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

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

No description available.

The effectiveness of preoperative relaxation training and preparatory information, separately and in combination, on postoperative pain was examined with respect to surgical patients' coping style (avoidance-sensitization). Subjects were 64 patients undergoing elective cholecystectomy or hysterectomy (abdominal or vaginal) in a large private hospital. Experimenters were advanced clinical psychology graduate students and trained undergraduate research assistants. On the afternoon prior to surgery, patients were contacted, completed an interview that was used to assess their coping style in the surgical situation (Cohen & Lazarus, 1973), and completed the state anxiety portion of the State-Trait Anxiety Inventory. Patients also completed the Pain Rating Index and the Present Pain Index of the McGill Pain Questionnaire. At this point in the preoperative session, patients were presented with materials and/or information corresponding to the group to which they were assigned. Treatments consisted of training in the Benson relaxation technique, receiving information about procedures and specific sensations they would experience, or a combination of relaxation training and information-imparting. Controls talked briefly with the experimenter of feelings about surgery and experiences in the hospital. Patients in all groups were revisited on the second (counting the day after surgery as the first postoperative day) and fourth postoperative days, and again completed the pain measures and the state anxiety measure. Patients were also encouraged to practice the relaxation technique, instructed concerning procedures and sensations they had yet to experience, both, or neither, depending on the group to which they were assigned. After each patient was discharged, his/her medical records were examined and the number and type of analgesics administered during the postoperative period, from the day of surgery until discharge, was tabulated. Preoperative interviews were rated according to coping style and patients were divided into two groups, sensitizers and avoiders. Data were analyzed in a 2 x 4 analysis of covariance. Results indicated that there were no main effects for treatment. It is possible that the treatments provided in this study were too brief to provide an adequate test of their effectiveness for patients in general. There were no significant main effects for coping style, although sensitizers generally reported more pain and received more analgesics than avoiders. An avoidant method of coping appeared to be an adequate method of adjustment to elective surgery and did not result in poorer recovery, as previous authors have suggested. Significant effects on postoperative pain were primarily a function of the interaction between treatment and coping style. Sensitizers reported less pain with relaxation training alone than sensitizers in any of the other groups. This effect was apparently owing to the anxiety-reducing nature of the technique and the fact that it encourages redirection of attention, away from discomforts. Avoiders reported low levels of pain and anxiety with no treatment. However, of the treatments provided, relaxation plus information did reduce some indices of pain below that of avoider controls. Finally, information-imparting did not appear to be beneficial for either sensitizers or avoiders. It was suggested that specific information may contribute to further sensitization to discomforts for sensitizers and conflict with avoidant processes of coping in avoiders. It was also suggested that more extensive preoperative preparation of sensitizers may be necessary to promote habituation to the discomforts of surgery. / Ph. D.

Sammanfattning                        Postoperativ smärtbehandling är otillräcklig trots ökad kunskap i smärtfysiologi och utvecklandet av nya farmakologiska riktlinjer. Obehandlad postoperativ smärta kan leda till komplikationer som fördröjd mobilisering, djup ventrombos, lungemboli, hjärtinfarkt, stroke och lunginflammation, vilka leder till ett ökat lidande för patienten både fysiskt och psykiskt samt ökade kostnader för samhället. Anestesisjuksköterskan lägger grunden för den postoperativa smärtbehandlingen före och under anestesin och ska arbeta preventivt för att patientens smärtbehandling ska vara tillräcklig. Syftet med studien var att belysa anestesisjuksköterskans strategier för att förebygga patientens postoperativa smärta efter generell anestesi. Semistrukturerade intervjuer genomfördes med fyra anestesisjuksköterskor på ett västsvenskt sjukhus och analyserades med kvalitativ innehållsanalys. Anestesisjuksköterskorna strävade efter att ge en individuell smärtbehandling till patienterna. Känslan som skapades vid det preoperativa mötet med patienten, typen av ingrepp, samt användandet av andra smärtbehandlingsmetoder påverkade planeringen av de intravenösa analgetikadoserna peroperativt. Genom att använda multimodal smärtbehandlingsmetod till patienter som opereras i generell anestesi skulle postoperativ smärta kunna förebyggas och bidra till minskat lidande för patienterna samt snabbare postoperativ återhämtning. Även vårdtiderna kan förkortas vilket kan leda till en samhällsekonomisk vinst. / Abstract                                      The management of postoperative pain is insufficient despite increased knowledge of the physiology of pain and the development of new pharmacological guidelines. Postoperative pain left untreated can lead to delayed mobilization and secondary complications such as deep venous thrombosis, pulmonary embolism, cardiac infarction, stroke and pneumonia. The outcome is increased mental and physical disability for the patient and increased costs for the society. The nurse anesthesist has a crucial role in postoperative pain management before and during anesthesia and needs to work preventively to secure sufficient analgesia for the patient. The aim of this study was to enlighten the nurse anesthesist’s strategies to prevent postoperative pain after general anesthesia. Semi-structured interviews with four nurse anesthetists at a hospital in the Southwest of Sweden were analyzed with qualitative content analysis. The nurse anesthesists strived to individualize pain management. The effect of the atmosphere created at the preoperative meeting with the patient, the character of the planned procedure and the usage of other methods of pain management all affected peroperative planning of dosage of intravenous analgesics. By using multimodality analgesia in patients who have surgery under general anesthesia postoperative pain could be prevented and hence contribute to reduced patient disability and faster postoperative recovery.  Furthermore, the in-hospital care time can be reduced which could mean socioeconomic benefits.

