Research on the efficacy of the rectus sheath block method.

OBJECTIVES: We aimed to retrospectively investigate the efficacy of ultrasound guided rectus sheath block (RSB) method in our study. METHODS: We scanned 235 patient files operated for abdominal pathology. Patients meeting the criteria were evaluated for intra-operative rectus sheath block and two different groups were formed. In these two groups of patients visual analogue scale (VAS) values recorded from the postoperative pain follow-up form and analgesic delivery (DEL) and analgesic demand (DEM) values recorded from patient controlled analgesia (PCA) device were compared. In addition, complaints of nausea, vomiting and constipation were evaluated. RESULTS: Postoperative VAS values (Postoperative 1, 12 and 24 hours p<0.001), DEM values (Postoperative 1, 12 and 24 hours p<0.001) and total amount of morphine consumed (Postoperative 1, 12 and 24 hours p<0.001) were lower in patients with RSB. Also, in patients with RSB nausea (p=0.014) and vomiting was less seen postoperatively (p=0.007). In the first 24 hours after surgery, constipation was seen in 8 patients with RSB and constipation was seen in 30 patients without RSB (p=0.00). CONCLUSION: Ultrasound guided rectus sheath block is an effective method for postoperative pain control.

Toma de medición intraabdominal a personas en estado crítico, por el profesional de enfermería / Taking measurement intraabdominal people in critical condition, by the nursing professional", "_e": "n

El aumento de la presión dentro de la cavidad abdominal se asocia a múltiples alteraciones fisiopatológicas, con una importante repercusión en aparatos y sistemas originando disfunción orgánica múltiple, lo que conlleva a un incremento en la morbimortalidad en pacientes en estado crítico, la medición de presión intraabdominal es un procedimiento que se está realizando con mayor frecuencia en las Unidades de Cuidados Intensivos, en donde los profesionales de enfermería tienen un papel muy importante en la toma e identificación de posibles complicaciones que ponen en riesgo la vida del paciente. La siguiente revisión tiene la finalidad de difundir el conocimiento y dar a conocer la importancia e intervenciones de enfermería en la medición de la presión intraabdominal.

The increase in the pressure inside the abdominal cavity is associated with multiple pathophysiological changes, with a significant impact in systems causing multiple organic dysfunction, leading to increased the morbidity and mortality in critically ill patients, the measurement of intra-abdominal pressure is a procedure that is being performed more frequently in the intensive care units, where nurses have an important role in taking and identifying possible complications that endanger the patient’s life. The following review has the purpose of disseminate knowledge and explain the importance and the nursing interventions in measuring intra-abdominal pressure.

Clinical outcomes of pediatric patients with acute abdominal pain and incidental findings of free intraperitoneal fluid on diagnostic imaging.

OBJECTIVES: The presence of free intraperitoneal fluid on diagnostic imaging (sonography or computed tomography [CT]) may indicate an acute inflammatory process in children with abdominal pain in a nontraumatic setting. Although clinical outcomes of pediatric trauma patients with free fluid on diagnostic examinations without evidence of solid-organ injury have been studied, similar studies in the absence of trauma are rare. Our objective was to study clinical outcomes of children with acute abdominal pain of nontraumatic etiology and free intraperitoneal fluid on diagnostic imaging (abdominal/pelvic sonography, CT, or both). METHODS: We conducted a retrospective review of medical records of children aged 0 to 18 years presenting to a pediatric emergency department with acute abdominal pain (nontraumatic) between April 2008 and March 2009. Patients with intraperitoneal free fluid on imaging were divided into 2 groups: group I, imaging suggestive of an intra-abdominal surgical condition such as appendicitis; and group II, no evidence of an acute surgical condition on imaging, including patients with equivocal studies. Computed tomograms and sonograms were reviewed by a board-certified radiologist, and the free fluid volume was quantitated. RESULTS: Of 1613 patients who underwent diagnostic imaging, 407 were eligible for the study; 134 (33%) had free fluid detected on diagnostic imaging. In patients with both sonography and CT, there was a significant correlation in the free fluid volume (r = 0.79; P < .0005). A significantly greater number of male patients with free fluid had a surgical condition identified on imaging (57.4% versus 25%; P < .001). Children with free fluid and an associated condition on imaging were more likely to have surgery (94.4% versus 6.3%; P < .001). CONCLUSIONS: We found clinical outcomes (surgical versus nonsurgical) to be most correlated with a surgical diagnosis on diagnostic imaging and not with the amount of fluid present.

Morphine analgesia in patients with acute appendicitis: a randomised double-blind clinical trial.

