RESUMEN
In hand surgery, ever since continuous at-home postoperative analgesia (CPA) was implemented, procedures which cause pain for more than 24h can now be performed in ambulatory surgery. The aim of our work was to study the feasibility of CPA. Our series comprised 40 patients with a mean age of 50 years. Twenty-four patients had an ASA score of 1 and 16 patients had an ASA score of 2. Indications were osteoarthritis and rheumatoid diseases. Three steps were involved: preoperative (patient screening and information), peroperative (placement of a peripheral nerve catheter through an axillary approach using an elastomeric device) and postoperative (at-home patient care provided by visiting nurses). Evaluation was rated using a CPA score (0 to 10) based on analgesia quality and network organization data. The global CPA score was 1.85. The quality of analgesia (2.6) scored less than the quality of organization (1.1). In the case of analgesia, sleep obtained the lowest score, followed by pain, and lastly, unwanted events. As far as organization was concerned, the network obtained the lowest score, followed by patient satisfaction, and lastly, patient information. Problems were encountered due to insufficient nurse training, analgesia failures, as well as unwanted events related to the oral antalgic treatment. However, technical success was almost always achieved. Our results show that the indications for ambulatory surgery could be extended and hospital-private practice networks be further developed. CPA appears to be a promising technique for analgesia and ambulatory surgery.
Asunto(s)
Analgesia/métodos , Mano/cirugía , Terapia de Infusión a Domicilio/métodos , Bloqueo Nervioso/métodos , Dolor Postoperatorio/tratamiento farmacológico , Cuidados Posoperatorios/métodos , Adulto , Anciano , Amidas/uso terapéutico , Analgesia/instrumentación , Analgesia/psicología , Anestésicos Locales/uso terapéutico , Artritis/cirugía , Catéteres de Permanencia , Enfermería en Salud Comunitaria/educación , Enfermería en Salud Comunitaria/métodos , Estudios de Factibilidad , Francia , Terapia de Infusión a Domicilio/instrumentación , Terapia de Infusión a Domicilio/psicología , Humanos , Persona de Mediana Edad , Bloqueo Nervioso/instrumentación , Bloqueo Nervioso/psicología , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Cuidados Posoperatorios/instrumentación , Cuidados Posoperatorios/psicología , RopivacaínaRESUMEN
OBJECTIVE: To determine the level of satisfaction in terms of pain relief and comfort among patients receiving different postoperative analgesia protocols after hand surgery under regional anaesthesia in a day care unit. METHODS: Cohort study among patients after hand surgery under regional anaesthesia during two consecutive three months time periods, with patient stratification according to the expected pain level with different balanced analgesia protocols (group A: carpal tunnel, group B: other surgery without bone involvement, group C: bone surgery). A telephone survey, scoring analgesia and comfort, each with a numerical (0-10) scale was conducted on days 1 and 7. During the first period analgesia for groups A and B was the same (acetaminophen-dextropropoxyphene or acetaminophen-codeine) and group C patients were treated with acetaminophen-ketoprofen-tramadol. In the second period analgesia was reduced for group A (acetaminophen alone) and increased for group B (acetaminophen-ketoprofen-tramadol) and group C (duration increased from 3 to 7 days). RESULTS: For carpal tunnel surgery, analgesia with acetaminophen alone was efficient, (Pain scale [PS] d0=2[0-10], PS d1=1 [0-10] and PS d2-d4=0,5 [0-10]). This surgery does not elicit important pain, there is no benefit in adding other analgesics. For group B, a significant improvement in postoperative pain was observed (postoperative d1 p<0.03) with a major increase in side effects (2/57 vs 17/48 p<0.001). For group C, therapeutic changes were ineffective (PS d0=2 vs 3.5 et PS d1=3 vs 5 [NS]) and we noticed an increase in side effects (p<0.05). One third of all patients are totally satisfied on day 7, logistic regression showing the role of inefficient analgesia in late postoperative period (PS>2 between d2-d4). Between day 1 and day 7, 20% of the patients change their point of view, those who feel less satisfied on day 7 complained of a more severe postoperative pain between day 2 and 4 (p<0.001) and between day 5-7 (p<0.01). CONCLUSION: For hand surgery on day case, quality of late postoperative analgesia (day 2-day 7) is strongly related to patient's satisfaction on day 7.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/uso terapéutico , Mano/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Satisfacción del Paciente , Acetaminofén/administración & dosificación , Acetaminofén/uso terapéutico , Adulto , Anciano , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Anestesia Local , Síndrome del Túnel Carpiano/cirugía , Codeína/administración & dosificación , Codeína/uso terapéutico , Estudios de Cohortes , Dextropropoxifeno/administración & dosificación , Dextropropoxifeno/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Cetoprofeno/administración & dosificación , Cetoprofeno/uso terapéutico , Masculino , Persona de Mediana Edad , Periostio/cirugía , Garantía de la Calidad de Atención de Salud , Factores de Tiempo , Tramadol/administración & dosificación , Tramadol/uso terapéuticoRESUMEN
