Background: Postoperative pain is expected and affects many patients who undergo surgery. To prevent complications and long-term pain, the nurse's role is to understand the patient's pain experience, assess the pain and treat it with both pharmacological and non-pharmacological treatments to relieve the patient's pain using a patient-centered approach. Purpose: The purpose was to investigate the experiences of adult patients with postoperative pain and pain relief. Method: A general literature study using a qualitative study design consisted of 10 scientific articles analyzed with an inductive approach according to Elo and Kyngäs. Results: Three categories were discovered: Postoperative experiences related to the patient, The patient's experience of postoperative pain treatment and the patient's experience of the care staff's response to postoperative pain. Conclusion: Postoperative pain is a complex and individual experience and pain descriptions can vary in intensity and form. Treatment choices, both pharmacological and non-pharmacological, affect how patients manage their pain. Nurses play an important role in patients' postoperative pain experience, which affects the outcome of pain management and pain relief.

Yes / Nausea and vomiting are common symptoms in palliative care. Haloperidol is often used as an antiemetic in this context, although direct evidence supporting this practice is limited. To evaluate the efficacy and clinical use of haloperidol as an antiemetic in nonpalliative care contexts to inform practice, the authors conducted a rapid review of (i) published evidence to supplement existing systematic reviews, and (ii) practical aspects affecting the use of haloperidol including formulations and doses that are commonly available internationally. In nausea and vomiting related to cancer treatment, haloperidol was superior to control in two small studies. In postoperative nausea and vomiting (PONV), two randomized controlledtrials found treatment with haloperidol comparable to ondansetron. In palliative care, an observational study found a complete response rate of 24% with haloperidol (one in four patients) which would be consistent with a number needed to treat (NNT) of 3 to 5 derived from PONV. There remains insufficient direct evidence to definitively support the use of haloperidol for the management of nausea and vomiting in palliative care. However, generalizing evidence from other clinical contexts may have some validity.

In der chirurgischen Therapie von Schilddrüsenerkrankungen bestehen weiterhin kontroverse Diskussionen hinsichtlich der adäquaten Operationstechnik bei bilateralen Resektionen. Rezidiv- und Komplikationsvermeidung stellen hohe Anforderungen an die Schilddrüsenchirurgie. Darüberhinaus bestehen weltweit divergierende Meinungen über Risikofaktoren für die spezifischen Operationskomplikationen, die postoperative Rekurrensparese und Hypokalzämie. In der chirurgischen Abteilung der Universitätsklinik Charité, Campus Virchow-Klinikum wurden im Rahmen einer prospektiven Schilddrüsenstudie 2728 Patientendaten aus den Jahren 1985-1999 erhoben und statistisch ausgewertet. Anhand der multivariaten Regressionsanalyse wurde gezielt nach Risikofaktoren für spezifische Operationskomplikationen gesucht. Das individuell indizierte chirurgische Vorgehen basiert auf dem operativen Standard, der neben überdurchschnittlich häufig angewandten ausgedehnten Resektionsverfahren ein Operieren in exakter Mikrodissektionstechnik mit Darstellung und Schonung der anatomischen Leitstrukturen beinhält. Bei den spezifischen Komplikationen waren 4,3% transiente und 0,4% permanente Rekurrensparesen sowie 19,5% transiente und 0,9% permanente Hypokalzämien zu verzeichnen. Die multivariate Analyse wurde sowohl für das Gesamtpatientengut als auch nur für Patienten mit benignen Schilddrüsenerkrankungen durchgeführt. Für die erste Gruppe ergab die Thorakotomie einen Risikofaktor für eine postoperative Rekurrensparese und Frauen, Strumen mit retrosternalem Anteil sowie Near Total-Operationsverfahren waren jeweils Risikofaktoren für eine postoperative Hypokalzämie. Für die zweite, benigne Patientengruppe stellten beidseitig voroperierte Patienten ein signifikantes Risiko für eine Rekurrensparese und Morbus Basedow-Patienten, Patienten mit sehr grossen Schilddrüsen (WHO III Struma, Schilddrüsen mit retrosternalem Anteil) sowie Near Total-Verfahren jeweils ein Risikofaktor hinsichtlich einer postoperativen, überwiegend transienten Hypokalzämie dar. Eine solide Interpretation der gewonnen Ergebnisse erlaubt die Schlussfolgerung bei Beachtung einer kleinen Gruppe von Risikopatienten, dass unter Berücksichtigung klarer Standards für Indikation und Operationsverfahren Schilddrüseneingriffe heutzutage sehr sicher und effektiv durchzuführen sind. / The surgical therapy of thyroid diseases gives reason for controverse discussion concearning the appropriate surgical technique by bilateral resection. The avoidance of recurrent goiter and surgical complications is a great demand for thyroid surgery. In addition to that exist worldwide diverge opinions about riskfactors for the specific complications after thyroid operations, recurrent laryngeal nerve palsy and hypocalcaemia. In the department of surgery, universityhospital Charité, campus Virchow-Klinikum, Berlin, Germany were 2728 patientfacts collected and statistically evaluated within a prospective study from 1985-1999. By means of the multivariate logistic regression analysis riskfactors for the specific surgical complications were searched. The individually indicated surgical procedure based upon standardized surgery, that contains beside numerous extended resections than average also the exact mikrodissection technique with preparation and preservation of all important anatomical structures. These study showed 4,3% transient and 0,4% permanent recurrent laryngeal nerve palsies as well as 19,5% transient and 0,9% permanent hypocalcaemiae. The whole number of patients and the patients with benign thyroid diseases were analysed through multivariat logistic regression separately. So, for the first group thoracotomy proved to be a riskfactor for recurrent nerve palsy just as femal patients, retrosternal goiter and near total resections showed to be riskfactors for hypocalcaemia. For the second, the benign group bilateral reoperation for recurrent goiter revealed to be riskfactor for recurrent nerve palsy. Graves´~disease, very large goiter (WHO III and retrosternal goiter) and near total resection showed to be a riskfaktor for a hypocalcaemia (mainly transient). A solid interpretation of the achieved results allows the conclusion by attention to a small group of riskpatients, that today thyroid surgery can be performed very safely and effectively when standards for indication and surgical techniques are considered.

