Postoperative Analgesia Management Evaluation in the Postanesthesia Unit: An Exploratory Analysis Based on Patient and Surgery Characteristics.

PURPOSE: Several methods have been proposed for postoperative pain management, including administration of opioid analgesics, epidural analgesia, and perineural and infiltrative techniques; however, data are lacking on the relationship between pain intensity, patients' age and gender, and surgery duration. DESIGN: Prospective, observational, single-center study. METHODS: The study included patients greater than or equal to 18 years old who underwent surgery with different anesthesia types, grouped according to the American Society of Anesthesiologists' physical status classification score. The McGill Pain Questionnaire was used to assess postoperative pain intensity. The postoperative pain evaluation was performed in the first 5 minutes on entering the postanesthesia care unit (PACU), and at 30 minutes and 24 hours after the operation. RESULTS: Our results showed a significant negative relationship between pain intensity as assessed at 5 and 30 minutes postoperatively and age. Postoperative pain intensity at 24 hours was significantly lower after low-risk surgeries lasting up to 1 hour; pain intensity was also significantly lower at 30 minutes following epidural anesthesia. When nonsteroidal anti-inflammatory drugs were not administered in the PACU, pain intensity was significantly lower at 5 minutes, 30 minutes, and 3 hours. CONCLUSIONS: Postoperative analgesic administration should be conducted in accordance with age and surgery type. Additionally, epidural anesthesia can reduce the immediate postoperative pain intensity.

Missed Nursing Care in the Postanesthesia Care Unit: A Cross-Sectional Study.

PURPOSE: This study aimed to investigate the prevalence, activities, and reasons for missed nursing care in the postanesthesia care unit (PACU) and the effect of intensive care unit (ICU) overflow patients. DESIGN: This is a single-center, cross-sectional survey. METHODS: Nineteen PACU-registered nurses of a tertiary care hospital participated. Over a 7-month period, participants were asked to complete a validated questionnaire, which included 19 items related to missed nursing care activities and 10 items related to reasons for missed nursing care. χ2 test and 1-way analysis of variance were used for data analysis. FINDINGS: Questionnaires (N = 397) were completed. Prevalence of missed nursing care activities was 78.1% and was significantly higher in cases of ICU overflow patients (P < .001). The three most reported missed nursing care activities were "drug preparation, administration, and assessment of effectiveness," "patient surveillance and assessment," and "care associated with pain"; prevalence was significantly higher in cases of ICU overflow patients (P = .036, P = .003, and P = .004, respectively). The three most reported reasons for missed nursing care were "inadequate number of nursing personnel," "unexpected rise in patient volume or acuity," and "heavy admission or discharge activity". CONCLUSIONS: The findings indicated missed nursing care was common in the PACU and increased in case of ICU overflow patients. Therefore, missed nursing care needs to be identified and minimized, while the number and length of stay of critically ill patients admitted to the PACU should be limited.

Nurse understaffing is associated with adverse events in postanaesthesia care unit patients.

AIMS AND OBJECTIVES: To investigate the associations between nurse staffing and the incidence and severity of hypoxaemia, arterial hypotension and bradycardia of postoperative patients during their postanaesthesia care unit stay. BACKGROUND: Nurse understaffing has been associated with adverse patient outcomes in a variety of hospital settings. In the postanaesthesia care unit, nursing shortage is common and can be related to compromised prevention, detection and treatment of adverse events. DESIGN: Observational, single-centre, prospective study that adhered to Strengthening the Reporting of Observational studies in Epidemiology checklist (see Supporting information Appendix S1); 2,207 patients admitted to the postanaesthesia care unit of a tertiary care hospital over a 5-month period were enrolled. METHODS: Incidence of hypoxaemia (arterial oxygen saturation <95%), arterial hypotension (systolic blood pressure <90 mmHg) and bradycardia (heart rate <50 beats per minute), along with episode severity, was recorded. Patients were classified into three groups as follows: sufficient staffing, low and high understaffing. Risk for hypoxaemia, arterial hypotension and bradycardia was adjusted according to patient, anaesthesia and operation characteristics. RESULTS: The incidence of hypoxaemia was significantly higher in the high understaffing group patients, while the incidence of arterial hypotension was significantly higher in both low and high understaffing group patients, compared to sufficient staffing group ones. In the high understaffing group patients, hypoxaemia and arterial hypotension episodes were of significantly higher severity. CONCLUSIONS: These associations between hypoxaemia and arterial hypotension and postanaesthesia care unit understaffing indicate that care quality and patient safety can be compromised in case patient acuity is not matched with sufficient nursing resources. RELEVANCE TO CLINICAL PRACTICE: Higher incidence of hypoxaemia and arterial hypotension advocates for the prevention of imbalances between patient number and care demands and the number of available nurses.

