Top PDF PAIN RELIEF IN POLYTRAUMA PATIENTS

SUMMARY: Assessment of pain during acute pain in polytrauma is often a difficult task, but is an essential element in emergency Polytrauma management. By default, multimodal pain therapy is the most effective and acceptable approach. A differentiation between nociceptive and neuropathic element of pain is important. Judicious use of opioids, regional blocks and subanaesthetic doses of ketamine all of which have a role in nociceptive pain whereas neuropathic pain require specific agents. Low side effect profile of gabapentin makes it an attractive option to use as a first line therapy in neuropathic pain. Emotional support is often a neglected, but integral component in rehabilitating phase and a must to prevent stress disorders.

Looking for health services is the most indicated attitude in the situation of VU-related pain. Team following up the inju- ry should evaluate pain and ofer efective analgesic methods for pain relief. Guidance about pain handling is critical for patients to have subsidies to minimize pain-related distress. Spiritual/religious methods, which comfort during anguish and aliction times, were strategies used by patients of this study, similarly to a study evaluating elderly with cancer 24 .

tiveness of drugs used to treat acute renal colic pain, however studies have not comparatively evaluated the costs of this treatment. In addition to symptoms relief, adequate pain management de- creases patients’ length of stay in the emergency department, de- creases treatment costs and, consequently, increases patients’ satis- faction with the quality of the assistance. his study is justiied by the almost inexistence of Brazilian publications related to hospital costs of renal colic diagnosis and management, as well as it may be useful to propose relections about the importance of institutional protocols, of adequately managing pain, as well as of associated characteristics which may help managing assistance and services. his study aimed at evaluating the costs of renal colic diagnosis and treatment in a private emergency service and the variables af- fecting such cost.

epinephrine reduces plasma concentration of lignocaine and minimizes toxicity and prolonged post-operative pain relief. We have also used 1% lignocaine with epinephrine. It has been suggested that upper limit for lignocaine with epinephrine 7mg/kg. As a fairly large volume of drug required for the block the concentration kept at 1% for lignocaine in our study. As the mean weight of our patients 61.3kg and mean volume used 35.3ml, it became clear that the total dose of the lignocaine employed by us was well within the upper recommended limit.

Treatment for such injuries is based on cold water compresses and oral analgesics (dipyrone is the rule, but the use of potent analgesics, such as tramadol hydro- chloride may be required). When painkillers do not control the pain, nerve anesthetic blockade (lidocaine 4.0 mL for adults) may be employed [1-4]. Based on our past experience, we suggest using serial application of topical commercial anesthetics with 0.25% lidocaine and 0.25% prilocaine in order to greatly decrease or eliminate the pain, these drugs take effect in about half an hour and last for several hours [1,4]. They are easy to apply, does not interfere with the approach adopted for this kind of accident, and it is especially useful for children and patients whose lesion sites do not allow blockades.

Another important point was that, in group 1, most patients pre- sented good pain relief at T 30 , with plasma fentanyl concentrations low- er than 0.63 ng/ml in the absence of any supplementary analgesia. In addition, many group 2 patients showed good pain relief despite a plas- ma fentanyl concentration below the minimum required for analge- sia, although the number of patients was smaller than in group 1. At T 120 , many group 1 patients still presented good pain relief with plasma fentanyl levels less than 0.63 ng/ml and did not require supplementa- ry analgesics. In group 2, few patients presented adequate pain relief and all of them requested supplementary analgesia. After four hours, some group 1 patients continued to present good pain relief, although they did not receive any analgesic supplement, and their plasma fen- tanyl concentration was less than 0.63 ng/ml. Four hours after epidu- ral injection, the plasma fentanyl concentration was higher than after two hours, probably because it was spreading out from the distribution sites of the drug.

RESULTS: In our study we enrolled 50 consenting patients who had superficial abarasions. Of the 50 patients 4 were excluded from the final study as they did not want to continue or wanted change of treatment. Hence the final study included 46 patients. The study was single blinded. The observer who questioned about pain did not know which dressing was used.

Methods: Patients ≥50 years with primary knee OA who were receiving oral or topical analge- sics were eligible. Patients were enrolled from seven healthcare centers in Portugal between January and December 2011. Pain and function were evaluated using the Brief Pain Inventory (BPI) and WOMAC. Quality of life was assessed using the 12-Item Short Form Health Survey (SF-12). Inadequate pain relief (IPR) was defined as a score >4/10 on item 5 of the BPI. Results: Overall, 197 patients were analyzed. The median age was 67.0 years and 78.2% were female. Mean duration of knee OA was 6.2 years. IPR was reported by 51.3% of patients. Female gender (adjusted odds ratio – OR 2.15 [95%CI 1.1, 4.5]), diabetes (OR 3.1 [95%CI 1.3, 7.7]) and depression (OR 2.24 [95%CI 1.2, 4.3]) were associated with higher risk of IPR. Patients with IPR reported worst outcomes in all dimensions of WOMAC (p < 0.001) and in all eight domains and summary components of SF-12 (p < 0.001).