Este estudo teve como objetivos analisar o conceito náusea em pacientes no período pósoperatório imediato; avaliar a validade de conteúdo e clínica do diagnóstico de enfermagem Náusea no período pós-operatório imediato, considerando-se o modelo de Fehring; identificar a incidência do referido diagnóstico em pacientes no período pós-operatório imediato; verificar possíveis associações entre os antecedentes de náusea obtidos na análise de conceito e os identificados nos pacientes com náusea no pós-operatório imediato e verificar a frequência de ocorrência das características definidoras principais e secundárias do diagnóstico Náusea. A pesquisa foi desenvolvida em três etapas: análise de conceito, validação de conteúdo e validação clínica. A análise de conceito seguiu as oito fases propostas por Walker a Avant: selecionar o conceito, definir o objetivo da análise, identificar a utilização do conceito, definir atributos definidores, desenvolver casos-modelos, desenvolver outros casos, identificar antecedentes e consequentes e verificar as referências empíricas. Essa etapa foi fundamental para a realização das etapas posteriores (validação de conteúdo e validação clínica), permitindo a construção de definições operacionais e a elaboração de instrumentos de coleta de dados mais direcionados ao cenário do paciente com náusea no período pós-operatório. Participaram da validação de conteúdo 52 expertos que responderam a um instrumento que continha dados de identificação profissional e de validação do diagnóstico de enfermagem Náusea (enunciado, definição, posição que ocupa na estrutura taxonômica e características definidoras, descritas em uma escala tipo Likert). A maioria dos expertos considerou o domínio 12 (Conforto), a classe 1 (conforto físico) e o enunciado (náusea) adequados ao diagnóstico. Foram sugeridas modificações na definição atual do referido diagnóstico de enfermagem. Quatro características definidoras foram consideradas principais (relato de náusea, salivação aumentada, aversão à comida e sensação de vômito) e oito foram denominadas secundárias (deglutição aumentada, gosto amargo na boca, palidez, taquicardia, diaforese, sensação de calor e frio, alterações da pressão arterial e dilatação pupilar). Na etapa de validação clínica, 106 pacientes foram incluídos na amostra. Para a coleta de dados, foram utilizados o questionário de avaliação pré, intra e pósoperatória e a Escala Hospitalar de Ansiedade e Depressão. A náusea foi avaliada em duas etapas: 1) análise das manifestações objetivas (dois enfermeiros simultaneamente) e 2) subjetivas (um enfermeiro). A incidência de náusea foi de 21,70% e, na maioria das vezes, de moderada intensidade. Os antecedentes associados à presença de náuseas no pós-operatório foram: sexo, idade, tipo de anestesia, presença de dor, movimentação e alimentação pósoperatória e odores nocivos. Na etapa 1, a característica definidora denominada principal foi relato de náusea, e as manifestações secundárias foram sensação de vômito, palidez e deglutição aumentada. O índice de concordância variou de 86,95% a 100,00%. Na etapa 2, as características consideradas principais foram relato de náusea e sensação de vômito, e as características definidoras secundárias identificadas foram salivação aumentada e sensação de calor e frio. Os escores totais do diagnóstico de enfermagem Náusea foram de 0,79 e 0,73 para as validações de conteúdo e clínica respectivamente, considerado válido para a Taxonomia da North American Nursing Diagnosis Association - International (NANDA-I). Concluiu-se que o relato de náusea, sensação de vômito, palidez, salivação aumentada, deglutição aumentada e sensação de calor e frio são fortes