[Agreement between verbal numerical scale and visual analog scale assessments in monitoring acute postoperative pain]. / Concordancia entre la escala verbal numérica y la escala visual analógica en el seguimiento del dolor agudo postoperatorlo.

OBJECTIVE: To determine the agreement between verbal numerical and visual analog scale assessments of acute postoperative pain on 3 consecutive days. METHODS: Pain data were recorded for 2 months for sequentially enrolled patients receiving parenteral opioids or neuraxial blocks for analgesia after major surgery in a tertiary level hospital. Each patient was asked to assess pain on the visual analog and verbal numerical scales every 24 hours for 3 consecutive days. Agreement was estimated by the intraclass correlation coefficient and the Spearman correlation coefficient. The results were analyzed in 2 age strata: age 65 years or younger and older than 65 years. RESULTS: Data for 159 patients (105 < or =65 years; 54 >65 years) were analyzed. The visual analog scale could not be used with 12 patients; all patients were able to assess pain on the verbal numerical scale. The intraclass correlation coefficient was > 0.70 for all 3 days; the highest coefficients were for patients over 65 years of age. CONCLUSIONS: Agreement between pain assessments on the visual analog and verbal numerical scales can be considered good or very good on all 3 days, with stronger agreement when the scales are used in patients over the age of 65 years. Cooperation was better for the numerical scale than for the visual analog scale. Scores on the verbal numerical scale were consistently higher than scores on the visual analog scale.

[Assessment of training in the control of acute postoperative pain based on analysis of pretraining and posttraining measures]. / Evaluación de una intervención educativa en el control del dolor agudo postoperatorio: estudio antes-después.

OBJECTIVE: To assess the efficacy of an acute pain unit's training on postoperative pain control for staff of trauma-orthopedic and general surgery departments. METHODS: Prospective pretest-posttest study in a tertiary care hospital. Physicians and nurses in the 2 surgical departments were given training sessions that included discussion with visual support and presentation of the acute pain unit's treatment protocols. Outcome measures used were visual analog scale (VAS) scores, patient satisfaction scores, number of days of treatment in accordance with the acute pain unit's protocol, and reasons for stopping treatment. Data for the year before and after the training program were analyzed. RESULTS: Data for 854 patients before training and 971 after training were analyzed. There were no differences between surgical specialties in the mean number of days of treatment. Nor did patient satisfaction scores differ (trauma-orthopedic surgery, -0.379, P = .352; general surgery, -0.927, P = .177). VAS score differences of less than 0.5 points were found in active and resting pain from the second and third days, respectively. There was improvement in both specialties in terms of the number of patients who completed the treatment initially prescribed by the acute pain unit. CONCLUSIONS: The staff training in postoperative pain control did not affect patient satisfaction, though a small improvement in active and resting VAS scores was noted. The training did have an effect on significantly improving overall compliance with the acute pain unit's treatment protocols.

[Comparison of intrathecal fentanyl and bupivacaine in combined spinal-epidural obstetric analgesia]. / Comparación del efecto de fentanilo frente a bupivacaína intratecal en una técnica anestésica combinada durante la analgesia obstétrica.

OBJECTIVES: To compare intrathecal injection of the opioid fentanyl to injection of bupivacaine, in terms of their effect of labour in the context within the combined spinal-epidural analgesia. METHODS: Prospective single-blind trial in primiparas randomized to 2 groups for sedation with 25 microg of fentanyl or 2.5 mg of bupivacaine, followed in both cases by epidural infusion of ropivacaine. We measured time from puncture to delivery of the neonate, rescue analgesia, pain assessed on a visual analog scale (VAS), motor block, side effects, sensory level, Apgar score, and maternal satisfaction. RESULTS: Sixty-four women were studied. The mean time elapsed between puncture and birth was 168.59 minutes (95% confidence interval [CI], 134.16 to 203.03 minutes) in the bupivacaine group and 189.13 minutes (95% CI, 151.93 to 226.32 minutes) in the fentanyl group. The mean difference was -20.53 minutes (95% CI, -70.21 to 29.15 minutes). Survival analysis applied to duration of labor, using type of delivery as the final outcome, also failed to show a significant between-group difference (chi2=0.59, P=.447). No significant differences in use of rescue analgesia, VAS scores, or motor block were observed. The incidence of pruritus in the fentanyl group was 34.37%, but there were no differences in maternal satisfaction. CONCLUSIONS: Our findings do not support the use of intradural fentanyl with the aim of shortening labor. Fentanyl leads to more pruritus, although this side effect does not affect maternal satisfaction.