Evaluation of Tramadol, Pentazocine Lactate and Meloxicam as Pre-emptive Analgesics for Pain Management in Canine Ovariohysterectomy

Background: It is usually accepted that some degree of post-surgical pain will be commonly present. There are different pain scales adopted in veterinary practice to assess these behavioural signs to measure pain. VAS had been used in human medicine for many years to measure pain and was found equally satisfactory in dogs. Pre-emptive analgesia (PEA) is grasping popularity in recent days, the concept of which originated during the time of growing appreciation of dynamic characteristics of pain pathway for obtaining effective analgesia prior to the surgical trauma. Methods: The present study was conducted to evaluate the effects of tramadol, pentazocine lactate and meloxicam as pre-emptive analgesics in dogs premedicated with glycopyrrolate, induction and maintenance with propofol continuous rate infusion (CRI) for certain clinical and physiological parameters. The animals were randomly divided into three equal groups viz. Group-T, Group-P and Group-M comprising six animals in each group and all were premedicated with glycopyrrolate, I/M. After 10 minutes of pre-anaesthetic administration, pre-emptive analgesia was given (Tramadol in Group-T, Pentazocine lactate in Group-P and Meloxicam in Group-M intravenously). After 10 minutes of pre-emptive analgesic administration, induction was achieved with propofol I/V and also maintained by CRI method up to 1 hour. Clinical and physiological parameters were recorded at 0 (baseline) minute before premedication, thereafter at 10 min, 30 min, 1 hr, 2 hr and 3 hr after pre-emptive analgesic administration. Result: There was no sedation observed within 10 min following pre-emptive analgesia and quality of sedation was recorded as score-0 in all the groups. Time for induction was significantly higher in group-M as compared to group-T and P. Quality of induction in all the groups ranged from score-0 to score1, assessment of peri-operative analgesia was recorded as score-0 in group-T and group-P, whereas in group-M it ranged from score-0 to score-1. Depth of anaesthesia was recorded as score-0 to score-1 in all the groups and quality of recovery was recorded as score-0 to score-1 in group-T and group-P and score-1 to score-2 in group-M. Assessment of post-operative analgesia by VAS was significantly lower in group-T as compared to group-P and M. In all the three groups, the heart rate increased significantly at 30 min interval and thereafter it decreased significantly till the end of the study. Respiratory rate also decreased significantly till 1 hr and thereafter it gradually increased till the end of study in all the groups. Rectal temperature, SpO2, systolic pressure and diastolic pressure decreased significantly at 30 min and thereafter increased gradually and approached base values in all the groups.

Evaluation of the effects of pain scale and analgesic administration on radiological imaging methods and hospitalization in trauma patients admitted to the emergency service

Background: Trauma, one of the major concerns in today’s world, exposes societies to important economic, social and health-related problems. Trauma is known to account for 10% of the world’s deaths. Objective: The aim of the study is to evaluate the demographic characteristics of trauma, which is common in emergency services and causes significant loss of workload and function when appropriate diagnosis and treatment methods are not applied, with radiological imaging methods, pain scale and analgesics. Materials and Methods: This prospective study included 1267 patients over the age of 18, who were admitted to the emergency department due to trauma between 1 January and 31 December 2019. The mean age of patients was 47.01 ± 14.97 year, with a male/female ratio of 1.46. 59.3% of the patients were male and 40.7% were female. Patients’ trauma types, radiology results, mortality, numerical pain scale and analgesic administration were evaluated. Results: Numerical pain scale score of trauma patients in the emergency department was 6.23 ± 2.02. Analysis of radiological imaging methods showed significance with age, numerical pain scale, thoracic and lumbar vertebrae, thoracic and abdominal injuries, types of trauma, consultation, hospitalization, analgesics administration and pain severity. Trauma types were insignificant with age and gender, but a significant relationship was found with all other parameters. Pain intensity was not correlated with gender and tetanus application but was significant with other variables. There was significance in radiological imaging methods and diagnostic types between injury types. Types of diagnosis were found to be correlated with imaging methods, orthopedic consultation, numerical pain scale and injury types. There was a significant correlation with the types of diagnosis, analgesia administration, consultation, and pain classification according to the pain rating scale. There was no correlation between age and gender according to pain intensity. However, there was a strong positive correlation with pain scale scores, consultation, hospitalization, types of trauma, administration of analgesia, and a weak correlation with radiological imaging methods. Conclusion: Early pain scale with radiological imaging and analgesic administration in trauma patients can reduce morbidity rates and shorten hospital stay.

