Postoperative Pain Management in Coronary Artery Bypass Grafting: An Integrative Review.

PURPOSE: To identify pharmacological and nonpharmacological interventions adopted for pain relief in the postoperative period of coronary artery bypass graft surgery. DESIGN: Integrative review. METHODS: Studies published in English, Spanish, and Portuguese from January 2010 to December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature on Health Science, PubMed, and Web of Science. Two hundred studies were identified and eleven were included. Methodological analysis was performed using the Medical Education Research Study Quality Instrument. FINDINGS: The studies found were organized into three thematic categories: pharmacological interventions (methadone, morphine, lidocaine gel, remifentanil, sufentanil, and nefopam), nonpharmacological interventions (low-level laser therapy, light-emitting diode, Class IV laser, and transcutaneous nerve stimulation) and anesthetic techniques (dexmedetomidine, ultrasound-guided pectoral nerve block, high thoracic epidural analgesia, and perioperative parasternal block with levobupivacaine). CONCLUSIONS: A greater tendency to use drug strategies for postoperative pain relief was identified. The drugs used demonstrated efficacy and safety in the treatment of pain, with the exception of nefopam, which showed little benefit in this population. Nonpharmacological interventions, used as adjuvants to drug treatment, were shown to be safe, effective, and well tolerated by the patients.

Effect of listening to music on anxiety, pain, and cardiorespiratory parameters in cardiac surgery: study protocol for a randomized clinical trial.

BACKGROUND: Preoperative anxiety and postoperative pain are frequent in cardiac surgeries and constitute important stressors for patients, which can cause several complications. One strategy that aims to alleviate these phenomena is listening to music as a non-pharmacological intervention. The aim of this study is to evaluate the effect of listening to music on preoperative state-anxiety, postoperative pain, at rest and when instructed to cough, and cardiorespiratory parameters in patients undergoing cardiac surgery. METHODS: A randomized, parallel, simple masking clinical trial will be conducted with patients 18 years of age or older who have undergone elective cardiac surgery by sternotomy, who agree to participate in the research and sign a free and informed consent form. Study participants will be randomly divided, in a 1:1 ratio, to one of the two groups: experimental (subjected to listening to music for 20 min in the pre- and postoperative period) or control (standard care in the pre- and postoperative period), using a randomization scheme generated by the Randomization.com website. The sample size calculation was obtained after conducting a pilot study. DISCUSSION: The results of the study may contribute to the implementation of non-pharmacological interventions in health services, highlighting the protocols for listening to music, to minimize anxiety and pain in cardiac surgery. TRIAL REGISTRATION: ReBEC RBR-8mdyhd . Posted on December 10, 2019.

Blood transfusion in Intensive Care Units: knowledge of the nursing team

Abstract Objective: To assess the knowledge of nursing team professionals in the Intensive Care Units of blood transfusion and related factors associated with it. Methodology: Cross-sectional, quantitative study, which was carried out in three hospitals. The non-systematic sample included 104 nursing professionals working in the Intensive Care Units of these health institutions. For data collection, a checklist instrument developed and validated by the authors was used. Results: The overall knowledge score registered an average of 50.4%. The factors associated with knowledge were as follows: Training and/or guidance and monitoring of the protocols/directions to carry out the transfusion process; Frequency of blood transfusion procedures carried out by professionals, and The self-confidence factor. For etapa pré-transfusão, etapa de transfusão and etapa póst-transfusão stages, the results were 48.3%, 52.2%, and 58.3%, respectively. Conclusions: This study identified that, on the one hand, nursing professionals possess increased knowledge of post-transfusion complications; and, on the other, that self-confidence, use of protocols, training programs, and having only one job are factors associated with increased knowledge and with vigilance during the procedure.

Resumen Objetivo: Evaluar el conocimiento de los profesionales del equipo de enfermería de Unidades de Cuidados Intensivos sobre transfusión de sangre y los factores asociados a ésta. Metodología: Se trata de un estudio transversal y cuantitativo, el cual se realizó en tres hospitales. La muestra, no sistemática, se constituyó por 104 profesionales de enfermería que laboran en las Unidades de Cuidados Intensivos de estas instituciones de salud. Para la recolección de los datos, se utilizó un instrumento de tipo check-list desarrollado y validado por las autoras. Resultados: La puntuación global de conocimiento presentó una media de 50,4%. Los factores asociados al conocimiento fueron Entrenamiento u orientación y seguimiento de protocolos/directrices para llevar a cabo el proceso de transfusión; Frecuencia de los procedimientos de transfusión de sangre realizados por el profesional; y El factor autoconfianza. Para las etapas: etapa pré-transfusão, etapa de transfusão y etapa póst-transfusão, los resultados fueron 48,3%, 52,2% y 58,3%, respectivamente. Conclusiones: El presente estudio evidenció no sólo que los profesionales de enfermería poseen un mejor conocimiento de las complicaciones postransfusionales, sino también que la auto-confianza, el uso de protocolos, los programas de entrenamiento y tener sólo un empleo son factores asociados a un mejor conocimiento y a la vigilancia durante la realización del procedimiento.

Resumo Objetivo: Avaliar o conhecimento dos profissionais da equipe de enfermagem de Unidades de Terapia Intensiva sobre hemotransfusão e fatores associados. Metodologia: Trata-se de um estudo transversal e quantitativo, realizado em três hospitais. A amostra, não sistemática, foi constituída por 104 profissionais de enfermagem que atuavam nas Unidades de Terapia Intensiva dessas instituições de saúde. Para a coleta de dados, utilizou-se um instrumento do tipo checklist desenvolvido e validado pelas autoras. Resultados: O escore geral médio de conhecimento foi de 50,4%. Os fatores associados ao conhecimento foram: Treinamento ou orientação e seguir protocolos/diretriz para a realização do processo transfusional; Frequência de procedimentos de hemotransfusão realizados pelo profissional; e O fator auto-confiança. Para as etapas: etapa pré-transfusão, etapa de transfusão e etapa póst-transfusão, os resultados foram 48,3%, 52,2% e 58,3%, respectivamente. Conclusões: O presente estudo evidenciou que os profissionais de enfermagem possuem melhor conhecimento das complicações pós-transfusionais e que a auto-confiança, o uso de protocolos direcionadores, os programas de treinamento e ter apenas um emprego são fatores associados com melhor conhecimento e vigilância durante a realização do procedimento.