RESUMO
Abstract Introduction Laparoscopic cholecystectomy (LC) is the common surgical intervention for benign biliary diseases. Postoperative pain after LC remains as an important problem, with two components: somatic and visceral. Trocar entry incisions lead to somatic pain, while peritoneal distension with diaphragm irritation leads to visceral pain. Following its description by Forero et al., the erector spinae plane (ESP) block acquired considerable popularity among clinicians. This led to the use of ESP block for postoperative pain management for various operations. Materials and methods This study was conducted between January and June 2019. Patients aged between 18 and 65 years with an American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective laparoscopic cholecystectomy were included in the study. All the patients received bilateral or unilateral ESP block at the T8 level preoperatively according to their groups. Results There was no significant difference between the groups in terms NRS scores either at rest or while coughing at any time interval except for postoperative 6th hour (p = 0.023). Morphine consumption was similar between the groups but was significantly lower in group B at 12 and 24 hours (p = 0.044 and p = 0.022, respectively). Twelve patients in group A and three patients in group B had shoulder pain and this difference was statistically significant (p = 0.011). Discussion In conclusion, bilateral ESP block provided more effective analgesia than unilateral ESP block in patients undergoing elective LC. Bilateral ESP block reduced the amount of opioid consumption and the incidence of postoperative shoulder pain.
Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Colecistectomia Laparoscópica/efeitos adversos , Analgesia , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/etnologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Ultrassonografia de Intervenção , Dor de Ombro , Analgésicos Opioides , Anestésicos LocaisRESUMO
OBJECTIVE(S): Since partial decriminalization of abortion in Colombia, Oriéntame has provided legal abortion services through 15 weeks gestation in an outpatient primary care setting. We sought to document the safety and acceptability of the second trimester compared to the first-trimester surgical abortion in this setting. STUDY DESIGN: This was a prospective cohort study using a consecutive sample of 100 women undergoing surgical first-trimester abortion (11 weeks 6 days gestational age or less) and 200 women undergoing second-trimester abortion (12 weeks 0 days-15 weeks 0 days) over a 5-month period in 2012. After obtaining informed consent, a trained interviewer collected demographic and clinical information from direct observation and the patient's clinical chart. The interviewer asked questions after the procedure regarding satisfaction with the procedure, physical pain and emotional discomfort. Fifteen days later, the interviewer assessed satisfaction with the procedure and any delayed complications. RESULTS: There were no major complications and seven minor complications. Average measured blood loss was 37.87 mL in the first trimester and 109 mL in the second trimester (p<.001). Following the procedure, more second-trimester patients reported being very satisfied (81% vs. 94%, p=.006). Satisfaction was similar between groups at follow-up. There were no differences in reported emotional discomfort after the procedure or at follow-up, with the majority reporting no emotional discomfort. The majority of women (99%) stated that they would recommend the clinic to a friend or family member. CONCLUSIONS: Second-trimester surgical abortion in an outpatient primary care setting in Colombia can be provided safely, and satisfaction with these services is high. IMPLICATIONS: This is one of the first studies from Latin America, a region with a high proportion of maternal mortality due to unsafe abortion, which documents the safety and acceptability of surgical abortion in an outpatient primary care setting. Findings could support increased access to safe abortion services, particularly in the second trimester.