BACKGROUND: The administration of analgesics to patients with acute abdominal pain due to acute appendicitis is controversial. A study was undertaken to assess the analgesic effect of morphine in patients with acute appendicitis. METHODS: A randomised double-blind clinical trial was conducted in Sina hospital, a general teaching hospital, from January 2004 to March 2005. Patients scheduled for appendectomy were randomised to receive 0.1 mg/kg morphine sulfate or saline (0.9%) to a maximum dose of 10 mg over a 5 min period. Patients were examined by surgeons not involved in their care before and after drug administration and their pain intensity and signs were recorded at each visit. The physicians were also asked to indicate their own treatment plan. The main outcome measures were pain intensity using a visual analogue scale (VAS) and signs of acute appendicitis. A favourable reduction in VAS score was defined as a change of >13 mm. RESULTS: Of the 71 patients enrolled in the study, 35 were allocated to receive morphine and 36 to receive placebo. One patient left the hospital before receiving morphine. No significant differences were seen between the two groups with regard to age, sex and initial VAS score. A more favourable change in VAS score was reported in the morphine group with a significantly greater reduction in the median VAS score than in the placebo group. Morphine administration did not cause significant changes in patients' signs or in the physicians' plans or diagnoses. No adverse events were seen in either group. CONCLUSION: Morphine can reduce pain in patients with acute appendicitis without affecting diagnostic accuracy. TRIAL REGISTRATION NUMBER: NCT00477061.

Randomized clinical trial of morphine in acute abdominal pain.

STUDY OBJECTIVE: Administration of analgesia to patients with acute abdominal pain is controversial. We test the hypothesis that morphine given to emergency department (ED) patients with acute abdominal pain will reduce discomfort and improve clinically important diagnostic accuracy. METHODS: Pain was measured with a standard 0- to 100-mm visual analog scale. ED patients with acute abdominal pain were randomized in a double-blind fashion to 0.1 mg/kg intravenous morphine or placebo. The primary endpoint was the difference between the 2 study arms in clinically important diagnostic accuracy. Clinically important diagnostic accuracy was defined a priori by its complement, clinically important diagnostic error, using 2 independent, blinded investigators to identify any discordance between the provisional and final diagnoses that might adversely affect the patient's health status. The provisional diagnosis was provided by an ED attending physician, who examined the patient only once, 15 minutes after administration of the study agent. The final diagnosis was obtained through follow-up at least 6 weeks after the index ED visit. RESULTS: We randomized 160 patients, of whom 153 patients were available for analysis, 78 patients in the morphine group and 75 patients in the placebo group. Baseline features were similar in both groups, including initial median visual analog scale scores of 98 mm and 99 mm. The median decrease in visual analog scale score at 15 minutes was 33 mm in the morphine group and 2 mm in the placebo group. There were 11 instances of diagnostic discordance in each group, for a clinically important diagnostic accuracy of 86% (67/78) in the morphine group and 85% (64/75) in the placebo group. The difference in clinically important diagnostic accuracy between the 2 groups was 1% (95% confidence interval [CI] -11% to 12%). Analysis by efficacy and intention to treat yielded similar results. Kappa for interobserver concordance in classification of clinically important diagnostic accuracy was 0.94 (95% CI 0.79 to 1.00). No patients required naloxone. CONCLUSION: Although administration of intravenous morphine to adult ED patients with acute abdominal pain could lead to as much as a 12% difference in diagnostic accuracy, equally favoring opioid or placebo, our data are most consistent with the inference that morphine safely provides analgesia without impairing clinically important diagnostic accuracy.

[Abdominal sepsis in surgical patients. Pathophysiology and prevention]. / Sepsi addominali nel malato chirurgico. Fisiopatologia e prevenzione.

Abdominal sepsis is a rare but life threatening condition due to several causes. Although several advances in medicine have been performed in last years, abdominal sepsis could have a negative potential evolving beyond exitus. The authors present a review of the literature and a commentary of their own clinical experience.

Acute abdominal emergencies during the first four weeks after spinal cord injury.

Diagnosing acute abdominal emergencies during spinal shock can be extremely difficult. Generally, the abdominal examination of an acutely cord-injured patient will not change with abdominal pathology. Loss of sensory, motor, and reflex functions mask typical signs. Nine hundred and forty-five medical charts were retrospectively examined to determine the incidence, causes, and risk factors for acute abdominal pathology during the first four weeks after spinal cord injury. Time of greatest risk was also investigated. Intraabdominal pathology was seen in 4.7% of the cases. Patients with complete cord lesions above the T5 level were most at risk. Respiratory distress was an additional risk factor for peptic ulcer disease. Decadron was found to be associated with pancreatitis but not with ulcers. Both pancreatitis and upper gastrointestinal hemorrhage appeared as early as three days postinjury. Findings of this study, as well as an understanding of the pathophysiology, symptomatology, and proper diagnostic workup assist in making the critical diagnosis.