Articles: acute-pain.
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Paediatric anaesthesia · Nov 2017
A prospective audit of pain profiles following general and urological surgery in children.
Postoperative pain is frequently undertreated in children both in hospital and at home following discharge. Pain has both short- and long-term consequences for children, their families, and the healthcare system. A greater understanding of procedure-specific postoperative pain trajectories is required to improve pain management. ⋯ Pain management was inadequate in most of the groups studied, particularly after appendicectomy or umbilical hernia repair, with most children experiencing at least moderate pain on the day of and day after surgery. There was a need for a standardized management, with increased dual analgesia prescribing, to ensure that children receive adequate postoperative analgesia in hospital and at home.
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Significant age- and experience-dependent remodelling of spinal and supraspinal neural networks occur, resulting in altered pain responses in early life. In adults, endogenous opioid peptide and endocannabinoid (ECs) pain control systems exist which modify pain responses, but the role they play in acute responses to pain and postnatal neurodevelopment is unknown. Here, we have studied the changing role of the ECs in the brainstem nuclei essential for the control of nociception from birth to adulthood in both rats and humans. ⋯ The expression patterns and levels of ECs enzymes and receptors were assessed using quantitative PCR and immunohistochemistry. In human brainstem, we show age-related alterations in the expression of key enzymes and receptors involved in ECs function using PCR and in situ hybridisation. These data reveal that significant changes on ECs that to this point have been unknown and which shed new light into the complex neurochemical changes that permit normal, mature responses to pain.
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Ulus Travma Acil Cer · Nov 2017
Computed tomography findings of primary epiploic appendagitis as an easily misdiagnosed entity: Case series and review of literature.
Primer epiploic appendagitis (PEA) is an uncommon condition. ⋯ Although it has no characteristic clinical and laboratory features, CT is the best modality for accurate diagnosis of PEA.
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Chronic post-thoracotomy pain (CPP) has a high incidence. However, less is known about risk factors and the influence of different analgesia therapies. ⋯ Preoperative thoracic pain and higher pain scores in the first five postoperative days seem to be the strongest risk factors for the development of CPP. CPP patients reported poorer mental and physical health before and six months after surgery.
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Although acute pain is a common presentation in the Emergency Department (ED), analgesics are often delayed until the patient is seen by a physician. We assessed the effect of a medical directive for nurse-initiated analgesia on time to first dose of analgesics, proportion of patients receiving analgesics in less than 30min, and total length of stay in the ED. ⋯ A medical directive for nurse-initiated analgesia in the ED was associated with significantly reduced time to the first dose of analgesic, and increased the proportion of patients receiving analgesics within 30min. We can conclude that medical directives for nurse-initiated analgesia effectively improve the timeliness and quality of care for patients with acute pain.