indicativos do diagnóstico de enfermagem Náusea. / The aims of this study were to analyze the nausea concept in patients during the immediate postoperative period; to assess the content and clinical validity of the nursing diagnosis nausea in the immediate postoperative period, considering Fehring\'s model; to identify the incidence of this diagnosis in patients during the immediate postoperative period; to check for possible associations between the nausea antecedents obtained in the concept analysis and those identified in patients with immediate postoperative nausea and to verify the frequency of the primary and secondary defining characteristics of the Nausea diagnosis. The research was developed in three phases: concept analysis, content validation and clinical validation. The concept analysis followed the eight phases proposed by Walker and Avant: select the concept, define the aim of the analysis, identify the use of the concept, define defining attributes, develop model cases, develop other cases, identify antecedents and consequences and check empirical references. This phase was fundamental to accomplish further phases (content validation and clinical validation), permitting the construction of operational definitions and the elaboration of data collection instruments that were better directed at the context of postoperative nausea patients. Fifty-two specialists participated in the content validation, who answered an instrument with professional identification data and the validation of the nursing diagnosis nausea (wording, definition, position in taxonomic structure and defining characteristics, described on a Likert scale). Most experts considered domain 12 (Comfort), class 1 (physical comfort) and the wording (nausea) adequate for the diagnosis. Modifications were suggested in the current definition of the referred nursing diagnosis. Four defining characteristics were considered primary (reported nausea, increased salivation, aversion toward food and gagging sensation), while eight were called secondary (increased swallowing, sour taste in the mouth, pallor, tachycardia, excessive sweating, feeling hot and cold, blood pressure alterations and pupil dilation). In the clinical validation phase, 106 patients were included in the sample. For data collection the pre, intra and post-operative assessment questionnaire and the Hospital Anxiety and Depression Scale were used. Nausea was assessed in two phases: 1) analysis of objective manifestations (two nurses simultaneously) and 2) subjective (one nurse). The incidence level of nausea corresponded to 21.70%, in most cases of moderate intensity. The following antecedents were associated with the presence of nausea and vomiting: gender, age, anesthesia type, presence of pain, postoperative movements and meals and harmful smells. In phase 1, the defining characteristic that was considered primary was reported nausea and the secondary manifestations were gagging sensation, pallor and increased swallowing. Agreement levels ranged between 86.95% and 100.00%. In phase 2, reported nausea and gagging sensation were considered primary characteristics, while increased salivation and feeling hot and cold were identified as secondary defining characteristics. The total scores of the nursing diagnosis Nausea corresponded to 0.79 and 0.73 for the content and clinical validations, respectively, which are considered valid for the Taxonomy of the North American Nursing Diagnosis Association - International (NANDA-I). In conclusion, reported nausea, gagging sensation, pallor, increased salivation, increased swallowing and feeling hot and cold are strong signs of the nursing diagnosis Nausea.

