol was more effective among these patients undergoing PCNL. Both drugs were well tolerated.