INCIDENCE OF HYPOTENSION AND ASSOCIATED-RISK FACTORS IN EPIDURAL ANESTHESIA WITH 2% LIDOCAINE AND EPINEPHRINE DURING ELECTIVE CESAREAN SECTION, EFFICACY AND SAFETY ASSESSMENT
Background: Cesarean section is a worldwide common surgery that requires anesthetic techniques. Many local anesthetics are being now used, but are associated with, dose- dependent and at different level, some side effects including toxicity. Hypotension was described as the first and threat side effect associated to neuraxial techniques. Despite many preventive strategies, it continues to challenge anesthesia providers around the world. Lidocaine was found to be less toxic compared with others commonly used and has been recommended for anesthesia procedures requiring large dose of local anesthetic including epidural anesthesia. The main purpose of this research was to determine the incidence of hypotension and identify the possible risk factors associated with it and thus, assess the efficacy and safety when lidocaine is applied together with epinephrine, in epidural anesthesia for elective cesarean delivery. Materials and methods: This retrospective observational institutional-based study, recruited 612 parturients who underwent elective cesarean section under epidural anesthesia with 2% lidocaine and 1/200000 epinephrine, at 1st affiliated hospital of Chongqing Medical University in 2019. Exclusion criteria included any contraindication to elective cesarean section delivery, general anesthesia, baseline systolic blood pressure < 100mmh and > 140 mm hg, gestational age < 37 weeks and > 42 weeks etc. SPSS 26.0 version and different appropriated tests were used for statistical analysis. P value < 0.05 was accepted as statistically significant. Results: The hypotension incidence was 13.2%, and identified factors associated with it were Baseline Systolic Blood Pressure < 120mmhg, gestational age < 40 weeks, maternal body weight ≤ 60 kg and duration of cesarean delivery (surgery) > 45 minutes. Conclusion: The variables in correlation with increased hypotension rate are baseline systolic blood pressure, gestational age, maternal weight, and surgery duration. 2%Lidocaine with epinephrine as adjuvant presented best outcomes towards both mother and neonates, was therefore efficacy and safe under…
COMPARATIVE STUDY ULTRASOUND GUIDED ABDOMINAL FIELD BLOCKS VERSUS PORT INFILTRATION IN LAPAROSCOPIC CHOLECYSTECTOMIES FOR POST-OPERATIVE PAIN RELIEF
Background and Aims: Effective post‑operative analgesia after laparoscopic cholecystectomy is important because it facilitates early amelioration, ambulation and short hospital stay. Aim: To compare the postoperative analgesic efficacy of ultrasound guided abdominal field blocks with port site infiltration with ropivacaine in laparoscopic cholecystectomy. Methods: An observational study was conducted in the Postgraduate Department of Anaesthesiology and Critical Care Medicine in collaboration with the Department of General Surgery, Government Medical College, Srinagar from October 2017 – December 2018. Patients were randomised into two groups to receive either local anaesthetic infiltration of the laparoscopy port sites (n = 40, Group A/standard group) and USAFBs (n = 40, Group B/study group) using a total dose of 30 ml of ropivacaine 0.2% with sterile technique. Randomisation was done by flipping of coin method. The primary objective was to measure magnitude of pain in first 24 hours using numeric rating scores (NRS). To estimate opioid consumption in first 24 hours postoperatively. To assess the quality of pain relief and patient satisfaction on a four point Patient satisfaction scale. Statistical analysis was done using SPSS version 21. Data were compared using the Chi‑square test and students’ t‑test. Results: Duration of analgesia was significantly longer in Group B than group A. Upon inter group comparison of A vs. B the results were statistically significant (p value
The ganglion Impar is an unpaired sympathetic structure located at the level of the Sacrococcygeal joint. The modified technique replaced the previously using technique of the Impar block via the horizontal approach through the anococcygeal ligament. Modified technique of Ganglion Impar block through transsacroccygeal approach is easy to perform and give maximum pain relief with margin of safety. Aims and objectives To study, 1) Ease and complications of Impar block through trans- sacrococcygeal approach 2) The analgesic efficacy of Impar block, 3) Duration of analgesic effect of Impar block Method In this retrospective study,15 patients who had chronic perineal pain had given ganglion Impar block.., The ganglion Impar block was given through trans-sacrococcygeal approach, After written and informed consent, patient was asked to lie down on his abdomen, facing down with a pillow under the pelvis to help flatten out the lower lumber spine’s natural curvature. Skin was infiltrate with local anaesthetic, after proper aseptic precautions. The needle is advanced under fluoroscopy guidance until correct needle placement is obtained. Once position is confirmed, therapeutic block is performed with administration of 2ml of 100% absolute alcohol after confirming 50% reduction in VAS from baseline with diagnostic block (0.125% Bupivacaine 5 ml). Attempts of procedure were recorded in all patients. VAS was assessed after 12 and 24 hours. Patients were discharged after 24 hours, asked to report every week and whenever VAS is more than 4 for 3 months Result Fifteen patients with advanced cancer with perineal pain who were not responding to pharmacotherapy treatment received a neurolytic ganglion Impar block through trans-sacrococcygeal approach. Thirteen Patients were not needed any medication. Two patients were needed Tab Morphine after 2 weeks of block. All the blocks were effective without any adverse events. All the patients had significant pain relief during 3 months follow…
