O presente estudo, realizado de maneira prospectiva, comparativa, aleatória e duplamente cega, avaliou a eficácia analgésica da utilização de 15, 25 e 35 mg/kg de dipirona sódica para obtenção de analgesia no período pós-operatório de cadelas submetidas à ovariosalpingohisterectomia e comparadas ao placebo, por meio de parâmetros objetivos (FC, FR, presssão arterial, dosagem plasmática de epinefrina e norepinefrina e sérica de cortisol) e subjetivos (escalas de avaliação da dor). Com base nos resultados obtidos, pôde-se concluir que a dipirona sódica na dosagem de 15 mg/kg não mostrou diferença analgésica do placebo e as dosagens de 25 e 35 mg/kg são igualmente eficazes para obtenção de analgesia pós-operatória de boa qualidade. / This prospective, comparative, randomized and double-blinded study aimed to compare 15, 25 and 35mg/kg of dipyrone for analgesia during ovariohysterectomy post-operative period to placebo by using objective (HR, RR, BP, plasma catecholamines and serum cortisol) and subjective (pain scales) parameters. So, it could be concluded that 15 mg/kg of dipyrone didn`t show statistically significant difference from placebo and 25 and 35 mg/kg of dipyrone can offer equally good quality of post operative analgesia in bitches submitted to ovariohysterectomy.

A utilização de anti-inflamatórios nao esteroidais previamente a atendimentos de urgência odontológica vem sendo estudada com a finalidade de proporcionar maior conforto pos-operatório ao paciente. Visando avaliar a influência de um antiinflamatório nao esteroidal administrado previamente ao procedimento endodôntico de urgência em pulpites irreversíveis, sobre a dor e sobre a quantidade de medicação consumida no pós-operatório, foi utilizado o cetorolaco de trometamina 10mg sublingual 1 hora antes do procedimento. Também foi avaliada a influência desta droga sobre a quantidade de anestésico necessária para o acesso indolor a câmara pulpar e sobre a diminuição da dor durante a espera pelo atendimento. Como em todo atendimento de urgencia em dentes com pulpite irreversivel e utilizado uma medicação intracanal a base de corticosteróide associado a antibióticos, propos-se avaliar a real necessidade da presenca do antibiotico no curativo de demora, comparando a medicação mais usada (OtosporinR) com hidrocortisona. Participaram da pesquisa 39 pacientes que procuraram o Setor de Urgência Odontológica da Faculdade de Odontologia de Bauru ou o Setor Odontologico do Pronto Socorro Central da Prefeitura Municipal de Bauru. Foram divididos em 4 grupos que receberam cetorolaco de trometamina ou placebo como medicação pós-operatória e OtorporinR ou hidrocortisona como medicação intracanal. Foram anotados os valores de intensidade de dor, em uma escala visual analógica, antes da medicação pré-operatória, antes do atendimento, após o atendimento e 1, 2, 4, 12, 24, 48 horas apos. Também foi anotada a quantidade de anestésico utilizado, o tempo de procedimento, o tempo de duração da anestesia e a quantidade de cetorolaco de trometamina e medicação socorro (paracetamol 750mg) consumida pelo paciente no pós-operatório. Dos resultados obtidos observou-se que os pacientes que receberam cetorolaco de trometamina como medicação pré-operatória tiveram uma redução da dor entre 52% e 73% no intervalo de espera para o atendimento e nos pacientes que tomaram placebo essa redução foi de 28% a 32%. Na dor pós-operatória nao houve diferença significativa entre os grupos em nenhum momento, porem o grupo que recebeu placebo pré-operatório e hidrocortisona como curativo de demora apresentou uma tendencia de intensidade de dor pós-operatória maior. A mesma tendência pode ser vista no consumo de medicação pós-operatória. A quantidade de anestésico utilizada e o tempo de procedimento nao sofreram influência da medicação pré-operatória, pois não houve diferença significativa entre os grupos. A avaliação da importância da medicação intracanal sobre a