Assuntos
Aborto Induzido/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Satisfação do Paciente , Estresse Psicológico/prevenção & controle , Curetagem a Vácuo/efeitos adversos , Aborto Induzido/psicologia , Adolescente , Adulto , Perda Sanguínea Cirúrgica/fisiopatologia , Perda Sanguínea Cirúrgica/prevenção & controle , Estudos de Coortes , Colômbia , Países em Desenvolvimento , Feminino , Seguimentos , Humanos , Organizações sem Fins Lucrativos , Dor Pós-Operatória/etnologia , Dor Pós-Operatória/fisiopatologia , Satisfação do Paciente/etnologia , Hemorragia Pós-Operatória/etnologia , Hemorragia Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/prevenção & controle , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Atenção Primária à Saúde , Índice de Gravidade de Doença , Estresse Psicológico/etnologia , Estresse Psicológico/etiologia , Estresse Psicológico/fisiopatologia , Hemorragia Uterina/etnologia , Hemorragia Uterina/fisiopatologia , Hemorragia Uterina/prevenção & controle , Curetagem a Vácuo/psicologia , Adulto JovemRESUMO
Estudo conduzido com o objetivo de comparar as escalas derivadas de julgamentos de diferenças e verificar a estabilidade e a concordância das estimativas da atribuição dos descritores à dor pós-operatória julgadas por três diferentes amostras. Participaram do estudo 19 sujeitos submetidos a hemorroidectomia, os quais foram divididos aleatoriamente em três grupos (Grupo C, T e F), que receberam via endovenosa cetoprofeno 100 mg, tenoxicam 40 mg ou soro fisiológico 0,9 por cento, antes do início da cirurgia. A tarefa de cada participante foi assinalar um escore, de 1 a 7, a cada descritor de dor sentida na primeira queixa após a cirurgia. Os descritores atribuídos à dor pós-operatória foram avaliados pelo método psicofísico de estimação de categorias. Os resultados obtidos foram: os descritores de maior atribuição para o Grupo C foram intensa, insuportável e terrível; para o Grupo T, foram intensa, tremenda e insuportável e para o Grupo F, foram insuportável, intensa e terrível
Assuntos
Humanos , Hemorroidas , Dor Pós-Operatória , Medição da Dor , Dor Pós-Operatória/etnologia , Dor Pós-Operatória/psicologiaRESUMO
The purpose of this study was to assess use of pain relief measures and satisfaction with postoperative pain management among non-Hispanic white and Mexican American older adults after abdominal surgery. Findings revealed interpatient and intraethnic diversity, endorsing the importance of careful patient assessment and examining patient satisfaction for quality assurance/improvement.
Assuntos
Americanos Mexicanos/psicologia , Dor Pós-Operatória/etnologia , Satisfação do Paciente/etnologia , Cuidados Pós-Operatórios/psicologia , População Branca/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comparação Transcultural , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/enfermagem , Inquéritos e QuestionáriosRESUMO
The objective of this study was to describe the influence of culture on 12 surgical patients. The data was collected by interviews and the analysis was based on the framework of the qualitative methodology. The results showed four categories of influence: the type of pain, the expectancy by pain, the meaning of the pain and the pain management. The meaning apprehended is suffering and was verbalized by metaphors. The study considers the importance of the cultural comprehension about pain by the nurse.
Assuntos
Atitude Frente a Saúde/etnologia , Dor Pós-Operatória/etnologia , Adulto , Idoso , Brasil , Comunicação , Humanos , Masculino , Metáfora , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Dor Pós-Operatória/classificação , Dor Pós-Operatória/enfermagem , Dor Pós-Operatória/prevenção & controle , Inquéritos e QuestionáriosRESUMO
This study examined the relationship between ethnicity and pain. The study addressed three major research questions. The first question asked whether there was a significant difference in Mexican American women's and Anglo American women's response to cholecystectomy pain. Secondly, the nurses' attribution of pain to each of the two ethnic groups was compared. Finally, the patient's evaluation of the pain being experienced was compared to the nurse's evaluation of the pain the patient was experiencing. The sample consisted of 60 patient subjects and 60 nurse responses. Data were collected at two major teaching hospitals in southern California. Patient pain was measured using the McGill Pain Questionnaire, amount of analgesics and three physiological measures. The nurse's assessment of patient pain was measured using the Present Pain Intensity scale. MANOVA was used to analyse differences between the two ethnic groups on all measures of pain and no significant differences were found between the two ethnic groups on any of the measures of pain. However, nurses judged the two ethnic groups' pain response differently, assigning more pain to Anglo Americans. Finally, a dependent t-test was used to compare nurses' and patients' evaluation of pain. There were significant differences. Nurses evaluated the patients' pain as being less than patients did. Pearson product-moment correlations were used to examine the relationship between pain and sample characteristics of both patients and nurses. For the nurses, pain was significantly related to the patient's education, place of birth, language and religion.