<p>Succinylcolin är ett icke-depolariserande muskelrelaxantia som används inom anestesisjukvård. En vanlig biverkning är postoperativ myalgi. Varför smärtan uppstår är inte helt klarlagd. Under många år har forskare runt om i världen försökt komma till rätta med problemet utan att helt lyckas.Olika läkemedel och strategier har prövats. En av de viktigaste uppgifter en sjuksköterska har är att förebygga och lindra lidande. Som anestesisjuksköterska finns det möjlighet att påverka den vård som ordineras. Syftet med studien var att undersöka vilka metoder som kan förebygga postoperativ myalgi orsakad av succinylcolin. En litteraturstudie baserad på tio vetenskapliga artiklar genomfördes. Resultatet visade att parecoxib preoperativt samt premedicinering med diklofenakplåster gav det bästa resultatet när det gäller reducerande av myalgi. Med hjälp av dessa så vanliga läkemedel kan onödigt lidande förebyggas och samhällsekonomiska resurser sparas.</p><p> </p>

<p>Vid operation av primär total höftplastik finns det olika metoder för postoperativ smärtlindring. En tidigare genomförd studie på ett mellansvenskt sjukhus (nedan kallad ”höftprojektet”) visade att ”Local infiltration analgesia” (LIA) initialt minskade postoperativ smärta, underlättade mobilisering samt förkortade vårdtiden, jämfört med spinalt morfin. I denna studie genomfördes en långtidsuppföljning av höftprojektet med mätningar efter 6 respektive 12 veckor. Studiegruppen hade fått LIA vid operationsslutet och kontrollgruppen spinalt morfin. Båda grupperna hade en spinal bedövning under operationen. Denna långtidsuppföljning genomfördes med hjälp av journalgranskning och hade en deskriptiv och jämförande design med en kvantitativ ansats. Studiegruppen bestod av 40 patienter och kontrollgruppen 11 patienter. Studerade variabler var smärta mätt genom Visuell Analog Skala (VAS), behov av analgetika och mobilisering. Resultatet visade att det inte fanns någon signifikant skillnad mellan de båda grupperna när det gäller mobilisering under ett längre perspektiv. Det fanns dock en signifikant skillnad när det gäller smärta efter 3 månader, då studiegruppen uppgav en lägre grad av smärta än kontrollgruppen.</p> / <p>There are several methods for postoperative pain treatment after primary total hip replacement. It was shown in a earlier study at a Swedish hospital (below named as "the hip project") that "Local infiltration analgesia" (LIA) decreased pain, facilitated early postoperative mobility and earlier discharge from the hospital, compared with spinally administered morphine. Present study is a long term follow up of the hip project with two measures at 6 and 12 weeks. The study group was given LIA towards the end of the operation while the control group were given spinal morphine at the induction. Both groups had spinal analgesia during the surgery. The long term follow up was conducted by a comparative design and the data was collected from the patient’s charts and files. The variables were pain measured by Visual Analogous Scale (VAS), need of pain relieves and general mobility. The study group contained of 40 patients and the control group of 11. The result relived no significant differences between the two groups regarding long term mobility. There was, however, a significant difference in pain after 12 weeks; the study group had less pain that the control group.</p><p> </p><p> </p>

Succinylcolin är ett icke-depolariserande muskelrelaxantia som används inom anestesisjukvård. En vanlig biverkning är postoperativ myalgi. Varför smärtan uppstår är inte helt klarlagd. Under många år har forskare runt om i världen försökt komma till rätta med problemet utan att helt lyckas.Olika läkemedel och strategier har prövats. En av de viktigaste uppgifter en sjuksköterska har är att förebygga och lindra lidande. Som anestesisjuksköterska finns det möjlighet att påverka den vård som ordineras. Syftet med studien var att undersöka vilka metoder som kan förebygga postoperativ myalgi orsakad av succinylcolin. En litteraturstudie baserad på tio vetenskapliga artiklar genomfördes. Resultatet visade att parecoxib preoperativt samt premedicinering med diklofenakplåster gav det bästa resultatet när det gäller reducerande av myalgi. Med hjälp av dessa så vanliga läkemedel kan onödigt lidande förebyggas och samhällsekonomiska resurser sparas.