intensidade da dor pós-operatória foi realizada nos grupos que receberam placebo como medicação pré-operatória e nao se observou diferença significativa entre os diferentes curativos de demora. Com base nos resultados, conclui-se que o cetorolaco de trometamina diminuiu expressivamente o nivel de dor, durante a espera pelo atendimento, porém, não influenciou a intensidade da dor e o consumo de medicamentos pós-operatório, assim como não alterou a eficácia da anestesia para o procedimento de urgência em pulpite irreversivel. A presença do antibiótico na medicação intracanal não interferiu na dor pós-operatória. / The use of nonsteroidal anti-inflammatory drugs before emergency dental treatment has been studied with the purpose to provide higher postoperative comfort to the patient. The objective of this study was to evaluate the influence of ketorolac tromethamine (10mg sublingual, taken 1 hour previously the emergency endodontic proceeding of irreversible pulpitis) in pain reduction and in the postoperative consumption of analgesic drugs. It was also analyzed the influence of this drug upon the amount of anesthetic necessary to the painless access into pulpal chamber and the pain reduction while waiting the appointment. Because an intracanal medication containing corticoid in combination with antibiotics is applied in teeth with irreversible pulpitis in every emergency treatment, it was proposed to evaluate the real necessity of the antibiotic in this intracanal medication, comparing the most popular medicine, OtosporinR, with hydrocortisone alone, in the same concentration present in this medicine. A total of 39 patients who presented either to Dental Urgency Sector from Dental School of Bauru (USP) or Emergency Dental Sector from Bauru City Hall were invited to participate. They were distributed in 4 groups that received either ketorolac tromethamine or placebo pretreatment and either OtosporinR or hydrocortisone alone as intracanal medication. It was noted the rates of pain intensity by means of a visual analogue scale, before the pretreatment medication, immediately before the appointment and 1, 2, 4, 12, 24 and 48 hours after the appointment. It was also recorded the amount of anesthetic used, the duration of proceeding, the time length of the anesthetic effect and the amount of ketorolac tromethamine and rescue medication (paracetamol 750mg) consumed by the patient at postoperative time. The patients who received ketorolac tromethamine as preoperative medication had a pain reduction between 52% and 73% during the waiting time for appointment and the patients who received placebo had a reduction between 28% and 32%. There was none statistically significant difference between the 4 groups with respect to the postoperative pain relief, in all the times analyzed. However, the group that received placebo before the appointment and hydrocortisone alone as intracanal medication showed higher pain intensity tendency as showed by the higher consumption of postoperative medication. The preoperative medication does not significantly influences the amount of anesthetic used and the duration of proceeding in all the groups. The efficacy of intracanal medication over postoperative pain intensity may be established in the groups who received placebo as preoperative medication and our results showed none statistically significant differences between them. The results of the present study indicate that ketorolac tromethamine does not affect the postoperative pain intensity, postoperative analgesic drugs consumption, and does not modify the effectiveness of the local anesthetic solution used for the emergency proceeding in teeth with irreversible pulpitis. However, it was very effective in reducing pain during the waiting time. With regard to the presence of antibiotic in the intracanal medication, our results indicate that it does not show any additional action to reduce postoperative pain.