Irrespective of the exact etiology, CPP represents a major challenge to health care providers, especially because of its common refrac- toriness to treatment. In this context, adding an efective and well- tolerated drug, as thalidomide, to our armamentarium of pain medications would be extremely valuable. Results presented herein – our two patients’ impressive pain relief response to thalidomide – suggest that this drug may have therapeutic value for interstitial cystitis/CPP. Moreover, based on our results, we hypothesize that suppression of TNF-alpha (a proved efect of thalidomide) may contribute to pain relief in patients with CPP. his hypothesis may lead to a better understanding of the currently unclear pathogen- esis of CPP. Finally, we hope to encourage further studies to estab- lish the eicacy and safety of thalidomide for chronic pelvic pain and other chronic pain conditions.

Objective: he objective of this study was to compare maternal satisfaction with childbirth accord- ing to whether or not combined spinal-epidural anesthesia (CSE) of pain relief was used during labor. Methods: A randomized, open clinical trial was performed with 70 pregnant women, 35 of whom received CSE anesthesia while 35 received only non-pharmacological forms of pain relief during labor. he variables evaluated were visual analogue scale (VAS) pain score, maternal satis- faction with the technique of pain relief used during childbirth and with delivery, the patient’s in- tention to request the same technique in a subsequent delivery, and loss of control during delivery. Results: VAS pain score decreased signiicantly in patients receiving CSE during vaginal delivery. Furthermore, maternal satisfaction with the technique of pain relief and with delivery was higher in the CSE group, and around 97% of the patients would repeat the same technique at future de- liveries compared to 82.4% of the women in the group using only non-pharmacological methods. With respect to the women’s impressions of their control during delivery, approximately half the women in both groups felt that they had lost control at some point during the process. Conclusion: he use of CSE was associated with a signiicant reduction in VAS pain scores during delivery and with greater maternal satisfaction with the pain relief method and with the childbirth process.

were not exposed to the drug. The risk of NEC was independent of the dosage and duration of Ranitidine therapy. Mortality was 6 times higher in Ranitidine group. Athena acknowledges the logics of the study conclusion. Gastric acidity is one of the important non-immunological defense mechanisms of human body. Ranitidine induced hypochlorhydria promotes colonization of pathogenic flora in neonatal gut thereby, may predispose to sepsis and NEC. But it is perplexing as to why the two groups did not differ in the incidence of certain opportunistic pathogens such as candida, staphylococcus and group B Streptococcus. Although Athena would not call for a ban of Ranitidine in neonatal practice based on this paper, she would definitely recommend weighing the risk-benefit ratio before prescribing Ranitidine in neonates. Congenital ab- normalities of kidney and urinary tract (CAKUT) are a com- mon cause of significant mortality and morbidity in infants. CAKUT is a spectrum ranging from innocuous malfor- mations such as supernumery kidneys to notorious posteri- or urethral valves. Even the most benign anomaly may be part of a syndrome spectrum and thus may determine the

For the construction of graphic protocols, were followed the national and international guidelines of research organizations that work in the perspec- tive of patient safety, the Brazilian legal framework with ordinances and resolutions, and data from a Scoping Review based on scientific literature ev- idence (Appendix 1). The phase of designing the graphic protocols also involved conducting a focus group with nursing professionals working daily in the emergency service to polytrauma patients. The purpose was to identify the necessary elements to compose the graphic protocols for evaluation of safe care to polytrauma patients related to the structure, process, and outcome of emergency care.

more severely increased in women (25). Arterial hypertension was found in 63.3% of the present patients. The prevalence of arterial hypertension in American patients with ADPKD reported in other studies was approximately 60%, even with normal renal function (14), possibly affecting 80% of the ADPKD patients with renal failure (26). An- other relevant issue related to arterial hyper- tension is stroke. In the present report, stroke was detected in 7 patients, with 2 of them being cases of confirmed hemorrhagic stroke. Of the 42 patients evaluated by MRA in the present investigation, 3 (7.1%) showed ICA. A similar frequency was also obtained in three large prospective studies (4 to 11.7%) from USA (7,27,28). The presence of a posi- tive family history is the main feature that affects the prevalence of ICA (29), reaching in these cases rates of 22 (7) and 25.8% (28). The frequency of ICA can also vary with age. ICA can also appear 10 years after a first examina- tion that did not demonstrate the presence of this alteration, although at a low rate (2.6%) (30). Another American study reported that new ICA appeared after 6 to 33 years (mean of 14.2 years) in 5 of 20 patients with a previous demonstration of the presence of ICA (31). Some investigators have suggested that rou- tine screening of all patients with ADPKD is not necessary because the risk of rupture is low (32). It has been suggested that this screen- ing should be recommended only to patients with a positive family history, patients with a personal history of subarachnoid hemorrhage, patients who will be submitted to major sur- geries, and to individuals with high-risk occu- pations (33).

