scholarly journals Strategies for postoperative pain relief in neurosurgical intensive care unit

2004 ◽  
Vol 51 (4) ◽  
pp. 93-100
Author(s):  
B. Milakovic ◽  
M. Dostanic ◽  
S. Ivanovic
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Pain Treatment ◽  
Ventilatory Support ◽  
Neuromuscular Blocking ◽  
Opioid Administration ◽  
Patient Will

Despite advances in neurosurgical and neuroanesthesiological practice, postoperative pain continues to be under treated. There are many modalities that may provide safe and effective postoperative analgesia. We discuss mainly systemic (e.g. opioids, nonsteroidal antiinflammatory agents) analgesic options. They still remain the most widely used method for providing pain relief in acute surgical situations. The exact choice or combination of analgesics utilized for a particular patient will depend on the riskbenefit profile and patient preferences. Especially is crucial to promptly involve the analgesics when an opioidtolerant patient requires aggressive pain treatment. But, opioid analgesia alone may not fully relieve all aspects of acute postoperative pain. Combinations of drugs acting on different mechanisms of nociceptive modulation will decrease the incidence of adverse effects and offer additive and/or sinergistic effects. Analgesic concentrations of ketamine infusions remain a valuable addition to opioid administration. Complementary medicine techniques used as adjuvant therapies have the potential to improve pain management and improve postoperative distress. Neuromuscular blocking agents (NMB) in the intensive care unit (ICU) patient facilitate intubation and ventilatory support, decrease oxygen consumption, facilitate bedside procedures and diagnostics, and potentially decrease intracranial pressure. Ideally, analgesics, sedatives and/or muscle relaxants should be combined into a multimodal approach to facilitate patient recovery after surgery. Although a great deal is known about specific drugs and dosage requirements, further research is needed that clearly examines optimal scheduling regimens if we are to maximize patient care. The most important rule of pain management is that pain is what the patient says it is.

Characteristics of Nonpharmacological Interventions for Pain Management in the ICU: A Scoping Review

2019 ◽  
Vol 30 (4) ◽  
pp. 388-397 ◽  
Author(s):  
Geraldine Martorella
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Scoping Review ◽  
Elderly Women ◽  
The Elderly ◽  
Self Report ◽  
Pharmacological Interventions

Pain relief in the intensive care unit (ICU) is of particular concern since patients are exposed to multiple painful stimuli associated with care procedures. Considering the adverse effects of pharmacological approaches, particularly in vulnerable populations such as the elderly, the use of non-pharmacological interventions has recently been recommended in the context of critical care. The main goal of this scoping review was to systematically map the research done on non-pharmacological interventions for pain management in ICU adults and describe the characteristics of these interventions. A wide variety of non-pharmacological interventions have been tested, with music and massage therapies being the most frequently used. An interesting new trend is the use of combined or bundle interventions. Lastly, it was observed that these interventions have not been studied in specific subgroups, such as the elderly, women, and patients unable to self-report.

Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients

1995 ◽  
Vol 4 (6) ◽  
pp. 435-442 ◽  
Author(s):  
DA Meehan ◽  
ME McRae ◽  
DA Rourke ◽  
C Eisenring ◽  
FA Imperial
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Pain Relief ◽  
Pain Intensity ◽  
Analogue Scale ◽  
Nursing Practice ◽  
Surgical Patients ◽  
Analgesic Administration

BACKGROUND: Pain can adversely affect a patient's physiological and psychological recovery, yet little is known about the pain experience of cardiac surgical patients. OBJECTIVES: To examine nursing practice regarding analgesic administration and measure pain intensity and patient satisfaction with pain management practices. METHODS: To establish baseline nursing practice regarding analgesic administration, charts were reviewed retrospectively in 50 adult cardiac surgical patients, and the same information was collected concurrently for a prospective sample of 51 patients. The subjects completed visual analogue scales as a measure of pain intensity twice daily while in the cardiothoracic intensive care unit and Pain Relief Satisfaction Questionnaires on the day after transfer from the unit. RESULTS: Patients in the prospective group received significantly more analgesia. Pain intensity was moderate (4 or greater on the Visual Analogue Scale). Women had higher overall visual analogue scale scores than did men, 4.57 versus 3.70. Patients in whom an internal mammary artery had been used as a bypass graft had significantly higher scores compared with patients with vein grafts. The Pain Relief Satisfaction Questionnaire responses indicated that 96% of the patients experienced effective pain management in the cardiothoracic intensive care unit. CONCLUSIONS: Despite receiving analgesic doses twice those reported elsewhere for similar populations, the patients in this study reported moderate pain intensity. This finding was confounded by the fact that 96% expressed satisfaction with their pain management in the cardiothoracic intensive care unit. Frequent assessment and documentation of both pain and pain relief from interventions are necessary if the healthcare team is to implement an individualized analgesic regimen.