No description available.

The aim of this study was to elucidate day surgery patients´ subjective experiences of postoperative pain after orthopedic and abdominal surgery and if there was any difference in the experience according to sex and age. Selection was not random and the study included 87 patients. Data were collected from patient questionnaires. VAS method was applied in the questionnaire to measure patients´ pain. The outcomes of the study show that there was no significant difference between women´s and men´s experiences of pain during days 1-7. It was found that patients undergoing orthopedic surgery had significantly more pain on day 7 compared to those patients who underwent abdominal surgery. There was a significant negative correlation between age and perceived pain on day 7. Patients in day surgery group had significantly less pain on day 7 compared with day 1. The patients who have undergone orthopedic surgery and younger patients had more pain on day 7 while the patients in day surgery group had a pain level decreased gradually and on day 7 was the lowest. It appears that pain relief on day 7 of younger patients and patients who have undergone orthopedic surgery is an area that can be improved.

Syftet med studien var att undersöka hur patienterna på en ortopedisk avdelning uppfattade sin postoperativa smärtbehandling och tillfredsställelse med vården. Metod: En enkätstudie med konsekutivt urval gjordes under hösten 2010 på en ortopedisk avdelning på ett sjukhus i Mellansverige. Urvalet bestod av 47 ortopediska patienter, både män och kvinnor, som genomgått operation och enkäten, som berörde hela den postoperativa vårdtiden, lämnades ut postoperativ dag tre. Åldrarna varierade mellan 23 och 82 år. Resultat: Majoriteten av patienterna ansåg sig nöjda med smärtbehandlingen och sin tid på avdelningen. Dock var frekvensen av smärtskattning låg från vårdpersonalens sida och nästan hälften av patienterna hade mer ont efter operationen än vad de förväntat sig. Slutsats: Patienterna var generellt sett mycket nöjda med sin smärtbehandling och med vårdtiden på avdelningen. Förbättringsbehov hos avdelningen är att smärtskatta tre gånger per dygn. För att kunna ge en mer säker bild av hur patienterna uppfattar sin smärtbehandling bör en ny studie göras med ett större urval. / The aim of this study was to examine how patients at an orthopedic ward perceive their postoperative pain management and satisfaction with care. Method: A survey by questionnaires with consecutive selection was made in the autumn of 2010 at an orthopedic ward at a hospital in Middle Sweden. The sample consisted of 47 orthopedic patients, both men and women, who had undergone surgery and the questionnaire, which concerned the entire postoperative hospital stay, was handed out postoperative day three. The ages ranged between 23 and 82 years old. Results: The majority of the patients considered themselves satisfied with the pain management and their time in the ward. However, the frequency of pain assessment by the nursing staff was low and almost half of the patients had more pain after surgery than they expected. Conclusion: Patients were generally satisfied with their pain treatment and their time in the ward. Need for improvement is to assess the pain three times per day. In order to provide a more accurate picture of how patients perceive their pain management a new study needs to be done with a larger sample.

Smärta i samband med intrakraniell kirurgi liknar smärta i samband med all annan form av kirurgi. Syftet var att granska hur barn med hjärntumör smärtbedömts och smärtbehandlats postoperativt efter tumörkirurgi. Metod: Totalt har journaler för 40 barn (20 barn på Akademiska barnsjukhuset i Uppsala och 20 barn på Astrid Lindgrens barnsjukhus vid Karolinska sjukhuset, Stockholm) som opererats för tumörer i hjärnan granskats, avseende smärtbedömning, användandet av smärtskalor, farmakologiska och ickefarmakologisk smärtbehandling de tre första postoperativa dygnen. Resultat: Studien visade att smärtskattning med smärtskalor användes på 12 av 40 barn. Den vanligaste formen av smärtbedömning som återfanns dokumenterad var en bedömning av sjuksköterskan. På Akademiska sjukhuset återfanns ingen dokumenterad smärtbedömning i 60 % av de granskade dygnen, på Astrid Lindgrens barnsjukhus var motsvarande siffra 20 %. De vanligaste läkemedlen som används på båda sjukhusen var paracetamol och opioider, framförallt morfin. Vid Astrid Lindgrens barnsjukhus används företrädelsevis stående ordinationer med paracetamol i kombination med opioidinfusioner. Vid Akademiska sjukhuset används framförallt paracetamol som stående ordination och opioidinjektioner som vid behovsordinationer. I dokumentationen återfanns ingen ickefarmakologisk behandling. För totalt 6 barn fanns omnämnt olika typer av distraktion eller tröst. Slutsats: Slutsatsen blir att utifrån journaldokumentation är systematisk smärtskattning av barn som opererats för tumörer i hjärnan, och utvärdering av given smärtbehandling bristfällig. / Pain in relation to intracranial surgery is similar to pain in relation to all other kind of surgery. Aim: The aim of this study was to review how children with brain tumour were assessed and treated for postoperative pain after tumour surgery. A total of 40 charts of children (20 children at Akademiska University Hospital and 20 children at Astrid Lindgren Children’s Hospital) who had gone through brain surgery have been reviewed with respect to pain assessment, use of assessment tools, pharmacological and nonpharmacological treatment the first tree days after surgery. Result: This study showed that pain assessment tools were used for 12 out of 40 children. The most used documented way of pain assessment was an assessment by the nurse. At the Akademiska University Hospital no documented pain assessment was performed in 60% of the reviewed days. At Astrid Lindgren Children’s Hospital the corresponding number was 20%. The most common drugs used at both hospitals were paracetamol and opioids, particularly morphine. At Astrid Lindgren Children’s Hospital they preferably used standing prescriptions of paracetamol in combination with morphine. At the Akademiska University Hospital they used paracetamol as a standing prescription and opioids as an on demand prescription. In the documentation no nonpharmacological treatment was found. For 6 children there was documentation of different types of distraction or consolation. Conclusion: The conclusion from the study of the documentation is that systematic pain assessment of children who had gone through brain surgery and evaluation of given pain treatment is insufficient.