Vid operation av primär total höftplastik finns det olika metoder för postoperativ smärtlindring. En tidigare genomförd studie på ett mellansvenskt sjukhus (nedan kallad ”höftprojektet”) visade att ”Local infiltration analgesia” (LIA) initialt minskade postoperativ smärta, underlättade mobilisering samt förkortade vårdtiden, jämfört med spinalt morfin. I denna studie genomfördes en långtidsuppföljning av höftprojektet med mätningar efter 6 respektive 12 veckor. Studiegruppen hade fått LIA vid operationsslutet och kontrollgruppen spinalt morfin. Båda grupperna hade en spinal bedövning under operationen. Denna långtidsuppföljning genomfördes med hjälp av journalgranskning och hade en deskriptiv och jämförande design med en kvantitativ ansats. Studiegruppen bestod av 40 patienter och kontrollgruppen 11 patienter. Studerade variabler var smärta mätt genom Visuell Analog Skala (VAS), behov av analgetika och mobilisering. Resultatet visade att det inte fanns någon signifikant skillnad mellan de båda grupperna när det gäller mobilisering under ett längre perspektiv. Det fanns dock en signifikant skillnad när det gäller smärta efter 3 månader, då studiegruppen uppgav en lägre grad av smärta än kontrollgruppen. / There are several methods for postoperative pain treatment after primary total hip replacement. It was shown in a earlier study at a Swedish hospital (below named as "the hip project") that "Local infiltration analgesia" (LIA) decreased pain, facilitated early postoperative mobility and earlier discharge from the hospital, compared with spinally administered morphine. Present study is a long term follow up of the hip project with two measures at 6 and 12 weeks. The study group was given LIA towards the end of the operation while the control group were given spinal morphine at the induction. Both groups had spinal analgesia during the surgery. The long term follow up was conducted by a comparative design and the data was collected from the patient’s charts and files. The variables were pain measured by Visual Analogous Scale (VAS), need of pain relieves and general mobility. The study group contained of 40 patients and the control group of 11. The result relived no significant differences between the two groups regarding long term mobility. There was, however, a significant difference in pain after 12 weeks; the study group had less pain that the control group.

Iatrogenic vascular injuries (IVIs) and injuries associated with vascular surgery can cause severe morbidity and death. The aims of this thesis were to study those injuries in the Swedish vascular registry (Swedvasc), the Swedish medical injury insurance where insurance claims are registered, the Population and Cause of death registries, and in patient records, in order to explore preventive strategies. Among 87 IVIs during varicose vein surgery 43 were venous, mostly causing bleeding in the groin. Among 44 arterial injuries, only 1/3 were detected intraoperatively. Accidental arterial stripping predominated, with poor outcome. Four patients died, all after venous injuries. IVIs increased over time, and constitute more than half of the vascular injuries registered in the Swedvasc. Lethal outcome was more common (4.9%) among patients suffering IVIs than among non-iatrogenic vascular injuries (2.5%). Risk factors for death were age, diabetes, renal insufficiency and obstructive lung-disease. Fifty-two patients died within 30 days after IVI. The most common lethal IVIs were puncture during endovascular procedures (n=24, 46%), penetrating trauma during open surgery (11) and occlusion after compression (6). Symptoms were peripheral ischemia (n=19), external bleeding (14), and hypovolemic chock without external bleeding (10). Most died within two weeks (n=36, 69%). After &gt;2 weeks the IVI as a cause of death was uncertain. Among 193 insurance claims after vascular surgery during 2002-2007, nerve injuries (91) and wound infections (22) dominated. Most patients suffered permanent injuries, three died. Patients with insurance claims were correctly registered in the Swedvasc in 82%. In 32 cases of popliteal artery injury during knee arthroplasty symptoms were bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Only twelve injuries (38%) were detected intraoperatively. Patency at 30 days was 97%, but only seven (22%) patients had complete recovery. Six of those had intraoperative diagnosis of popliteal injury and immediate vascular repair. In conclusion, registration of IVIs is increasing and outcome is often negatively affected by diagnostic and therapeutic delay. Not all fatalities after IVIs are attributable to the injury itself. The most common causes of insurance claims after vascular surgery were nerve injuries, and 82% were correctly registered in Swedvasc.

Diss. Linköping : Univ., 2004.