Pain management in the critically ill

2016 ◽  
Author(s):  
Ross D. MacPherson
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Critically Ill ◽  
Controlled Trials ◽  
Care Environment ◽  
Significant Pain ◽  
High Level

Despite the fact that patients in the critical care environment are more likely than others to have significant pain, there have been few controlled trials and even fewer examples of high level evidence that can be used to guide pain management. This chapter surveys the main modalities for pain management in the intensive care unit. Parenteral strategies remain the most commonly used form of administration and opioids are still the basis of good pain management. However, in recent times there have been a number of new opioids made available and some of these have a clear application in the critical care environment.In addition to opioids there are a range of adjunct agents that can be usedto give better quality pain relief, while at the same time reducing opioid requirements. Numerous studies have confirmed that pain managementin the critical care environment could be better managed. Strategies to improve pain management are suggested.

scholarly journals A fájdalmas beavatkozások száma és a fájdalomcsillapítás módozatai egy hazai neonatalis intenzív centrumban

2021 ◽  
Vol 162 (48) ◽  
pp. 1931-1939
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Pain Management ◽  
Pain Relief ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Prospective Observational Study ◽  
University Teaching ◽  
Neonatal Intensive Care Units

Összefoglaló. Bevezetés: A neonatalis intenzív centrumokban kezelt betegek naponta számos fájdalmas beavatkozáson eshetnek át. A kezeletlen fájdalom következményeinek ismerete ellenére, fájdalmuk csillapítása még messze nem ideális. Célkitűzés: Obszervációs tanulmányunk célja az osztályunkon kezelt koraszülötteket és beteg újszülötteket ért fájdalmas beavatkozások gyakoriságának és természetének meghatározása volt. Vizsgáltuk a procedurális fájdalom esetén alkalmazott gyógyszeres és nonfarmakológiai fájdalomcsillapítók használatát, valamint a beavatkozások számát és a fájdalomcsillapítás alkalmazását befolyásoló tényezőket. Módszerek: A vizsgálatba az osztályunkon 2019. 09. 01. és 2019. 12. 31. között kezelt betegeket vontuk be. Prospektív adatgyűjtést végeztünk a hospitalizáció első 14 napján, egy erre a célra kialakított kérdőíven, amelyet az egészségügyi személyzet valós időben töltött ki. Eredmények: Kutatásunkba 143 gyermeket tudtunk bevonni. A vizsgálati időszak alatt 43-féle fájdalmas beavatkozás történt, összesen 13 314 alkalommal, amiből 12 953 első, 361 többszöri kísérlet volt. Gyermekenként átlagosan 93,1 beavatkozást végeztünk a hospitalizáció első 2 hetében, ami átlagosan 8,2 fájdalmas procedúrát jelentett naponta és gyermekenként. Fájdalomcsillapítás összesen 4190 alkalommal, a beavatkozások 31,5%-ában történt. Ennek 55,5%-a folyamatos gyógyszeres, 40,7%-a nem gyógyszeres, 2,5%-a alkalmi gyógyszeres, 1,3%-a kombinált terápia volt. A legkisebb születési súlyú, legrövidebb gestatiós időre született és a lélegeztetett koraszülöttek szenvedték el a legtöbb fájdalmas beavatkozást. Következtetés: Betegeink nagyszámú fájdalmas beavatkozáson esnek át, és ezek nagyobb részénél nem történik fájdalomcsillapítás. A beavatkozások tervezésével, összehangolásával, a gyógyszeres és nem gyógyszeres fájdalomcsillapítás kiterjedtebb alkalmazásával jobb fájdalommenedzsment lenne elérhető. Orv Hetil. 2021; 162(48): 1931–1939. Summary. Introduction: Preterm infants and sick neonates treated in neonatal intensive care units may undergo numerous painful interventions. Despite rapidly growing knowledge about consequences of untreated pain, pain management of neonates is far from ideal. Objective: To determine the frequency and nature of painful procedures and corresponding analgesic therapies in neonates treated in a neonatal intensive care unit of a university teaching hospital in Hungary. Methods: A prospective observational study was performed between September and December 2019. We collected data of all painful procedures, pharmacological and non-pharmacological analgesic therapy performed on neonates during the first 14 days of hospitalization. For data collection, we used a questionnaire designed for this purpose, which was completed in real time by the medical staff. Results: 143 children were enrolled. 43 types of painful interventions were performed, a total of 13,314 times, of which 12,953 were the first, 361 multiple attempts. Each neonate was subjected to a mean of 93.1 interventions in the first 2 weeks of hospitalization, representing an average of 8.2 painful procedures per day per child. Pain relief was performed a total of 4190 times, in 31.5% of the interventions. Of this, 55.5% were continuous pharmacological, 40.7% non-pharmacological, 2.5% occasional drug, and 1.3% combination therapy. Ventilated neonates and preterm infants with shorter gestational age and lower birth weight had the most painful procedures. Conclusion: Patients treated in our unit undergo a large number of painful interventions, most of which are not accompanied by analgesia. Increased efforts are needed to promote our better pain management. Orv Hetil. 2021; 162(48): 1931–1939.