Bakgrund: Smärta är en individuell upplevelse som kan vara svår att förmedla till andra men är ett oundvikligt fenomen efter kirurgiska ingrepp. Sjuksköterskor ska utifrån ett helhetsperspektiv bedöma patientens postoperativa smärta. Studier visade att det finns en skillnad mellan sjuksköterskors bedömning och patienters upplevelse av smärta. Smärtbedömningen kan försvåras av flera faktorer. Syfte: Syftet med denna litteraturbaserade studie var att beskriva faktorer som påverkar sjuksköterskors bedömning av postoperativ smärta hos patienter. Metod: En litteraturöversikt som baserades på 15 kvalitetsgranskade och systematiskt valda vetenskapliga artiklar. Resultat: Patienterna upplevde att deras smärta ofta underskattades av sjuksköterskorna. Sjuksköterskorna ansåg att den verbala förmågan att utrycka smärta är den viktigaste faktorn för att göra en adekvat smärtbedömning. Sjuksköterskor erkände svårigheterna med att bortse från sina egna värderingar och acceptera vad patienten uttryckte om sin smärta. Slutsats: Sjuksköterskor tenderade att underskatta patienters smärta. Flera faktorer påverkar sjuksköterskan i bedömningen av den postoperativa smärtan där den verbala kommunikationen identifieras som den tillförlitligaste faktorn. Sjuksköterskor måste förbättra smärtutvärderingen och göra den på ett mer metodiskt och kontinuerligt sätt. / Background: Pain is an individual experience which can be difficult to convey to others but it is an inevitable phenomenon after surgery. Nurses must assess the patient's postoperative pain from a holistically perspective. Studies indicated that there is a difference between nurses’ assessments of pain intensity and patients’ experience of pain. Several factors complicate pain assessment. Aim: The aim of this literature–based study was to describe factor that affects nurses in the assessment of postoperative pain in patients. Method: A literature review based on 15 peer-reviewed and systematically selected scientific articles. Findings: Patients felt that their pain was often underestimated by nurses. Nurses considered that the verbal ability to express pain is the most important factor in order to make an adequate assessment of pain. Nurses admitted the difficulty of ignoring their own values and accept what the patient expressed about their pain. Conclusion: Nurses tended to underestimate patients' pain. Several factors affect the nurse in the assessment of postoperative pain which verbal communication is identified as the most reliable factor. Nurses must improve the evaluation of pain assessment and provide it in a more systematic way.

In clinical situations, most of the patients suffer from inflammation and acute postoperative pain after surgery. Postoperative pain has been emphasized as a very crucial issue in improving the quality of medical care in each medical center. Therefore, management of the postoperative pain is an effective approach to reduce the painful unpleasant feeling, complications, and death rate after surgery. Surgical trauma results in the induction of COX-2, leading to the release of prostaglandins, which sensitize peripheral nociceptors and increase the excitability of spinal neurons, producing pain hypersensitivity in the surrounding uninjured tissue.The purpose of this study is to test the preventive effect of COX-2 inhibitor SC-236 for post-operative pain by rat plantar incision model.Then, we explored whether SC-236 is more effective in reducing the hyperalgesia and inflammation response administered before incision than after incision. Furthermore, we used male Sprague-Dawley rats received plantar incision were used in this study, the rats received subcutaneous injection of SC-236 before or after plantar incision. Behavior teste of mechanical allodynia¡Bthermal hyperalgesia and COX-2 expression level was determined at 4 h and 1, 2, and 3 days after surgery. Mechanical allodynia was measured by mechanical withdrawal threshold that was determined by stimulating with von Frey filaments stimulation. Thermal hyperalgesia was measured by thermal withdrawal thermal tested by radioactive thermal assay. Mechanical allodynia¡Bthermal hyperalgesia and COX-2 expression level were measured at various time points by behavior teste¡Breal-time polymerase chain reaction¡Bwestern blot and immunohistochemistry. The data from pre-incisional injection of SC-236 was compared with that from post-incisional injection of SC-236.The results revealed pre-incisional injection of COX-2 inhibitor significantly inhibited thermal hyperalgesia but not mechanical allodynia then post-incisional injection of COX-2 inhibitor group. Skin of pre-incisional injection of SC-236 show significant decreased mRNA expression of COX-2 at 1 day and 2 day after incision evidenced by real-time polymerase chain reaction. Western blot and immunohistochemistry also show significant decreased protein expression of COX-2 at 4 hours and 1 day after incision. Therefore, pre-incisional administration of SC-236 could prevent the surgical wound induced thermal hyperalgesia and decrease mRNA and protein expression level of cutaneous COX-2 at 4 hours and one day after surgical incision compared to post-incisional administration of SC-236 .

