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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Learning needs assessment is the term applied to the process of identifying or diagnosing a learner's educational needs. It is the foundation of a systematic continuing medical education (CME) programme. Needs assessment has been identified as the most pressing problem of medical education directors in North America. Furthermore, the CME learning needs, interests or motivations of anaesthetists have never been studied. The amount of time and effort required for needs assessment is probably a major deterrent to this activity. The investigators adopted simple and straightforward means of assessing the "perceived learning needs" and topic interests of anaesthetists. Questionnaires were sent by mail to anaesthetists practicing in teaching and non-teaching hospitals in the Toronto area. The questionnaire presented a list of CME content areas. The respondents were asked to indicate on scale of 1 to 10 their Current Expertise, Ideal-Desired Expertise, and Interest-Motivation levels for each content area. Need Score for each content area was calculated by taking the difference between Ideal and Current Expertise responses. A total of 101/305 anaesthetists (29%) responded to the survey. Most of the respondents had been in anaesthesia practice for less than ten years. Regional nerve block, acute pain control, and medicolegal considerations received high overall ranks in both the need and interest categories. Paediatric anaesthesia, anaesthesia for trauma surgery and thoracic anaesthesia had top ranks among the subspecialty fields. Regional anaesthesia techniques received higher need and interest ranks than intravenous and inhalational techniques. The learning needs of anaesthetists of a large urban centre have been identified, and this information is useful to CME planners.
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PMID:The continuing medical education needs of anaesthetists. 139 49

The reliability of some behavioral and physiological indices used for the recognition and assessment of acute pain in lambs after castration and tail docking has been examined. Changes in the indices were measured after blocking neural activity with local anaesthetic (lignocaine) and after an opioid antagonist (naloxone) was administered. Six lambs, aged less than one week, were allocated randomly to each of six treatments. (i) control handling and blood sampling; (ii) castration plus tail docking with tight rubber rings; (iii) local anaesthesia; (iv) local anaesthesia followed by castration and tail docking; (v) intravenous naloxone only (0.2 mg kg-1); and (vi) intravenous naloxone followed by castration and tail docking. Local anaesthesia eliminated the behavioural and plasma cortisol changes which usually follow castration and tail docking. Naloxone had a limited effect on the increase in cortisol but altered the behaviour. The results support the view that such indices are useful for assessment of the response to acute pain and that, although endogenous opioids do reduce pain in young lambs after castration and tail docking, the effect is small.
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PMID:Effects of local anesthesia and intravenous naloxone on the changes in behaviour and plasma concentrations of cortisol produced by castration and tail docking with tight rubber rings in young lambs. 178 83

A fundamental challenge in the medical community is to manage postoperative/acute pain both effectively and adequately. The stress response cycle must be incorporated and adverse physiological effects, resulting complications, and prolonged hospital stays must be documented. The inadequacies of traditional method of pain management are compared with new technology using patient-controlled analgesia and epidural opioids. Setting up an acute pain service and training, and certification of the nurses, who are managed by the Anesthesia Department, are described. This type of program is best coordinated by the PACU. The value of marketing this service to physicians and the community will reap immeasurable rewards.
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PMID:Acute pain service in a community hospital. 183 31

An acute pain service in a new district general hospital is described. We have reported incidence of severe pain, common postoperative anaesthetic problems and patient satisfaction in relation to the analgesic technique. Over half the patients were treated by intermittent intramuscular injection of opioid, but increase in the use of continuous intravenous therapy and in particular patient-controlled analgesia, was welcomed by both medical and nursing staff.
Anaesthesia 1991 Mar
PMID:Introducing an acute pain service. 201 94

The postanesthesia nurse encounters patients with pain daily in nursing practice. The intensity of patients' acute postsurgical pain varies from mild to very severe. Currently, the treatment of choice for postsurgical pain is administration of a narcotic, usually in titrated intravenous doses. When the pain is mild and the patient is able to cope until the narcotic reduces the intensity of the pain, narcotics alone are satisfactory. However, the patient with severe pain may not be able to cope with the length of time required for the narcotic administered to produce pain relief. For those patients additional measures are needed to assist them in coping with the pain. Nursing interventions may benefit the adult postanesthesia patient who is experiencing acute pain upon emergence from anesthesia. Physiology of pain transmission and nursing research in the area of acute pain control are the basis for interventions. Preoperative education and sensory preparation, distraction, deep breathing, and progressive muscle relaxation are additional interventions with potential to enhance acute pain control in the PACU.
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PMID:Exploring nursing interventions for acute pain in the postanesthesia care unit. 221 24