Assessment of the implementation of a nurse-initiated pain management protocol in the emergency department

ABSTRACT Objectives: to assess the implementation of a nurse-initiated pain management protocol for patients triaged as semi-urgent, and its impact in pain intensity, in the Emergency Department. Methods: a prospective cohort study for adult patients with pain who had been triaged as semi-urgent and admitted to the hospital’s Emergency Department. Patients who received the intervention (pain-management protocol with analgesic administration) were compared to those who were managed using the conventional approach (physician evaluation prior to analgesic administration). Results: of the 185 patients included, 55 (30%) received the intervention, and 130 (70%) were managed conventionally. Patients in the intervention group were more likely to have taken pain medication in the 4 hours prior to admission, and reported higher levels of pain at admission and more significant reductions in pain level. Conclusions: despite low protocol adherence, the intervention resulted in higher reported pain relief.

Parental administration of analgesia to children attending the emergency department with acutely painful conditions.

Background Acute paediatric pain management is often suboptimal in the emergency setting. There is a paucity of published literature on parental administration of analgesia to children, prior to their arrival at the emergency department (ED). The objective of this study was to describe the prevalence of pre-hospital analgesic administration by parents/guardians of children ≤16 years presenting to ED, with acutely painful conditions. Methods This was a prospective cross-sectional study conducted across two EDs in the South of Ireland with a collective annual attendance of approximately 100,000 patients. A consecutive sample of 400 parents/guardians of children aged between 6 months and 16 years, who were self-referred to ED with acutely painful conditions, were included. Data collected included patient demographics, pain score and analgesia administration. Data was analysed with SPSS software using descriptive and inferential statistics. Results 189/400(47%) children received analgesia from their parents/guardians pre-ED arrival. Factors independently associated with increased parental administration of analgesia were: pain score ≥5/10 53.4%(95%CI 48%-59%) vs ≤4/10 29%(95%CI 21%-38%), children with siblings 49.7%(95%CI 45%-56%) vs without siblings 35.3%(95%CI 24%-47%) and presenting <48 hours from onset of pain 50.1%(95%CI 45%-55%) vs presenting ≥48 hours 30.5%(95%CI 19%-42%). Of the 400 participants, 211(53%) received no analgesia before attending ED. Reasons for parents not administering analgesia included: 62/211(29.4%) did not think the child needed it, 39/211(18.5%) accident did not happen at home, 34/211(16.1%) did not want to mask the presence of the pain, 20/211(9.5%) believed the hospital should give medications, and 18/211(8.5%) afraid it would be wrong/harmful. Conclusions Over half the children presenting to ED, with acutely painful conditions, did not receive adequate or timely pain relief pre-ED arrival, causing avoidable suffering. Parental misconceptions about acute pain management are major barrier to analgesic administration. Educational strategies are required to dispel misconceptions, which may ultimately improve the care for this population.

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

Purpose To explore the severity and duration of postoperative pain, the management of analgesics, and postoperative recovery in children undergoing tonsil surgery. Method Participants included 299 children aged 4–17 years undergoing tonsillotomy ± adenoidectomy (TT ± A) or tonsillectomy ± adenoidectomy (TE ± A). Data were collected up to 12 days. The child rated pain on the Face Pain Scale-Revised (FPS-R) and recovery using the Postoperative Recovery in Children (PRiC) questionnaire. Caregivers assessed their child's pain, anxiety, and nausea on a numeric analog scale and kept a log of analgesic administration. Results High pain levels (FPS-R ≥ 4) were reported in all surgical and age groups (TT ± A age 4–11, TE ± A age 4–11, TE ± A age 12–17), but there were variations in pain intensity and duration within and between groups. The TE ± A group scored more days with moderate to very excruciating pain and lower recovery than the TT ± A group, with the worst outcomes reported by older TE ± A children. The majority of the children used paracetamol + COX-inhibitors at home, but regular administration of analgesics was lacking, particularly during late evening and at night. Few were received rescue medication (opioid or clonidine) despite severe pain. Physical symptoms and daily life activities were affected during the recovery period. There was moderate agreement between child and the caregiver’s pain assessment scores. Conclusion Children reported a troublesome recovery with significant postoperative pain, particularly older children undergoing tonsillectomy. Pain treatment at home was suboptimal and lacked regular analgesic administration. Patient information needs to be improved regarding the importance of regular administration of analgesics and rescue medication.

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: ‘child sex (male)’, ‘child age (younger)’, ‘type of pain (traumatic)’ and ‘analgesic administration’. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child’s experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960