<p>Mycket forskning inom ämnet postoperativ smärta är gjord. Det är ett komplext ämne och studier visar att det förekommer att patienter smärtlindras otillräckligt. Syftet med den här studien var att beskriva vilka metoder sjuksköterskan använder sig av för att bedöma akut postoperativ smärta, och vilka för och nackdelar som finns med de olika metoderna. Vi ansåg att en litteraturstudie var mest lämpad för vår studie och har använt oss av tolv artiklar i resultatet. Där identifierade vi fyra kategorier som beskriver hur sjuksköterskan bedömer postoperativ smärta. (1) Hur patienten ser ut, (2) Kommunikation, (3) Erfarenheter och (4) Smärtskattningsskalor. Ofta vägs flera av dessa kategorier in när sjuksköterskan bedömer smärta. Resultatet visar att sjuksköterskan har en tendens att bedöma smärtan utifrån tidigare erfarenheter och det händer att de ibland undervärderar patientens smärtnivåer. Det framgår också att patientens verbala beskrivning om smärtupplevelsen är den mest tillförlitliga indikatorn i bedömningen av akut postoperativ smärta.</p> / <p>There has been a lot of research conducted on the subject matter of postoperative pain. It’s a complex subject matter with studies showing the presence of inadequate pain relief. The purpose of this study is to describe the methods and tools nurses use to assess acute postoperative pain, and the pros and cons of the various methods. A literature review was conducted and twelve articles where used for the results. Four categories describing how nurses assess postoperative pain were identified. (1) What the patient looks like, (2) Communication, (3) Previous experiences and (4) Pain rating scales. It’s common for multiple categories to be used by nurses assessing pain. Results show nurses have a tendency to assess pain from previous experiences, and in the process sometimes underestimating the patients’ true pain levels. Results also show that the most accurate indicator of a postoperative pain in patients is their own verbal expression of said pain.</p>

Postoperativ smärta är en smärta som är förväntad av både patient och sjuksköterska. Mötetmellan sjuksköterska och patient med postoperativ smärta innefattar sjuksköterskans kunskap och fördomar om smärta, samt patientens känsla av utlämnande och upplevelse av smärta. Syftet var att genom en litteraturstudie belysa viktiga faktorer i mötet mellan sjuksköterska och patient med postoperativ smärta. Därtill två frågeställningar; Vad är viktigt för sjuksköterskan i bemötandet av patienter med postoperativ smärta? Vad är viktigt för patienten med postoperativ smärta i mötet med sjuksköterskan? Metod Litteraturstudie med Graneheim och Lundmans analysmetod som verktyg. Litteraturstudien grundar sig i vetenskapliga artiklar. Resultat Nio betydelsefulla faktorer i mötet mellan sjuksköterska och patient med postoperativ smärta framkom ur artiklarna. Resultatet presenteras i sjuksköterskan perspektiv och ur patientens perspektiv. Föreliggande studier visar på att det finns hinder i kommunikationen mellan sjuksköterska och patient med postoperativ smarta. Diskussion En rak och klar kommunikation är en viktig faktor i mötet mellan sjuksköterska och patient med postoperativ smärta. Sjuksköterskan hjälper patienten att uttrycka sig och är beroende av förmågan att observera även det icke-verbala kroppsspråket. Genom att sjuksköterskan ger patienten god information skapas en trygghet och mötet mellan sjuksköterska och patient med postoperativ smärta blir mer optimal.