AANA journal
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Randomized Controlled Trial Comparative Study
A comparison of the pain perceived during intravenous catheter insertion after injection with various local anesthetics.
This study compared 4 local anesthetics, 1% lidocaine, 1% lidocaine with sodium bicarbonate, 2% chloroprocaine, and 0.5% bupivacaine, in a double-blinded manner for pain on intradermal injection and pain during subsequent intravenous (IV) cannulation with an 18-gauge catheter. The subjects rated their pain, using 100-mm visual analog scales, related to the local injection itself and again after the IV catheter was inserted. No statistical differences were noted in pain scores after the injection of the local anesthetic (P = . 134) or on insertion of the IV catheter itself (P = .394). ⋯ We found that there were no differences in pain produced by 1% lidocaine, 1% lidocaine with sodium bicarbonate, 2% chloroprocaine, and 0.5% bupivacaine during intradermal injection. There were also no differences in pain produced by an 18-gauge IV catheter being inserted after administration of any of these local anesthetics. Thus, any of these 4 local anesthetics may be used, and the choice may be based on other factors such as price and convenience.
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Randomized Controlled Trial
Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.
There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. ⋯ Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer.
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As part of a 5-year study funded by the National Cancer Institute, all graduate nursing students, including student registered nurse anesthetists (SRNAs) participated in a 2-credit-hour course called Interdisciplinary Palliative Care. Medical and health science students also participated in the course, with more than 800 students completing the course to date. The sample consisted of 62 master's-level students enrolled in either the first or second year of the nurse anesthesia program. ⋯ There was an overall improvement in knowledge and attitudes related to course content. Students reported that, through the development of new knowledge, they felt better able to care for and advocate for their patients. Further research is needed into the appropriate roles that Certified Registered Nurse Anesthetists (CRNAs) can play in palliative and end-of-life care.
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Ellagic acid (EA), a dietary supplement, is purported to have anti-inflammatory, antinociceptive properties via cyclooxygenase (COX) inhibition. We measured the antinociceptive efficacy of EA alone and in combination with a nonselective COX inhibitor and a selective COX-2 inhibitor. We assigned 54 male Sprague-Dawley rats to 1 of 6 groups to be given the following compounds: (1) vehicle, (2) ketorolac (nonselective COX inhibitor), (3) meloxicam (selective COX-2 inhibitor), (4) EA, (5) EA plus ketorolac, and (6) EA plus meloxicam. ⋯ The analysis of variance suggested a significant difference (F = 2.44; P = .048). The least significant difference post hoc analysis suggested that at 8 hours, EA plus ketorolac provided greater antinociception than all other compounds (P = .04). Furthermore the combination of EA plus ketorolac provided longer antinociception than all other compounds (P = .03) such that EA plus ketorolac was effective at 24 hours.
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Randomized Controlled Trial
Perioperative administration of gabapentin for shoulder arthroscopy: a prospective, randomized, double-blind, placebo-controlled study.
Recent studies suggest gabapentin has opioid-sparing effects and may reduce acute postoperative pain. However, there is limited research on the efficacy of gabapentin when combined in a multimodal approach after shoulder arthroscopy under general anesthesia with an interscalene block. We conducted prospective, double-blind study of 70 patients who were randomized to receive either 300 mg of gabapentin or placebo 1 hour before surgery, then twice a day for 2 days. ⋯ Total morphine equivalents on day 1 (gabapentin, 9.75 mg [6.58 mg], vs placebo, 9.52 mg [4.75 mg]; P = .88) and day 2 (gabapentin, 9.21 mg [6.66 mg], vs placebo, 6.93 mg [5.44 mg]; P = .17) were similar. Adverse effects and sleep patterns were similar (P > .05). These results suggest this dosing regimen of gabapentin is not efficacious in improving outcomes in patients undergoing shoulder arthroscopy under general anesthesia with an interscalene block.