The Effectiveness of Cancer Pain Management in a Tertiary Hospital Outpatient Pain Clinic in Thailand: A Prospective Observational Study.

Objectives: The objective was to examine the effectiveness of the updated approach. Methods: With IRB approval, outpatients with cancer were enrolled from January to December 2018. Assessments were recorded at baseline and three consecutive visits (BL, FU1, FU2, and FU3), including Numerical Rating Scale (NRS), the Brief Pain Inventory (BPI), the Edmonton Symptom Assessment System (ESAS), side effects, and analgesic use. The primary outcome was a favorable response, defined as an NRS decrease more than 30% or NRS <4. Secondary outcomes included trends over time in BPI, ESAS, side effects, and analgesic use. Pain response predictors at FU3 were analyzed using logistic regression. Results: Among 150 patients, 72 (48%) completed follow-ups. Of these, 61% achieved a favorable response at FU3. Pain interference diminished at all visits relative to baseline (p < 0.05). Median morphine equivalent daily dosage (MEDD) at BL was 20 mg/day, with a statistically significant, but clinically modest increase to 26.4 mg/day at FU3. Radiation therapy during pain care was a predictor of pain responders. Conclusion: The current Siriraj multidisciplinary approach provided effective relief of pain and stabilization of other cancer-related symptoms. Radiation therapy during pain care can be used to predict pain outcomes. Ongoing improvement domains were identified and considered in the context of cultural, economic, and geographic factors.

Effects of Sucrose and Nonnutritive Sucking on Pain Behavior in Neonates and Infants undergoing Wound Dressing after Surgery: A Randomized Controlled Trial.

INTRODUCTION: Wound dressing, a procedure that pediatric patients are commonly exposed to postoperatively, can cause strong physiological and pain behavioral responses despite being brief. This study evaluated the effects of using 24% sucrose plus a pacifier versus a pacifier alone to reduce the pain response from dressing wounds in neonates and infants. MATERIALS AND METHODS: Thirty-two neonates and infants who underwent surgery and required postoperative wound dressing were randomized to a pacifier group (n = 16) and a 24% sucrose plus pacifier group ("sucrose group"; n = 16). Demographic data, crying time, and pain behaviors were recorded using a video recorder. The pain behaviors were assessed independently using the neonatal infant pain scale (NIPS) by three assessors, who were expert in pediatric pain assessment and blinded to the subject allocations. RESULTS: Participants in the sucrose group were older than those in the pacifier group (6.19 ± 2.95 vs. 3.88 ± 3.2 months). While there were no differences in the NIPS scores of the two groups at 30, 120, and 240 seconds, the incidence of moderate-to-severe pain was lower in the sucrose group than the pacifier group at 120 seconds (37.5 vs. 50%). The crying time was lower in the sucrose group, but without statistical significance. CONCLUSION: The 24% sucrose plus pacifier was not superior to the pacifier alone in decreasing pain behavioral responses. Dressing wound pain produced a high-intensity pain behavioral response. A pain management strategy should be developed to lessen the postoperative procedural pain in pediatric patients.

Effects of a restrictive fluid regimen in pediatric patients undergoing major abdominal surgery.

OBJECTIVE: To investigate the effects of restrictive fluid regimen during major abdominal surgery in pediatric patients. BACKGROUND: In adults, a restrictive and goal-directed regimen as opposed to a liberal-fluid regimen results in better outcomes after various major surgical procedures. The different ratio of body fluid distribution in pediatric patients from those of adults may influence different needs of fluid. METHODS: This stratified, randomized, controlled trial was conducted in 25 pediatric patients (mean age <3 years) undergoing major abdominal surgery. Patients were allocated to two groups based on their perioperative fluid management. 'control group' received maintenance plus deficit plus interstitial space replacement plus ongoing loss, whereas 'restrictive group' had a similar treatment, but were given no interstitial space replacement. Intraoperative fluid resuscitation was guided by hemodynamics and base excess. Parameters recorded included hemodynamic variables, the volume and type of intravenous fluid, blood chemistry (including lactate, base excess, and electrolyte), chest X-ray, body weight, complications, and return of bowel function. RESULTS: Patients in control group needed significantly less additional fluid for resuscitation compared to restrictive group (0.62 ± 3.51 ml · kg(-1) · h(-1) vs 5.04 ± 4.16 ml · kg(-1) · h(-1) ; P = 0.012). In restrictive group, heart rates were higher (P = 0.012) and base excess showed more negative results (P = 0.049). There were no differences between the groups in terms of the total volume requirement, postoperative kidney function, chest X-ray, variation of body weight and the postoperative outcomes. CONCLUSIONS: Volume preload corresponding with an estimated interstitial space replacement was suitable for application to pediatric patients undergoing major abdominal surgery.

Obesity, epidural analgesia, and subcostal incision are risk factors for postoperative desaturation.

PURPOSE: This study was designed to determine the incidence of oxygen desaturation after upper abdominal surgery during the first 48 hr on general surgical wards and also to identify risk factors for oxygen desaturation. METHODS: This descriptive study was conducted in 206 patients not expected to receive supplemental oxygen postoperatively who were undergoing upper abdominal surgery in a tertiary care university hospital. Desaturation was classified either as constant, i.e., oxygen saturation < 90% for > three minutes or < 85% once or as episodic, i.e., when oxygen saturation is decreased by > or = 5% below baseline for one to two minutes ten times or more during the night period. Possible risk factors were elderly patients (> 70 yr), obesity (body mass index [BMI] > 25 kg.m(-2)), smoking, surgical time > 180 min, postoperative pain control methods, intraoperative blood loss, and site of incision. RESULTS: Of the 206 patients enrolled, 171 were retained for analysis. Desaturation occurred in 65 patients (38%). Forty-eight of these had constant hypoxemia with nadir oxygen saturation values ranging from 71-89%. The remaining 17 patients experienced nocturnal episodic hypoxemia. After multivariate analysis, the three factors that correlated with postoperative desaturation were BMI > 25 (adjusted odds ratio [OR] 3.06; 95% confidence interval (CI) 1.38-6.79; P = 0.006), subcostal incision (OR 2.68; 95%CI 1.34-5.38; P = 0.005), and neuraxial opioids (OR 2.44; 95%CI 1.21-4.91; P = 0.013). CONCLUSION: Oxygen desaturation is common after upper abdominal surgery, and the risk factors are obesity, a subcostal incision, and neuraxial opioid administration.