scholarly journals Luaran Terapi Berdasarkan Jenis Pemberian Analgetik pada Pasien Pasca Operasi Ortopedi

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nurul Irna Windari ◽  
Zullies Ikawati, Apt. ◽  
Eni Purwaningtyastuti
Keyword(s):  
Postoperative Pain ◽  
Orthopedic Surgery ◽  
Postoperative Pain Management ◽  
Exact Test ◽  
Independent Variable ◽  
The Mean ◽  
The Difference ◽  
The Many ◽  
Fentanyl Administration ◽  
Intravenous Ketorolac

Postoperative pain was suffered by 80% of the total patients. One of the many surgical procedures performed is orthopedics. Ketorolac and fentanyl are often used for postoperative orthopedic pain. Appropriate postoperative pain management with adequate analgesic administration will accelerate pain reduction and shorten the patient's hospital stay. This study aims to determine the difference in the effect of continuous fentanyl and intravenous ketorolac on pain targets achievement and Length of Stay (LOS) of patients after orthopedic surgery. This study is a prospective cohort study, involving inpatients after orthopedic surgery in Dr. Sardjito Yogyakarta in July-October 2019. The independent variable is continuous fentanyl and intravenous ketorolac, while the dependent variable is the achievement of pain targets and LOS. The analysis was conducted by Fisher's exact test, Mann Whitney's test, and multivariate analysis to determine the dominance of variables on the research outcomes. There were 59 patients after orthopedic surgery in this study. A total of 34 patients in the continuous fentanyil group and 25 patients in the intravenous ketorolac group. There was no difference in the effect of continuous fentanyl administration and intravenous ketorolac on pain targets achievement (P = 0.711), while there were differences in the effect of continuous fentanyl administration and intravenous ketorolac on the average LOS of patients in the hospital (P = 0,000). Continuous fentanyl and intravenous ketorolac can both produce the achievement of adequate postoperative orthopedic pain targets, but the mean LOS becomes shorter in patients with intravenous ketorolac.

Comparative Analysis of Inpatient Costs for Obstetrics and Gynecology Surgery Patients Treated With IV Acetaminophen and IV Opioids Versus IV Opioid-only Analgesia for Postoperative Pain

2017 ◽  
Vol 51 (10) ◽  
pp. 834-839 ◽  
Author(s):  
Ryan N. Hansen ◽  
An T. Pham ◽  
Belinda Lovelace ◽  
Stela Balaban ◽  
George J. Wan
Keyword(s):  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Obstetrics And Gynecology ◽  
Opioid Use ◽  
Cesarean Section Delivery ◽  
Hospitalization Costs ◽  
The Difference ◽  
Multivariable Regression Models

Background: Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures. Objective: Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption. Methods: We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients. Results: We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = −$760.4 to −$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = −10.0 to −6.4), whereas the difference in LOS was not significant, at −0.09 days (95% CI = −0.19 to 0.01; P = 0.07). Conclusion: Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.

scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

Relative Adherence of Bacteroides Species and Strains to Actinomyces viscosus on Saliva-coated Hydroxyapatite

1989 ◽  
Vol 68 (9) ◽  
pp. 1308-1312 ◽  
Author(s):  
J. Li ◽  
R.P. Ellen
Keyword(s):  
Liquid Scintillation ◽  
Mineral Surface ◽  
Standard Strain ◽  
Input Concentration ◽  
Bacteroides Species ◽  
In Vitro Simulation ◽  
Independent Variable ◽  
The Mean ◽  
The Difference

The study was designed to compare the adherence of several Bacteroides species to A. viscosus. Using 3H, we labeled 24 laboratory strains, including 13 Bacteroides species and I I fresh clinical isolates of three Bacteroides species. Their adherence to A. viscosus bound to a saliva-coated mineral surface was quantified by liquid scintillation. Adherence relative to a standard strain, B. gingivalis 2561, was compared. Among the lab bacteroides, those of B. gingivalis (eight strains) were the greatest binders (mean, 80.5 ± 12.4%). Strains of other lab bacteroides bound less well (mean, 33.4 ± 6.3%). The difference in means was statistically significant (p<0.01). The mean for B. gingivalis strains was also significantly greater than that for strains of B. intermedius (51.7 ± 6.2%). Attachment of B . gingivalis was saturable in experiments in which either input concentration or time was the independent variable, indicating that B. gingivalis cells do not accumulate in this in vitro simulation of plaque formation by binding to each other. Subculture did not seem to affect the degree of binding.

