ABSTRACT
An audit of epidural anesthesia in an Indian teaching hospital is described. The authors reviewed Acute Pain Service (APS) documentation of epidural anesthesia and outcomes form the procedure over a 6-month period. Variances from established protocols were noted and reasons for these variances are discussed.
Subject(s)
Anesthesia, Epidural/adverse effects , Guideline Adherence , Pain Clinics/standards , Pain, Postoperative/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , India , Infant , Male , Middle Aged , Practice Guidelines as TopicABSTRACT
BACKGROUND: Breast surgery is associated with frequent post-operative nausea and vomiting (PONV). Studies have suggested that hormonal status affects PONV. Estrogen has been implicated in many emetic syndromes. Estrogen receptor (ER) and progesterone receptor (PR) status in breast tissue are hormonally affected. Kakugawa et al., in 2007, found a clear trend toward higher serum level of estrone, estradiol, and dehydroepiandrosterone sulfate in post menopausal women with PR-positive cancer. PURPOSE: To investigate the possibility of an association between ER and/or PR status of breast tumor and incidence of PONV after breast cancer surgery. METHODS: This observational study included 315 female patients undergoing major breast surgery. Relevant patient data, and intra-operative and postoperative details were noted. Incidence of PONV was noted using the PONV score. Patients were divided into two age groups: less than or equal to 50 years and more than 50 years of age. The ER and/or PR status of the patient was unknown to the investigator until the final analysis. RESULTS: Use of the chi-squared test revealed no association between ER and/or PR and total PONV. Patients below 50 years had higher incidence of total PONV (p = 0.023). In patients above 50 years, the incidence of PONV was higher in the ER-positive group (p = 0.018). CONCLUSION: The incidence of PONV is higher for patients below 50 years of age. The positive association between ER positivity and PONV in patients above 50 years of age could be attributed to the altered hormonal milieu in these patients and should be investigated further.
Subject(s)
Breast Neoplasms/metabolism , Breast Neoplasms/surgery , Mastectomy/adverse effects , Postoperative Nausea and Vomiting/etiology , Postoperative Nausea and Vomiting/metabolism , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , Female , Humans , Mastectomy/methods , Middle AgedABSTRACT
This report describes a noninterventional audit of current patient-controlled analgesia (PCA) use in an Indian cancer hospital over a 1-year period. Because there appeared to be an underutilization of PCA in the authors' hospital, they performed this audit. A major reason to start PCA was inadequate analgesia despite ongoing epidural or standard PRN analgesic regimes, especially in thoracic, major abdominal, and pelvic bone surgeries. PCA was used for an average 52.13 hours. The reason to stop the PCA in 72 patients was minimal usage due to decreased need after the second postoperative day. Multiple triggers at the same time were a common problem encountered in 21 patients. A blocked intravenous (IV) line was encountered in 12 patients. Thirty-one patients ranked their pain relief with PCA as excellent and 39 patients stated it as good. Their protocols shall be suitably amended to ensure that PCA shall be used in immediate postoperative period as a principal modality of pain relief, especially in the above-mentioned group in absence of epidural analgesia.