OBJECTIVES: This study was designed to assess patient satisfaction after regional anaesthesia for limb surgery. METHODS: An anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient) and submitted to 314 patients operated in two institutions (one university hospital with anaesthesiology residents and one specialised in orthopaedics with experienced anaesthesiologists). Items explored were information modalities, pain and anxiety during procedure and global satisfaction rated with four levels (very satisfied [VS], satisfied [S], partially satisfied [PS], non-satisfied [NS]). Patients were interviewed by telephone at postoperative D1 and D8 by a pharmacist student not involved in the patient's care. RESULTS: Inspite of a high level of patient satisfaction at D8 (VS: 50%, S: 44%), some interesting aspects should be emphasised: a) sedation given before nerve block was not efficient to reduce anxiety and pain during procedure; b) VS levels decreased from D1 (56%) to D8 (50%) mainly because of late postoperative pain (after discharge) and discomforts; c) willingness to undergo the same nerve block again (294/314) was not correlated with patient's satisfaction since among PS and NS patients, a majority (9/15) wished for a block in case of renewed limb surgery; d) multivariate analysis showed that VS level was highly correlated with the quality of communication by the anaesthesiologist mainly for informations about pre and postoperative periods. No correlation was found with pain level during procedure; e) satisfaction levels were not different in the two institutions. CONCLUSION: This study has emphasised some important factors of patient satisfaction which were not sufficiently taken into account in our daily practice.
Asunto(s)
Anestesia de Conducción , Satisfacción del Paciente , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Ansiedad/epidemiología , Ansiedad/psicología , Extremidades/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bloqueo Nervioso , Procedimientos Ortopédicos , Dolor Postoperatorio/epidemiología , Dolor Postoperatorio/psicología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , TeléfonoAsunto(s)
Proteínas Sanguíneas/metabolismo , Lesiones Encefálicas/sangre , Hidroxibutiratos/farmacología , Fenobarbital/farmacología , Oxibato de Sodio/farmacología , Adolescente , Adulto , Anciano , Lesiones Encefálicas/enzimología , Femenino , Humanos , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
During experimental utilization on the dog (per os) of several types of materials capable to be modified by the liver after digestive absorption, sugars appeared naturally opaques in the gastric cavity and so they could substitute in C.T. to the habitual materials of contrast, we also notice some belated modifications on intra hepatic density that might be in relation with the metabolism of intra hepatic glucose.
Asunto(s)
Metabolismo de los Hidratos de Carbono , Tomografía Computarizada por Rayos X/métodos , Animales , Carbohidratos , Perros , Glucosa/metabolismo , Hígado/diagnóstico por imagen , Hígado/metabolismo , Estómago/diagnóstico por imagen , Factores de Tiempo , Tomografía Computarizada por Rayos X/veterinariaRESUMEN
Naloxone was used in 20 patients divided into two series: series A consisted of 10 adults with an average age of 50.6 years (+/- 12.03) and series B 10 children with an average age of 8.5 years (+/- 5.16). Naloxone was given in the treatment of postoperative respiratory depression related to persistence of morphine impregnation, the patients having received either fentanyl (mean dose 0.04 mg/kg/h) or dextromoramide (mean dose 1.15 mg/kg/h). The mean dose of naloxone was 0.26 mg +/- 0.10, i.e. 3.9 microgram/kg in series A, and 0.13 mg +/- 0.11, i.e. 5.3 microgram/kg in series B. In both series, study of ventilatory function showed correction and stabilisation of the various parameters (F/min, Vt and V) up to 180 minutes after the injection. Recovery was rapid in both groups (7 to 10 min) and of good quality. Whilst it was accompanied in a number of cases by the recurrence of pain, the latter never required specific relief. The administration of naloxone was associated with an increase in heart rate (non-significant) at 10 min in series A and 30 min in series B. Apart an episode of nausea in one case of series A, no disagreeable side effects were observed.