Anesthesiologists have always played a leading role in research into pain and its treatment. Their efforts, however, have been focused on acute or postoperative pain problems. It was the American anesthesiologist John J. Bonica who fought for an increased interest in chronic pain. The establishment of the first Multidisciplinary Pain Center at the University of Washington in Seattle, the foundation of the International Association for the Study of Pain (IASP) and Melzack and Wall's now 25 year old gate control theory were the driving forces behind rapid developments in research and treatment in the area of chronic pain. The realization that chronic pain was the most frequent cause of disability in the United States also gave an impetus for new efforts in treatment. The classic anesthesiological topics, such as operative anesthesia emergency medicine and intensive care, have been extended to include acute pain services and chronic pain treatment facilities. This reflects the understanding that anesthesiological knowledge and techniques can be valuable to patients in severe acute pain and those in lingering long-term chronic pain phases. Anesthesiologists are skilled in the use of opioid narcotics and in the administration of strong analgesics. Many severe pain problems can be solved by correct use of the analgesic regimen. Special ways of administering narcotic analgesics, such as epidural infusion or patient-controlled analgesia, have already alleviated the pain problems of many patients. Anesthesiological techniques are also crucial in diagnosis. Sequential differential blockade and simple nerve blocks can be helpful in the diagnosis and classification of the pain problems. Anesthesiological contributions to a chronic pain service are not restricted to medical interventions. Organizational skills are also needed for efficient running of multidisciplinary pain treatment facilities. Clinical practice in surgical anesthesia means that anesthesiologists are experienced in interdisciplinary work and familiar with the advantages and dangers of team work. Despite international acceptance of the multidisciplinary approach to chronic pain, there is still a lack of appropriate facilities in the German-speaking countries, and we consider it important that anesthesiologists commit themselves to increasing general awareness of what is needed.
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PMID:[The multidisciplinary outpatient pain clinic in relation to anesthesia. An important task for the anesthesiologist]. 227 62

Although epidural catheterization has many advantages in anesthesia and in the treatment of acute pain, spinal epidural abscess is a serious complication after the procedure. Since it is presumed that the epidural space is contaminated by bacteria on the skin via the space around the catheter, it seems important to clarify bacterial re-growth after application of skin disinfectant. Therefore, bacterial growths on human back 1, 2 days, and 1 week after application of disinfectants were studied in summer and winter to elucidate whether there are differences between the two seasons. Four disinfectants, 0.5% chlorhexidine in 80% ethyl alcohol (CA), 0.2% benzalkonium in 80% ethyl alcohol (BA), 10% povidone iodine (PI), and 80% ethyl alcohol (EA) were applied on the back of 76 adult healthy volunteers, and the specimens were taken by agar-contact method. The frequencies of positive cultures for bacteria were higher in summer than in winter. The frequencies of positive culture in summer after the applications of CA, BA, PI, and EA were as follows, respectively: 50%, 20%, 5%, and 40% after 1 day; 47%, 50%, 60%, and 50% after 2 days; and 82%, 82%, 70%, and 64% after 1 week. In winter, these frequencies after the application of CA, BA, PI, and EA were as follows, respectively: 0%, 0%, 18%, and 18% after 1 day; 5%, 26%, 32%, and 58% after 2 days; and 21%, 21%, 32%, and 42% after 1 week. We conclude that when an epidural catheter is in situ, more frequent skin disinfection has to be carried out, preferably by CA, in summer than in winter, since the presence of sweat on the back seems to hasten the re-growth of bacteria.
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PMID:[Skin disinfectants for nerve blocks and their long-lasting antimicrobial effects]. 234 93

The purpose of this study was to determine the effects of three cognitive behavioural strategies in the management of abortion pain. The interventions were drawn from the multidimensional model of pain suggested by the gate control theory. Forty patients undergoing abortion with local anaesthesia were instructed in one of four interventions: relaxation, pleasant imagery, analgesic imagery, and a pain discussion (attention control) group. Pain was measured using Johnson's two-dimensional graphic rating scales labelled sensation and distress. Speed of recovery and analgesic use were included as objective dependent measures. No significant differences were found among the four groups on any dependent measures although subjects receiving the pleasant imagery intervention reported the lowest subjective ratings of pain sensation and distress. Findings are discussed in terms of past research and implications for the management of acute pain experienced during abortion.
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PMID:Management of pain during abortion. 264 7

Even though hypnosis is a very old form of therapy, a number of points still need to be made clear. We do know, however, that endorphins are not involved in the pain control process and that hypnosis effects and placebos are quite different. Under the proper conditions, hypnosis is very easy to use, without any risk and without any side effects. The use is more limited in the case of acute pain, because the developments in modern anaesthesia preclude the use of hypnosis in the fields of surgery and dentistry. On the other hand, hypnosis can be helpful for patients suffering from burns, cancer pain, or other chronic pain.
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PMID:[Pain and hypnosis]. 267 70

To determine how pain is assessed and managed in the early postoperative period, what the prescribing habits and general opinions on postoperative pain are, and what suggestions for future improvement could be made, questionnaires were sent to 430 anesthesia departments in the FRG. Of these, 188 were returned (38% response). Systemic treatment (opiates, major and minor tranquilizers, peripherally acting analgesics and spasmolytics) was preferred in most cases, although regional anesthesia/analgesia seems to be rather popular. Data are given not only for analgesic techniques, but also for the most frequently used drugs. The study highlighted deficiencies in communication between the anesthetic staff and the patients that resulted in poor assessment of acute pain problems. The findings indicate a need to document pain and pain relief more often and more precisely in order to improve postoperative pain control.
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PMID:[Status of postoperative pain therapy in West Germany. Results of a representative survey]. 288 94


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