scholarly journals Comparison of Preemptive Analgesic Effects of Intravenous Ketorolac and Oral Pregabalin in Patients Undergoing Mandibular Fracture Surgery: A Randomized Clinical Trial

2020 ◽  
Vol 12 (2) ◽  
pp. 51-57
Author(s):  
Javad Yazdani ◽  
Saeed Nezafati ◽  
Ali Mortazavi ◽  
Farrokh Farhadi ◽  
Milad Ghanizadeh
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Postoperative Period ◽  
Opioid Analgesic ◽  
Mandibular Fractures ◽  
Analgesic Effects ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Intravenous Ketorolac

Background: Preemptive analgesia is one of the techniques to manage postoperative pain, which increases patient satisfaction and decreases the duration of hospitalization. The present study aimed to evaluate and compare the pain relief achieved by preoperative intravenous ketorolac and oral pregabalin in patients undergoing surgery for mandibular fractures. Methods: In the present clinical trial, 60 patients with unilateral fractures of the mandible were randomly assigned to two groups. In group A, intravenous injections of ketorolac 30 mg and in group B, pregabalin 150 mg capsules were administrated one hour preoperatively. The severity of pain was determined using a visual analog scale (VAS) up to 24 hours postoperatively. Finally, the total doses of an opioid analgesic (pethidine) prescribed for each patient in mg during the first 24 hours and the time for the request of the first analgesic dose in minutes were recorded for each patient. Then, their means were compared between the two groups. Results: Maximum pain severity was experienced immediately after surgery, which decreased gradually during the 24-hour postoperative period (P < 0.0001). The mean severity of pain immediately after regaining consciousness and the mean pain score during the 24-hour postoperative period were lower in the pregabalin group than in the ketorolac group (P < 0.0001). In the ketorolac group, a slightly higher dose of the opioid was administered; however, the difference was not significant (P > 0.05). Conclusions: The oral administration of pregabalin 150 mg one hour preoperatively was more effective than the intravenous administration of ketorolac 30 mg in relieving postoperative pain.

scholarly journals Assessment of quality of care in acute postoperative pain management

2009 ◽  
Vol 66 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Dragana Milutinovic ◽  
Verica Milovanovic ◽  
Miroslava Pjevic ◽  
Mirjana Martinov-Cvejin ◽  
Tomislav Cigic
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Nursing Care ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Care Quality ◽  
Acute Postoperative Pain ◽  
Nursing Care Quality ◽  
The Difference

Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP) was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA), discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (?), multiple correlation coefficient (R) were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5) and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57%) evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001). The analysis of patients evaluation (MANOVA p < 0.05 and discriminative p < 0.05) indicates the existence of significant difference between the assessment of nursing care quality in managing acute postoperative pain as regards to clinics as the place for pain management, patient's sex and his expectations. Evaluation from 'communication' subscale gives the greatest contribution (24.9%) to the difference between the observed clinics, and the greatest contribution (25.7%) to the difference in evaluation of nursing care quality as regards to patients' sex has the evaluations from 'procedure' subscale. Conclusion. The results of this study show a useful evidence and identify aspects of nursing care in postoperative management of acute pain which are still to be improved. According to the patients' answers the priority should be given to a regular assessment of the intensity of postoperative pain and evaluation of the effects of analgesic therapy.

scholarly journals Variability in trauma case volume in orthopedic surgery residents

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Travis D. Blood ◽  
Joseph A. Gil ◽  
Christopher T. Born ◽  
Alan H. Daniels
Keyword(s):  
Orthopedic Surgery ◽  
Trauma Surgery ◽  
Orthopedic Trauma ◽  
Upward Trend ◽  
Case Volume ◽  
Trauma Case ◽  
The Mean ◽  
The Difference ◽  
Case Logs ◽  
Orthopedic Trauma Surgery