Introduction The project of valorization of the workers of the Municipal Health Secretariat of the city of Messias brings as priority the worker health of the community health agent and of endemics. The project was created according to the reports of the professional daily target audience during conversation rounds, which shared the need for a broader attention to the working and health conditions of the category. Thus, strategies were created aiming at actions involving the continuous care line, including health education, promotion and prevention. The actions are carried out with a multiprofessional Primary Care team, Family Health Support Center and specialized service actions involving integral, individual and collective care. Objectives To promote and prevent health education, seeking to improve physical, psychological and social aspects and strengthen the professional bond. Methodology The project is a descriptive study with a cross-sectional quali-quantitative approach. An individual assessment was performed based on the WHOQOL-bref questionnaire with some adaptations by the Family Health Support Center team. This questionnaire will be reapplied and analyzed every four months for reevaluation with the multiprofessional team to continue the care of each member of the group. The meetings are held monthly and according to the need of the community. Results Improve interaction, cooperation, rapprochement and flexibility in the category of Community Health and Endemic Agents and with other professionals, thus awakening to health care. Conclusion As a permanent project, continuous and having started this year, it has been possible to observe several reports and shared evaluations since the last monthly meeting where there was an improvement in the team relationship and acceptance of self-care. In contact with other professional categories of primary care, it can be seen in daily living, the enthusiasm of community health agents to participate in the project.
Introduction: Neuralgia is a pain that stretches along the path of a nerve. As regions of the head and neck are more affected places and a trigeminal neuralgia is more common among facial neuralgias. Objective: To review the literature on the concept, diagnosis and treatment of trigeminal neuralgia. Methodology: An integrated review was carried out in the MEDLINE, LILACS and SCIELO Virtual Library databases, using the following documents: Neuragia and Trigêmeio. The results of the research were published in all cases, in Portuguese, Portuguese and Portuguese. Results and Discussion: The search resulted in 6,205 articles, these, 30 were separated by amount of subject matter, however, only Nine meeting the inclusion criteria. A trigeminal neuralgia belongs to the group of chronic pain conditions and is classified as primary and secondary. It has a predominance of females, between 50 and 70 years of age and almost always is unilateral. Pain is characterized as paroxysmal, acute, superficial, triggered by the estimation of trigger zones, most of the life born and the skin of the middle region of the face. The patient may present hyposthesia or paraesthesia of a certain area and paralysis of one or more masticatory muscles. The diagnosis is clinical, as well as complementary tests in cases of neuropathic pain. The initial treatment is done by non-invasive methods, with the use of carbamazepine medicines. It can be surgically tested, which is success in 70 and 85% of cases. Conclusion: The articles presented, of facial neuralgias, one that is a bit slower and more common. It has a variable and prolonged clinical course regarding the frequency and intensity of pain. The treatment can be medicated or surgical.
Introduction: Cervical cancer is the second most frequent neoplasm in the female population. Among its range of symptoms, pain is one of the most exceeded. Total pain is a set of physical, psychic, social, and spiritual problems that may be present at any time of illness. More precisely in cervical neoplasia in young patients, this type of pain may be present due to falling ill in the productive phase. Objective: to discuss the presence of total pain in patients with uterine cervix cancer in palliative care. Methodology: This is an integrative review of the literature. The LILACS and SciELO databases were used. The following descriptors were used: Cancer pain; Nursing care and cervical neoplasias. From this, 45 articles were found. Contextualizing the inclusion criteria, which were: available text, language in Portuguese and year of publication from 2011 to 2016, 18 articles emerged. With the reading, it was noticed that 10 of these met the objective of the research. Results and Discussion: It was verified that all articles bring the definition of pain according to the National Association for the Study of Pain, in which it is a sensitive and emotional experience, which may be associated with actual or potential tissue damage. 40% demonstrate that poor pain relief is a reality for many patients. Already 30% report that the tendency to focus only on the physical aspect of pain and to exclude the other components is a great obstacle to the management of pain in palliative care. Conclusion: Total pain in patients in palliative care is influenced by several factors, necessitating a multidimensional approach. It has been realized that it is not possible to control physical pain, nor any other symptom, without the simultaneous control of all other aspects that cause suffering to patients.
