Articles: pain-management.
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The opioid crisis has changed the culture and expectations of pain management, elevating the importance of nonpharmacologic pain interventions (NPIs) into multimodal pain management programs. Little is known about use of NPIs in hospitalized patients. ⋯ Results suggest that patients and nurses may benefit from education about using NPIs in acute care. Nurses have a critical role influencing positive pain-related outcomes, and tablet technology can enhance patient use of NPIs during hospitalization.
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Paediatric anaesthesia · Oct 2022
Scheduled Methadone Reduces Overall Opioid Requirements after Pediatric Posterior Spinal Fusion: a single center retrospective case series.
Posterior spinal fusion to correct adolescent idiopathic scoliosis is associated with significant postoperative pain. Different modalities have been reported as part of a multimodal analgesic plan. Intravenous methadone acts as a mu-opioid agonist and N-Methyl-D-aspartate (NMDA) antagonist and has been shown to have opioid-sparing effects. Our multimodal approach has included hydromorphone patient-controlled analgesia (PCA) with and without preincisional methadone, and recently postoperative methadone without a PCA. ⋯ A protocol with intraoperative and scheduled postoperative methadone doses resulted in a 45% reduction in opioid usage compared to a PCA-based protocol with similar analgesia after pediatric posterior spinal fusion.
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Anaesthesiology represents a rapidly evolving medical specialty in global healthcare, currently covering advanced peri-operative, pre-hospital and in-hospital critical emergency management (CREM), intensive care medicine (ICM) and pain management. The aim of the European Society of Anaesthesiology and Intensive Care (ESAIC) is to develop and promote a coordinated interdisciplinary and multidisciplinary European network of Anaesthesiology and Intensive Care Medicine (AICM) societies for improvement of patient safety and outcome, and to enhance political and public awareness of the role of anaesthesiologists all over Europe. The ESAIC promotes coordinated interdisciplinary and multidisciplinary care for severely compromised patients, based on the European training requirements (ETR) within the European Union of Medical Specialists (UEMS). ⋯ Amongst the 42 European national societies surveyed (41 members of ESAIC-NASC plus Luxembourg), nineteen (45%) also include terms related to critical care medicine or ICM in their names, seven (17%) include terms related to reanimation and three (7%) to resuscitation. In recent years, several national societies revised their names to better reflect their gradual embrace of peri-operative medicine, ICM, CREM and pain management. Approximately 70% of ICU beds in Europe, and 100% in Scandinavia, are being run by anaesthesiologists, the remaining 30% being managed by physicians from other surgical or medical specialties. To emphasise future needs and resources of European AICM, the ESAIC drafted an ICM roadmap in terms of clinical practice, organisation of healthcare, interprofessional and interdisciplinary collaboration, patient safety, outcome and empowerment, professional working conditions, and changes in research, teaching and training required to meet future challenges and expectations.
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Quality improvement in conservative pain management (QUIKS), a module for nonoperative patients in the QUIPS project was tested on a cohort of tumor patients regarding its applicability. ⋯ The application of the questionnaire was well accepted by the patients but required a high level of assistance in completing it. A high level of pain was observed during the hospital stay and the adjustment of pain therapy or the involvement of pain medicine specialists was rare. The interpretation of statements regarding the quality of tumor pain may be limited as other (pre-existing) pain entities, such as nontumor-associated pain or chronic tumor pain could not be clearly delineated.
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Undergoing potentially painful procedures is necessary among patients of all ages. Nurses are responsible to optimize safety and minimize harm for patients. The American Society for Pain Management Nursing (ASPMN) holds the position that all patients undergoing painful procedures have the right to safe and effective pain management throughout the phases of care, and that the interprofessional healthcare team ensures such ethical obligation is fulfilled within a framework of the patients or their designees' goals and preferences. From that position, all nurses, clinicians, and health care organizations are strongly encouraged to offer multimodal pain management that includes integrative interventions when managing procedure related pain.