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.

To diagnose the anatomic rectal pain origin, upper hy- pogastric plexus anesthetic block prevents sensory in- formation from the rectum via sacral plexus to reach the central nervous system. However, several nociceptive transmission pathways are involved with rectal sensi- tivity: upper or middle rectal plexus, lower mesenteric or lower hypogastric plexuses, sympathetic pathways by splanchnic nerves or sympathetic trunk and white communicating branch until spinal cord. In addition, nociceptive information may travel through the pre- vertebral plexus and follow parasympathetic pathways by pelvic splanchnic nerves 16 .

At axial computed tomography, a radi- olucent line parallel to the longest axis of the petrous pyramid is observed (Figure 1). The most common complications of longitudinal fractures include ossicular in- juries, tympanic membrane rupture and hemotympanum, with conductive hearing loss. Less commonly, the facial nerve may be affected (3) .

This study investigates the prevalence of self-medication among undergraduate nursing students seeking to relieve pain and characterizes the pain and relief obtained through the used medication. This epidemiological and cross-sectional study was carried out with 211 nursing students from a public university in Goiás, GO, Brazil. A numerical scale (0-10) measured pain intensity and relief. The prevalence of self-medication was 38.8%. The source and main determining factor of this practice were the student him/herself (54.1%) and lack of time to go to a doctor (50%), respectively. The most frequently used analgesic was dipyrone (59.8%) and pain relief was classified as good (Md=8.5;Max=10;Min=0). The prevalence of self-medication was higher than that observed in similar studies. Many students reported that relief obtained through self-medication was good, a fact that can delay the clarification of a diagnosis and its appropriate treatment.

If pain processing is affected centrally in PD, as hypothesised, this could result in a generalised hypersensitivity to noxious sen- sations (Cury et al., 2016), which may influence the onset of and/or exacerbate painful symptoms in PD (Broen et al., 2012). Evidence for this hypersensitivity is, however, inconsistent. While several studies have found increased pain sensitivity in PD patients compared to healthy controls (HCs) in response to noxious exper- imental stimulation (Chen et al., 2015; Lim et al., 2008; Mylius et al., 2009), others have failed to find such an effect (Granovsky et al., 2013; Massetani et al., 1989; Vela et al., 2007). This incon- sistency may be influenced by methodological differences across studies, including variation in sample size, dopaminergic and anal- gesic medications, disease duration and symptom severity (Fil et al., 2013; Priebe et al., 2016). Nevertheless, to our knowledge, there has been no systematic effort to synthesize available evi- dence from experimental studies and to explore potential sources of study heterogeneity using meta-analytic techniques. Examining the influence of dopamine medication may be especially revealing, both to provide evidence for possible mechanisms of action and for informing potential analgesic treatment.

been proposed for the EIMD mechanism, namely: lactic acid, muscle spasm, muscle damage in the conjunctive tissue, muscle damage, inflammation and the enzymatic efflux theories. However, the interaction of two or more theories seems to explain the muscle pain. EIMD may affect athletic performance causing reduction in joint range of motion, attenuation of the shock and peak torque. Alterations in the muscular sequencing and recruiting patterns may also occur, causing unusual stress in the muscular ligaments and tendons. These compensation mechanisms may increase the risk of additional damage if early return to sport occurs. A series of treatment strategies was introduced to help to alleviate the EIMD severity and to restore the maximum function of the muscles as soon as possible 7 . Many interventions such as warming-up, stretching,

Figure 1 shows that a total of 72 studies were found through the search conducted in April 2017. Primarily, eight articles were excluded because they were repeated in the different databases (PubMed, PsycINFO and LILACS), with 64 studies remaining. Next, the titles and abstracts of the studies were read, considering the objectives proposed for the present review, and the inclusion and exclusion criteria were applied independently by two researchers. In cases of disagreement, the authors reached a consensus through discussion. A total of 52 articles were excluded for the following reasons: (a) review articles, book chapters, study protocols, method protocols (n = 19); (b) did not use pain as a measure (n = 9); (c) the sample included only full-term infants (n = 8); (d) the study evaluated the experiences of the health professionals (n = 3); (e) the study used another pharmacological or non-pharmacological pain relief method (n = 2); (f) the article was not freely available (n = 1); (g) the focus of the study was only on the mother, without the measurement of pain (n = 4); (h) articles in languages other than those established as inclusion criteria (n = 2); (i) articles found outside the time frame (n = 3); and article with methodological problems that invalidated the results (n = 1). Finally, 12 studies were selected for analysis.