Patients experience some degree of pain accompanying all surgical procedures. If this pain is not adequately treated, it will cause severe physiological and psychological damage. It will even affect patients' postoperative recovery. However, if preemptive analgesia is administered before noxious stimuli arise, rather than afterwards, it is significantly more effective. The purpose of this study is to recognize that reasonable effort and time should be spent to determine a patient's tolerance level towards pain before surgery. Then, the appropriate dosage of analgesia can be given immediately after surgery to alleviate pain. By administering effective pain relief, it will improve patient¡¦s satisfaction with medical services. Using classic experimental design (which consists of an experimental group and a control group), this study focuses on cases of patients who had hemorrhoid surgery in a certain hospital in southern Taiwan. The experimental group and the control group consist of a total of 75 valid samples. The experimental group received customizing analgesic postoperative care, while the control group received conventional analgesic postoperative care. Patient¡¦s satisfaction questionnaires were gathered from patients on the day they were discharged from the hospital. Instruments used in the experiment include VAS, PThM, and patient¡¦s satisfaction questionnaires.To examine the basic characteristics of the samples in both the experimental group and the control group, two statistical methods, Chi-square test and independent T test, were adopted. For patient¡¦s satisfaction questionnaires, Mann-Whitney-Wilcoxon test of nonparametric method was adopted to examine if obvious differences in satisfaction levels existed between the two groups. The result of the experiment shows the analgesic effect from customizing analgesic postoperative care is far better than conventional care. The patient¡¦s satisfaction toward the doctor's professional skill was higher as well. On the other hand, the patient¡¦s satisfaction level toward the whole medical process had no obvious improvement. This study proves that customizing analgesic postoperative care can effectively prevent postoperative pain from occurring. However, to raise patient¡¦s satisfaction towards the whole medical process, better professional medical skill is required as well as improved medical services.