Orthopedic trauma surgery is a critical component of resident education. Surgical case logs obtained from the Accreditation Council of Graduate Medical Students from 2009 to 2013 for orthopedic surgery residents were examined for variability between the 90<sup>th</sup> and 10<sup>th</sup> percentiles in regards to the volume of cases performed. There was an upward trend in the mean number of cases performed by senior residents from 484.4 in 2009 to 534.5 in 2013, representing a 10.3% increase. There was a statistically significant increase in the number of cases performed for humerus/elbow, forearm/wrist, and pelvis/hip during this period (Pth and 90<sup>th</sup> percentile case volumes narrowed over the study period, the difference between these groups remained significant in 2013 (P=0.02). In 2013, all categories of trauma cases had a greater than 2.2-fold difference between the 10<sup>th</sup> and 90<sup>th</sup> percentile of residents for numbers of trauma cases performed. Although case volume is not the sole determinant of residency education and competency, evidence suggests that case volume plays a crucial role in surgeon confidence and efficiency in performing surgery. Further studies are needed to better understand the effect of this variability seen among residents performing orthopedic trauma surgery.

scholarly journals A Comparison between Bupivacaine Alone and Bupivacaine with Tramadol in Epidural Block for Postoperative Pain Management

Esculapio ◽  
2021 ◽  
Vol 16 (4 (oct 2020 - dec 2020)) ◽  
Author(s):  
Saadia Khaleeq ◽  
Azib Ali ◽  
Sahir Shafiq ◽  
Muhammad Muazzam Butt ◽  
Mudassar Aslam ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Pain Score ◽  
Postoperative Pain Management ◽  
Epidural Block ◽  
Vas Score ◽  
Group A ◽  
The Mean ◽  
Group B

Objective: This study was designed to compare the mean pain score with bupivacaine versus tramadol plus bupivacaine in patients undergoing surgery under general anesthesia. Randomized Controlled Study. Anesthesia department of SIMS medical college/Services Hospital, Lahore. Duration is 13 months from 20th August2017 till 24th September 2018. Method: 80 patients aged 20-60 years of ASA I & II status, undergoing elective surgery were selected. Patients were randomly divided into two groups (Group A and B) of 40 each, using random numbers table. An epidural catheter was placed at L3-L4 intervertebral level. Group A was given 30 ml of 0.125% bupivacaine and Group B was given 25mg Tramadol plus 0.125% bupivacaine mixture in the same volume. General anesthesia was induced with IV Propofol 2mg/kg and atracurium 0.5mg/kg. After recovery from anesthesia, patients were shifted to HDU. Post-operative pain was assessed using the 10-point VAS score. Injection nalbuphine 0.1mg/kg was given as rescue analgesic when VAS score became more than 4. Results: The mean age of patient in Group A was 37.5 ± 9.1 years and 38.6 ± 7.0 years in Group B. Mean BMI in Group A was 33.2 ± 4.3 and 32.2 ± 4.2 in Group B. The mean pain score after 12 hours of surgery was 3.6 ± 0.8 in Group A and 1.5 ± 0.9 in Group B, p value was significant. Conclusion: Thus, the present study concludes that epidural administration of tramadol as adjuvant with bupivacaine is more effective in postoperative pain relief as compared to bupivacaine alone. Key Words: Bupivacaine, Epidural, Postoperative pain, Tramadol. How to Cite: Khaleeq S, Ali A, Shafiq S, Butt M M, Aslam M, Jehangir MU. A Comparison between Bupivacaine alone and Bupivacaine with Tramadol in epidural block for postoperative pain management. Esculapio.2021;17(1): page number. Esculapio.2020;16(04):101-104.

scholarly journals A Pharmacokinetic Approach to Postoperative Pain: Continuous Infusion of Pethidine

1979 ◽  
Vol 7 (1) ◽  
pp. 25-32 ◽  
Author(s):  
J. V. Stapleton ◽  
K. L. Austin ◽  
L. E. Mather
Keyword(s):  
Postoperative Pain ◽  
Intravenous Infusion ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Abdominal Hysterectomy ◽  
Blood Concentrations ◽  
The Mean ◽  
State Concentration ◽  
Infusion Regimen ◽  
Pharmacokinetic Approach

In an attempt to improve postoperative pain management an intravenous infusion of pethidine was designed to provide stable therapeutic blood concentrations. Ten female patients undergoing elective abdominal hysterectomy were studied. After commencement of the infusion, blood pethidine concentrations increased rapidly and exceeded 0.46 μg/ml after four hours. The mean steady-state concentration of 0.67 μg/ml was reached by twenty-four hours. This infusion regimen resulted in the abolition of severe pain after three hours and analgesia continued for the duration of the two day study. Significant blood concentrations of the metabolite norpethidine were found although clinically no toxic effects were observed. Side effects of pethidine were infrequent. Controlled continuous intravenous infusion of pethidine produced stable blood concentrations and provided excellent pain control.

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