Pain assessment and management in critically ill postoperative and trauma patients: a multisite study

1999 ◽  
Vol 8 (2) ◽  
pp. 105-117 ◽  
Author(s):  
KC Carroll ◽  
PJ Atkins ◽  
GR Herold ◽  
CA Mlcek ◽  
M Shively ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Pain Intensity ◽  
Critically Ill ◽  
Severe Pain ◽  
Management Practices ◽  
Management Plan ◽  
Trauma Patients

BACKGROUND: Pain in critically ill patients is undertreated. OBJECTIVES: To examine patients' perceptions of pain and acute pain management practices in a large metropolitan area to provide direction for improvements in pain relief. METHODS: In a descriptive, correlational study, data were collected from 213 patients in 13 hospitals. Interviews with patients, chart reviews, and interviews with nurse leaders were used to examine institutional and individual approaches to pain management. RESULTS: Twenty-eight percent of patients did not recall an explanation of a pain management plan, and 64% were often in moderate to severe pain while in the intensive care unit. High pain intensity correlated with wait for an analgesic (P < .001), expectations of less pain (P < .001), and longer stay in the intensive care unit (P < .001). Low satisfaction correlated with expectations of less pain (P < .001), often being in moderate to severe pain (P < .001), and long wait for an analgesic (P < .001). In the first 24 hours postoperatively, only 54% of patients had a numerical pain rating documented; 91% had a pain description. The amount of opioid given on postoperative day 1 was influenced by pain intensity (P < .001), the patient's age (P = .03), type of surgery (P = .002), and route of analgesic (P < .001). Only 33% of patients had nonpharmacological pain interventions documented. CONCLUSIONS: Despite moderate to severe pain, patients are generally satisfied with their pain relief. Measuring patients' satisfaction alone is not a reliable outcome for determining the effectiveness of pain management. Realistic expectations of patients about their pain may enhance coping, increase satisfaction, and decrease pain intensity after surgery.

scholarly journals Predicting factors that determine patients’ satisfaction with post-operative pain management following abdominal surgeries at Komfo Anokye Teaching Hospital, Kumasi, Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251979
Author(s):  
Priscilla Felicia Tano ◽  
Felix Apiribu ◽  
Emile Kouakou Tano ◽  
Adwoa Bemah Boamah Mensah ◽  
Veronica Millicent Dzomeku ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Teaching Hospital ◽  
Pain Treatment ◽  
P Value ◽  
Access To Information ◽  
Operative Care ◽  
Post Operative Pain ◽  
Pearson Coefficient

