RESUMO
BACKGROUND: Multimodal pain management for surgery patients may include the use of a combination of scheduled oral pain medications with as-needed (PRN) oral opioids. Multiple concurrent time demands on nursing staff frequently cause delays in the delivery of oral PRN pain medication compromising pain management. PURPOSE: Postoperative pain control was compared using a wireless oral patient-controlled analgesia device for the delivery of oxycodone with a control group receiving PRN oxycodone from nursing staff. METHODS: Thirty patients were prospectively randomized into each of 2 groups after total hip arthroplasty. Patient demographics, pain scores, drug dose data, and physical therapy data were collected from chart reviews. Additional data were obtained from patient and nursing surveys. RESULTS: Device patients recorded statistically lower pain scores while taking lower doses of oxycodone on postoperative Day 1 as compared with the control group. Patient surveys indicated that those in the device group reported lower pain scores 24 hours prior to discharge, albeit not statistically different from the control group. Men in the device group reported statistically lower pain scores with physical therapy than men in the control group. Findings from the nursing survey indicate that nurses favored the device over nurse-administered PRN. CONCLUSION: Patients using the wireless patient-controlled analgesia (PCA) (oral) device had less pain at rest and with activity (men) while taking lower doses of oxycodone with each dose. Nursing surveys indicated that nursing staff in this orthopedic postoperative unit found the device easy to use, reliable, and efficient. They also recommended its adoption for those capable of using it.
Assuntos
Administração Oral , Analgesia Controlada pelo Paciente/normas , Analgesia/normas , Idoso , Analgesia/métodos , Analgesia Controlada pelo Paciente/métodos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Estudos ProspectivosRESUMO
OBJECTIVES: To propose at the auriculotherapists a New Universal Nomenclature of Auriculotherapy, able to receive any mapping whatsoever. DESIGN: We built this proposition by using electronic database search to find the different formulations of Auricular Acupuncture Points (AAPs), by studying neuroradiology methods describing reliable and reproducible marks able to adapt to all brain morphologies, by studying the analysis of brain dissections, showed us the internal organization of the brain; and after having proved the neurophysiological correlations between auricular displays and their brain correspondences. RESULTS: Since the 1950s, the study of Auriculotherapy by Paul Nogier and his students regularly progressed. The World Health Organization recognized it in 1987 and developed the First International Nomenclature in 1990. The number of therapeutic zones of the ear, in proportion to the constant progress in neurophysiology, never stops growing. This growth presents a major problem: all the first classifications became inappropriate and unfit. We propose a Universal Nomenclature of Auriculotherapy which is a biomathematical model of the brain anatomic organization, with 189 areas on the lateral ear and 89 areas on the medial ear. CONCLUSION: The Universal Auriculotherapy Nomenclature we proposed to the World Federation of Chinese Medicine Societies and which approved it at its International Convention in September 2011 in London, gives accurate Cartesian Marks and is able to receive any mapping whatsoever. Dispatching around 57 countries (Europe, America, China, Russia and Africa) and 195 Acupuncture Societies, it will facilitate the work of auriculotherapists and allow a scientific progress of the subject worldwide. This progress will allow the largest number of people to have a common tool for education, research, and publications of the discipline.
Assuntos
Pontos de Acupuntura , Acupuntura Auricular , Bases de Dados Factuais , Terminologia como Assunto , Humanos , Medicina Tradicional ChinesaRESUMO
BACKGROUND AND OBJECTIVES: Although many studies have found no difference between thoracic epidural block and unilateral thoracic paravertebral block after thoracotomy, no previous studies have compared epidural block with bilateral thoracic paravertebral block (bTPVB) in patients undergoing open liver resection. We aimed to investigate whether there was a significant analgesic advantage of thoracic epidural over bTPVB after liver resection. METHODS: This randomized, prospective, open-label study included adult patients undergoing elective open liver resection. Patients were randomized to receive either thoracic epidural block or bTPVB, through which ropivacaine (0.2%) was infused for 3 days. The primary outcome was pain Verbal Rating Scale (VRS) score (0-10) at rest and with postoperative incentive spirometry. Secondary outcomes included VRS at rest, inspired volumes during incentive spirometry, patient-controlled analgesia hydromorphone utilization, measures of hemodynamic stability, and postoperative bowel function. RESULTS: Eighty patients completed the study and received thoracic epidural block (n = 41) or bTPVBs (n = 39). No catheter-related complications were noted. The primary outcome, pain (VRS) with incentive spirometry, was significantly lower in the epidural group (epidural vs bTPVB, mean [SD]) (4.5 [2.7] vs 5.4 [2.7] at 24 hours postoperatively, and 3.2 [2.1] vs 4.6 [2.4] at 48 hours postoperatively). Maximal inspired volumes at 24 hours postoperatively (917 [379] vs 1042 [468] mL) and cumulative utilization of patient-controlled analgesia hydromorphone during the first 48 hours postoperatively (10.7 [7.9] vs 13.6 [8.5] mg) were not significantly different between groups. Decrease in mean arterial pressure from baseline at 24 hours postoperatively was greater for the epidural group (-12.6 [15.8] vs -3.8 [16.2]; P = 0.016). CONCLUSIONS: This study suggests that there is a modest analgesic advantage of thoracic epidural over bTPVBs for patients after open liver resection.