Comparison between lornoxicam quick-release and parecoxib for post-operative analgesia after laparoscopic cholecystectomy: A prospective randomized, placebo-controlled trial.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are valuable for post-operative pain as they reduce the use of opioids. Cyclooxygenase-2 inhibitors and traditional NSAIDs can be used. This is a prospective, randomized, placebo-controlled trial to study the efficacy and the safety of the oral administration of lornoxicam quick release tablets versus intravenously administered parecoxib for the management of pain after laparoscopic cholecystectomy (LC). MATERIALS AND METHODS: One hundred and eight patients, American Society of Anesthesiologists I-II, were randomized to either group A (n = 36): Lornoxicam quick-release 8 mg PO, group B (n = 36): Parecoxib 40 mg intravenous (IV) or group C (n = 36) placebo, for post-operative analgesia, 30 min before the operation and 12 and 24 h post-operatively. All patients received a standard dose of meperidine 1 mg/kg intramuscularly before the incision and post-operatively as rescue analgesia, when visual analog scale (VAS) pain score was <4. Pain at rest and on movement was assessed at 20 min, 3, 6, 12, 18 and 24 h post-operatively. Total meperidine administration and adverse events were also recorded. RESULTS: There were significantly lower VAS pain scores at 20 min, 3, 6, 12 and 18 h at rest or with movement in the lornoxicam quick release and parecoxib groups compared with the placebo group. The number of patients requiring rescue analgesia (meperidine) was significantly higher in the placebo group (P = 0.001). The average dose of meperidine administered was significantly higher in the placebo group, both at 20 min (P = 0.013/0.007) and 24 h (P = 0.037/0.023) post-operatively. VAS scores and meperidine requirements were similar in patients who received lornoxicam or parecoxib. CONCLUSIONS: Parecoxib 40 mg IV and lornoxicam quick-release 8 mg PO every 12 h are equivalent adjuvant analgesics with a greater efficacy than placebo for post-operative analgesia in patients undergoing LC.

Uterine arteriovenous malformations induced after diagnostic curettage: a systematic review.

PURPOSE: To perform an extensive systematic review to examine all the available literature reporting iatrogenic acquired arteriovenous malformation (AVM) induced after diagnostic curettage and to describe a further case of a 34-year-old woman presenting with acute vaginal bleeding due to AVM induced after uterine curettage for termination of pregnancy. METHODS: We searched the electronic databases: MEDLINE (1950-2011), Embase (1980-2011), Cochrane Library (2004-2011), Cinahl (1981-2011), Popline (2004-2011). RESULTS: Initial search extracted 333 relevant articles. Final assessment resulted to the inclusion of 91 studies, 85 case reports and 6 observational studies. Studies are dated between 1954 and 2011. A metanalysis of the 85 case reports reporting 100 patients was performed. The mean age of the women diagnosed with AVM was 30 ± 9.1 years, range (16-72) years, 96 women were premenopausal (96%) and 4 were postmenopausal (4%). Ultrasound imaging was applied in 86 patients (86%), and ultrasound combined with angiography was performed in 51 patients (51%). Uterine artery embolization (UAE) was the most common treatment option performed in 59 patients (59%). Total abdominal hysterectomy was performed in 29 patients (29%). Spontaneous resolution of AVM occurred in six patients (6%). In 17 patients (17%), recurrence occurred after treatment with UAE. Twenty-four articles reported pregnancies in 27 patients (27%). CONCLUSION: Ultrasound imaging with appropriate knowledge of color Doppler features minimizes the use of inappropriate interventional procedures such as diagnostic curettage. UAE is effective in treatment, and rarely leads to complications.