Introduction Poorly controlled postoperative pain has been known to be characterized by longer post-operative care, longer hospital stays with increased readmission rates, and decreased patient satisfaction. Post-operative pain has been continuously addressed in the past three (3) to four (4) decades and has been shown that 20 to 80% of post-operative patients suffer ineffective pain management. Objective The study was aimed at assessing the factors that may predict the satisfaction of patients with early postoperative pain management following abdominal surgeries at the Komfo Anokye Teaching Hospital, Kumasi. Methodology A descriptive cross-sectional study was conducted among patients who had undergone abdominal surgeries between October 2019 and December 2019 at the Komfo Anokye Teaching Hospital. Structured questionnaires based on the IPO-Q were used to obtain responses from the patients. Descriptive and Inferential statistical analysis were employed in analyzing the data obtained from the respondents of the study. Results 138 patients were involved in this study. The mean age of patients in the study was 45.81 (±16.81) years. A higher percentage, 58.7% of the patients were males. 39.1% had completed their tertiary level of education. The majority (50.7%) of the patients had had persistent pain for more than three (3) months. The satisfaction of the patients with the post-operative pain management received was generally high among a significant majority of the patients. Meanwhile, among the factors that influence the satisfaction of the patients with the post-operative pain management received, type of analgesia and pain relief methods (Pearson Coefficient = 0.523, p-value <0.05), patient’s ability to request more pain relief, (Pearson Coefficient = 0.29, p-value <0.05), patient’s access to information about their pain treatment options from the Nurses (Pearson coefficient = -0.22, p<0.05), were the only predictors of satisfaction in patients. Conclusion This study found out that patients were generally satisfied with the post-operative pain management offered by their healthcare providers although the degree of satisfaction depended largely on the type of analgesia and pain relief methods, the ability to request for more pain relief, and access to information on pain treatment.

Regional analgesia techniques for pain management in patients admitted to the intensive care unit

2019 ◽  
Vol 85 (10) ◽  
Author(s):  
Ruben Rubio-Haro ◽  
Javier Morales-Sarabia ◽  
Carolina Ferrer-Gomez ◽  
José de Andres
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pain Management ◽  
Regional Analgesia

Weaning From Noninvasive Ventilatory Support in Infants With Severe Bronchiolitis: An Observational Study

2021 ◽  
Author(s):  
Julie Cassibba ◽  
Claire Freycon ◽  
Julia Doutau ◽  
Isabelle Pin ◽  
Alexandre Bellier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Pediatric Intensive Care Unit ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
Winter Season ◽  
Pediatric Intensive Care ◽  
High Flow Nasal Cannula ◽  
Tertiary Center

Abstract Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized over a winter season in a Pediatric Intensive Care Unit.Methods: A retrospective observational study in a pediatric intensive care unit in a tertiary center. Infants hospitalized for a severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) was analyzed.Results: Data from 95 infants (median age 47 days) were analyzed. On admission, 26 (27%), 46 (49%) and 23 (24%) infants were supported by CPAP, NIV and HFNC, respectively. One (4%), nine (20%) and one (4%) infants failed weaning while supported by CPAP, NIV or HFNC, respectively (p=0.1). In infants supported by CPAP, CPAP was stopped directly in 5 patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 hours, [IQR 0-26]) than for CPAP (24 hours, [14-40]) and NIV (28 hours, [19-49]) (p<0.01).Conclusions: The weaning phase represent a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step down” strategy may lead to an increase in duration of weaning.

scholarly journals Adaptive Support Ventilation as a Sole Mode of Mechanical Ventilation-An Observational Study

2017 ◽  
Vol 1 (1) ◽  
pp. 8-12
Author(s):  
L.K. Rajbanshi ◽  
M. Dali ◽  
S.B. Karki ◽  
K. Khanal ◽  
B. Aryal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Observational Study ◽  
Ventilatory Support ◽  
Control Mode ◽  
Adaptive Support Ventilation ◽  
Support Ventilation ◽  
Adaptive Support ◽  
The Mean

Introduction Adaptive support ventilation (ASV) is a close loop dual control mechanical ventilation mode. This mode can automatically change its parameters to weaning mode once the patient is actively breathing converting volume targeted pressure control mode to volume targeted pressure support mode. We aimed to observe the outcome of the patients ventilated with ASV as a sole mode in terms of duration of mechanical ventilation, duration of weaning from the ventilatory support and length of Intensive care unit (ICU) stay.Methodology We conducted a prospective observational study for the duration of six months (Sept 2015 to Feb 2016) to assess the clinical outcome of the patients ventilated by ASV as a sole mode of ventilation. The study conducted observation of 78 patients without chronic respiratory, renal, hepatic and neurological disease who were admitted in our intensive care unit for invasive ventilatory support.Results Out of the 187 patients who required invasive and noninvasive ventilation, only 78 patients fulfilled the criteria to be included in the study. It was observed that the mean duration of mechanical ventilation was 5.4 days while weaning as well as tracheal extubation was successful within 13 hours of initiation of weaning. The mean duration of ICU stay was found to be 6.3 days.Conclusion We concluded that the patient ventilated by ASV mode were effectively weaned without the need of changing the ventilator mode. However, the safety of ASV mode needs to be established by large randomized control trail in a wide spectrum of patients.Birat Journal of Health Sciences 2016 1(1): 8-12

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