Thesis (MSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Postoperative pain is still the most common and anticipated problem following surgery and inadequate post-operative pain management remains problematic. There is a significant variation in post-operative pain experience of patients following identical surgical procedures and this has been related to a variety of psychological factors. Depression has been considered a predictor of post-operative pain. The overall aim of the study was to determine the relationship between depressive symptoms and subjective pain experienced in dental surgery. The Beck Depression Inventory (BDI) was administrated to a sample of 35 patients presenting with dental impaction to assess general depression severity. Participants were assigned to one of two groups using a cutoff score of 10 on the BDI. Pain was measured by a Visual analog pain scale. The results showed that participants with pre-operative depressive symptoms had a trend to experience more pain pre-operatively but less pain post-operatively than participants without depressive symptoms this difference was however not statistically significant. No significant correlations were found between the presence of depressive symptoms pre-operative and pain perception pre-operatively and post-operatively. However significant relationships were found between the absence of depressive symptoms pre-operative and pain perception pre-operatively and post-operatively. Pre-operative depressive symptoms were also found to be predictive of post-operative depressive symptoms. The study concluded that pain and depression co-occur, but the direction of causality is not clearly understood. The use of psychotherapeutic tools for identifying pre-operative predictors for intense post-operative pain will enhance the quality of pain management and therefore has a positive impact on the quality of life of the patient. / AFRIKAANSE OPSOMMING: Post-operatiewe pyn is een van die mees algemene en verwagte probleme na afloop van chirurgie en onvoldoende behandeling van die pyn bly problematies. Daar is 'n beduidende verskil in die ervaring van post-operatiewe pyn van pasiënte na identiese chirurgiese prosedures en dit hou verband met 'n verskeidenheid van sielkundige faktore. Depressie word beskou as 'n voorspeller van post-operatiewe pyn. Die hoof doel van die studie was om die verhouding tussen depressiewe simptome en subjektiewe pyn ervaring in tandheelkundige chirurgie te bepaal. Die Beck Depression Inventory (BDI) is gebruik om die erns van algemene depressie onder ‘n steekproef van 35 pasiënte wat presenteer met tand impaksie te evalueer. 'n Afsny-telling van 10 is gebruik om die deelnemers toe te wys aan een van twee groepe. Pyn was gemeet deur 'n Visuele analog pynskaal (VAS). Die resultate het getoon dat deelnemers met pre-operatiewe depressiewe simptome 'n neiging het om meer pyn pre-operatief, maar minder pyn post-operatief te ervaar as deelnemers sonder depressiewe simptome. Die verskil was egter nie statisties beduidend nie. Geen beduidende korrelasies is gevind tussen die teenwoordigheid van pre-operatiewe depressiewe simptome en die persepsie van pyn pre-operatief en post-operatief nie. Beduidende verbande is egter gevind tussen die afwesigheid van pre-operatiewe depressiewe simptome en persepsie van pyn pre-operatief en post-operatief. Pre-operatiewe depressiewe simptome het ook post-operatiewe depressiewe simptome voorspel. Die studie het bevind dat pyn en depressie saam voorkom maar die rigting van oorsaak is nie uitgewys. Die gebruik van psigoterapeutiese instrumente vir identifisering van pre-operatiewe voorspellers vir intense post-operatiewe pyn sal die gehalte van pynbehandeling verbeter en sodoende 'n positiewe impak op die kwaliteit van lewe van die pasiënt hê.

No description available.

Background: Approximately 2,8 million surgical procedures were performed in Sweden 2016. After surgery, patients experienced different degrees of postoperative pain. Under treated postoperative pain created great suffering for patients, delayed the recovery after surgery and could increase the risk of complications. Therefore, it is of importance to explore and describe patients’ experiences regarding pain in conjunction with surgery, in order to improve postoperative pain relief from a nursing perspective. Aim: To describe how patients experience postoperative pain and pain relief. Method: A literature review was conducted in which four qualitative studies and three quantitative studies were included. The studies were subjected to assurance of quality and Friberg’s three-step analysis was used. Results: Two categories and eight subcategories emerged. The two categories were (1) The time before surgery and (2) The time after surgery. The categories illustrated how patients experienced postoperative pain and pain relief before and after surgical procedures. Conclusion: Patients had previous experiences, expectations, knowledge and beliefs about postoperative pain and pain relief that affected their experiences before surgery. After the procedure, patients' difficulty in communicating, their participation, the attitudes of healthcare professionals and the degree of attendance of the nurse were important experiences related to postoperative pain and pain relief.

Pain is common among women undergoing first trimester surgical abortions. At the postoperative unit, department of gynaecology, University Hospital, Uppsala, the goal is that 80 % of the women should rate pain as £ 3 on a numeric rating scale (NRS), when leaving the unit. The aim of the study was to investigate how rating was performed at the unit and to investigate patient’s perceptions of pain after having undergone first trimester surgical abortion. 20 patients (74%) participated in the study. Ninety percent of the patients rated their pain as NRS £ 3 when leaving the unit. Seven patients (35 %) rated their pain as NRS > 3 directly after operation, and 2 (10 %) patients NRS > 3 when leaving the unit. There were no correlations between patient’s age and ratings of pain. There was no difference in rating of pain between patients with prior vaginal delivery and patients who had no prior vaginal delivery. There were no correlations between ratings of pain and gestational age. Conclusion: It is important that patients undergoing first trimester surgical abortions receive adequate pain treatment. The unit’s goal for postoperative pain treatment is achived, 90 % of the patients rated their pain as NRS £ 3 when leaving the unit.