No description available.

BACKGROUND Uterine evacuation (EVAC) and manual vacuum aspiration (MVA) are commonly performed minor gynaecological procedures, often being done on an out-patient basis. These procedures are associated with pain, but the severity and extent of the pain experienced, especially in the post-procedure period, is not well studied. OBJECTIVES The aim of this study was to determine whether patients who underwent EVAC and MVA procedures, experienced pain postoperatively; and if so, to quantify the degree of pain experienced. These patients were at Chris Hani Baragwanath Academic Hospital (CHBAH). The objectives of this study were to determine whether patients (having undergone EVAC and MVA) experienced pain postoperatively, and to also determine the intensity of the pain. Additionally, to ascertain whether patient age, gestational age or the duration of the procedure, had any impact on the pain experienced. METHOD A sample of 53 patients were selected, presenting for EVAC and MVA at CHBAH. There were 26 patients in the EVAC group and 27 in the MVA group. Information was collected from patient interviews and their hospital files and subsequently recorded on data sheets. Data collected on each data sheet included: patient age, gestation, procedure (EVAC or MVA), reason for procedure, length/duration of procedure and analgesia received prior to and during the procedure. Pain was assessed at intervals of 10 minutes, 40 minutes, 2 hours and 3 hours post-procedure. This was achieved using a ratio, which was determined from a visual analogue scale (VAS). Patients who had pain greater than 3/10 on the VAS score, received rescue analgesia in the form of diclofenac, 1mg/kg diluted in 250 ml of Ringer‘s lactate, over 30 minutes intravenously. RESULTS Patients in the MVA group experienced significantly more pain immediately postoperatively than the patients in the EVAC group. However, there were no significant differences found in pain experienced between the two groups at 40 minutes and thereafter. CONCLUSION Patients undergoing EVAC do experience pain, but if multimodal analgesia is provided, the pain experienced is not significant. Patients undergoing MVA experience significant pain post-procedure. It is recommended that improved analgesia protocols should be instituted.

Thesis (M.A.)--York University, 2004. Graduate Programme in Kinesiology and Health Science. / Typescript. Includes bibliographical references (leaves 85-101). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss&rft%5Fval%5Ffmt=info:ofi/fmt:kev:mtx:dissertation&rft%5Fdat=xri:pqdiss:MQ99325

The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts. Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed. Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample. Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome. Future research directions and potential clinical appplications that follow from these findings were discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Meng, Zhaoyu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 61-74). / Abstracts in English and Chinese. / Declaration of Origination --- p.II / Abstract --- p.III / Acknowledgement --- p.VII / Table of Contents --- p.VIII / List of Tables --- p.XI / List of Figures --- p.XII / List of Abbreviations --- p.XIII / Chapter Chapter 1. --- Review of postoperative pain --- p.1 / Chapter Chapter 2. --- Candidate Genes --- p.6 / Chapter 2.1 --- μ Opioid Receptor Gene --- p.6 / Chapter 2.2 --- ATP-binding cassette B1 (ABCB1) / multiple drug resistance 1 (MDR1) gene --- p.10 / Chapter 2.3 --- Catechol-O-methyltransferase (COMT) gene --- p.10 / Chapter 2.4 --- βArrestin2 gene --- p.11 / Chapter 2.5 --- Transient receptor potential (TRP) gene --- p.11 / Chapter 2.6 --- GTP cyclohydrolase 1 (GCHl)gene --- p.12 / Chapter Chapter 3. --- Hypothesis and Experimental Design --- p.15 / Chapter 3.1 --- Hypothesis --- p.15 / Chapter 3.2 --- Objectives --- p.15 / Chapter 3.3 --- Experimental design --- p.15 / Chapter 4.4 --- Role in this study --- p.16 / Chapter Chapter 4. --- Methods --- p.17 / Chapter 4.1 --- Patients --- p.17 / Chapter 4.2 --- Anesthetic procedure --- p.17 / Chapter 4.3 --- Postoperative management --- p.18 / Chapter 4.4 --- Patient follow-up --- p.19 / Chapter 4.5 --- Definition of endpoints --- p.19 / Chapter Chapter 5. --- Genotyping --- p.22 / Chapter Chapter 6 --- Statistical Analysis and Sample Size --- p.24 / Chapter 6.1 --- Statistical analysis --- p.24 / Chapter 6.2 --- Sample size --- p.26 / Chapter Chapter 7. --- "Demographic, genotype and haplotype result" --- p.28 / Chapter 7.1 --- Patient characteristics --- p.28 / Chapter 7.2 --- Genotypes and haplotypes --- p.30 / Chapter Chapter 8. --- Acute postoperative pain --- p.35 / Chapter Chapter 9. --- Morphine consumption for early postoperative pain --- p.41 / Chapter 9.1 --- Patients using alternative analgesia --- p.41 / Chapter 9.2 --- Result in the patients using morphine alone --- p.41 / Chapter Chapter 10. --- Opioid-related Side Effects --- p.47 / Chapter Chapter 11. --- Chronic postoperative pain --- p.49 / Chapter 11.1 --- Patient characteristics --- p.49 / Chapter 11.2 --- Association of genetic polymorphisms and Chronic postoperative pain --- p.51 / Chapter Chapter 12. --- Discussion --- p.54 / Chapter 12.1 --- Acute postoperative pain --- p.54 / Chapter 12.2 --- Chronic postoperative pain --- p.57 / Chapter Chapter 13. --- Conclusion --- p.60 / References --- p.61 / Appendix I. Morphine Consumption and and Number of Demands for Patient Controlled Analgesia (PCA) in Patients with Different Genotypes --- p.75 / Appendix II. Opioid Related Symptom Distress Scale Score on Day 1 and Overall Score of Each Day in Patients with Different Genotypes --- p.79 / Appendix III. Opioid Related Symptoms Distress Scale Score in Patients with Different Genotypes --- p.83

Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.S.)--University of Michigan, 1976.

Thesis (doctoral)--Universität Hamburg, 1978.

Thesis (M.S.)--University of Michigan, 1976.

This study was designed to describe the use of analgesics ordered pro re nata (PRN) in the management of acute post-operative pain. Specifically, the study purpose was to answer the following questions. What amounts and frequencies of analgesic are ordered PRN by physicians for patients in the first 48 hours following a cholecystectomy? What amounts and frequencies of analgesic are given by nurses to patients in the first 48 hours following a cholecystectomy? What is the patient's summational description of his/her pain at 24 and 48 hours following a cholecystectomy? A descriptive survey design was used. A convenience sample of 22 subjects participated in the study. These subjects met the study criteria and were scheduled for elective cholecystectomy at one of the two hospitals used. Data were gathered by auditing the charts for information pertinent to the prescriptions and administration of the analgesics and by interviewing the subjects. There was considerable variability in the amounts and frequencies of analgesics prescribed and in those given to the post-operative subjects. No routine patterns were identified. There was a significant difference in the amounts of analgesics prescribed and given between the two hospitals, the reasons for which were not explored. The decision to use the PRN-prescribed analgesics appeared to be made by the nurses but evidence of accountability taken by nurses for their role in assessing pain and evaluating the effectiveness of the analgesics was not reflected in the reviewed records. Analgesics for use in the Post-Anaesthetic Recovery Room in the immediate post-operative period were prescribed by the anaesthetists. All initial analgesics were given by the intravenous route in this setting. Subjects at Hospital B were prescribed and received considerably more analgesics (83%) than those at Hospital A. Analgesics for use on the ward were prescribed by the surgeons. All orders were for meperidine hydrochloride to be given PRN and all orders were unchanged for the 48-hour period studied. The amount of meperidine prescribed and given per intramuscular dose was usually within the 75 to 100 milligrams optimal dosage range for the drug. The meperidine was usually prescribed with a four hour interval between doses. Doses of meperidine were given with considerably longer intervals between doses than the duration of action of the drug. For the 48-hour period, the mean total amount prescribed, based on the maximum possible dosage was 1154 milligrams. The median total amount prescribed was 1050 milligrams. The mean total amount given was 625 milligrams or 54% of the prescribed amount and the median total amount given was 587 milligrams or 56% of the prescribed amount. Subjects on the ward at Hospital A were prescribed and given significantly more meperidine than those at Hospital B. The patients' summational descriptions of their pain emphasized the individuality of the pain experience. The physical sensations described were consistent with previous literature descriptions of postoperative pain. The subjective data collected reflected the difficulties and complexities of pain management. An often-stated assumption in the literature is that nurses use PRN-prescribed analgesics inappropriately in managing post-operative pain; that is, patients are uncomfortable because the analgesics are not given in adequate amounts or frequently enough. In this study, a relationship was not identified between the amounts of meperidine received by subjects and how they reported their post-operative pain. This finding suggests that the assumption, that increasing the analgesics used would increase patient comfort, requires further investigation. Based on the findings of this study, implications for postoperative pain management and nursing practice, and suggestions for further research were made. / Applied Science, Faculty of / Nursing, School of / Graduate