Introduction: According to the International Association for the Study of Pain (IASP), pain is an unpleasant sensation or emotional experience associated with actual or potential tissue damage.1 Furthermore, pain involves psychological and social factors, so it is a multidimensional, complex, subjective and perceptive phenomenon. Pain in chronic wounds is a concern for both the patient and the health care team. This is a complex approach and requires a multidisciplinary approach. Objective: To describe the experience of a resident nurse within the multidisciplinary team in the care of patients with chronic wounds. Methodology: This is an experience report of a resident nurse during the care of patients with impaired skin integrity at the university hospital of Aracaju. The nurse worked with a multiprofessional team, consisting of psychologist, physiotherapist, speech therapist, nutritionist, pharmacist, social worker and dentist. Results and Discussion: Several approaches were used in the treatment, to mention: adequacy of technique and coverage in dressings, intensification of decubitus changes and movement in bedridden patients, besides the execution, adequacy and orientation of basic human needs. Interventions with the medical team consisted of a crucial and difficult point for the improvement of the pharmacological management of pain. In addition, daily humanization has become a key element in the best response to the treatment and its consequences. Thinking about the patient as a biopsychosocial and spiritual being, we use specialized psychological support, interventions that encompass social issues, involvement of religious beliefs when recognized as a comfort point in the suffering process, and music therapy during multidisciplinary care. Conclusion: The developed activities promoted better results in pain management and evidenced the importance of the performance of the multiprofessional team as a determinant for this improvement. In addition to exposing the best model of approach and humanization to the patient and family.
Introduction: Population aging is now a global event, determining greater growth of the elderly population in relation to the other age groups. The hearing loss due to aging is known as presbycusis, characterized by bilaterally decreased auditory acuity, generally for high frequency sounds, due to degenerative and physiological changes in the auditory system that have arisen with increasing age. Studies have shown that chronic diseases affecting the elderly may be related to hearing disorders. Among these diseases, the most frequent are diabetes mellitus and hypertension. Objective To describe the hearing loss of elderly patients with diabetes mellitus (DM) and systemic arterial hypertension (SAH) from a bibliographic survey. Methodology: This is a bibliographic review research carried out in the SciELO database. Inclusion criteria were: complete scientific papers published in the Portuguese language, published in the period from 2011 to 2015,that present in the title some of the descriptors: elderly, diabetes mellitus, systemic arterial hypertension. Results and Discussion: We found 27 articles, of which 7 were selected for the review, since the others did not present data relevant to the research, were duplicated and did not fit the other inclusion criteria. According to the research, drastic changes were observed when comparing the elderly living with DM and SAH with those without chronic diseases, also showing an adverse effect on the cochlea, resulting in the loss of hair cells that, through mechanotransition, detect the sounds. Conclusion: It can be observed that the elderly with DM and SAH presented higher hearing loss of high frequency neurosensory when compared to groups without these chronic diseases, suggesting a synergistic effect of the medications to treat the pathologies.
Introduction: The oncology has been developing rapidly and the pharmacist’s main challenge is to be up-to-date with new studies about the subject. Palliative care is involved in the protection and responsibility for the patient’s well-being. This area requires a multidisciplinary team that cares for patients suffering from serious diseases, even if there is a possibility of cure. The purpose of pharmaceutical care is to analyze prescriptions, check drug interactions, dosages and side effects. Objetive: To identify the importance of the pharmacist in the palliative care of cancer patients. Methodology: Review of published researches from 2010 to 2017 in the Google Scholar, Scielo and Bireme databases, using the descriptors pharmaceutical care and Palliative Care. Results and Discussion: The pharmacist can intervene in therapy to reduce symptoms, as often the medications may be responsible for some of these symptoms. It can also check if the therapy can be well tolerated if it is being uncomfortable for the patient to receive a particular drug or suggest to the doctor in charge to replace a drug of unpleasant taste, for example. Pharmaceutical care in palliative care is focused on informing the health team about the availability of medicines, regarding pharmacotechnical possibilities and legal aspects, as well as patients and their families, about the correct use and storage of medicines. Conclusion: The presence of the pharmacist in palliative care is extremely important both in the patient’s medical treatment and in ensuring the necessary comfort to the patient and the promotion of health in general.