PubMed · 1767929
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I R Jenkins, R H Riley. 1991. PCA administration set failure.. https://pubmed.ncbi.nlm.nih.gov/1767929/
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A MAJOR CHALLENGE: Management of post-operative pain is insufficient. One out of 2 patients suffers intense or very intense pain during the first days after surgery. The inefficacy of analgesic therapy is related to lack of a sufficiently organized pain-relief protocol. Patients are insufficiently informed, prescriptions lack precision, postoperative pain is not regularly evaluated, and patient controlled analgesia (PCA) and loco-regional techniques are insufficiently applied. NECESSARY STEPS: Pain relief protocols in surgery units should be organized in a stepwise fashion. The first step is to record the patient's level of pain every 8 hours during the first 5 days after surgery. The second step is to define the role of each health carer in the implementation of analgesic techniques. The third step is to develop adapted analgesic techniques (paracetamol and anti-inflammatory drugs, subcutaneous morphine, PCA and loco-regional techniques, particularly peripheral blocks for orthopedic surgery). The final step is an evaluation phase aimed at assessing the impact on the management of postoperative pain in the unit. LOW COST: Optimally, the entire procedure, integrated into an overall quality assurance program, is directed by one reference physician assisted by a nurse specially qualified in pain relief. The overall financial burden, including drug costs, material and health care personnel is minimal. In French units, it has been estimated at around 10 to 20 F per patient per day.
PURPOSE: Posthemorrhoidectomy pain control remains a challenging problem. Transcutaneous electrical nerve stimulation is known to be effective in the treatment of many diseases. Our aim was to investigate the effect of transcutaneous electrical nerve stimulation on pain relief in patients undergoing hemorrhoidectomy. METHODS: Sixty patients with symptomatic hemorrhoids were randomly allocated into two groups, the acupoint group (n = 30) and the nonpoint control group (n = 30). Transcutaneous electrical nerve stimulation was applied to those patients who received hemorrhoidectomy, and patient-controlled analgesia was achieved by injection of morphine through ambulatory infusion pumps. The dependent measures in this study were pain score from 0 (no pain) to 10 (agonizing pain), analgesic doses administrated through patient-controlled analgesia, and postoperative complications. RESULTS: The subjective pain scores evaluated 8, 12, 16, and 24 hours after hemorrhoidectomy in the control group and the acupoint group were 5.9 +/- 0.5 and 4.1 +/- 0.5, 5.7 +/- 0.5 and 3.5 +/- 0.4, 4.1 +/- 0.4 and 2.3 +/- 0.3, and 3.2 +/- 0.4 and 1.9 +/- 0.2, respectively (two-way analysis of variance; P < 0.05). There was a significant difference between treatment groups in morphine use, with 11.6 +/- 2.2 mg in the control group and 6.2 +/- 1.3 mg in the acupoint group (P < 0.05). The acupoint group tended to have less postoperative acute urinary retention (Fisher's exact probability test; P = 0.145) and less need for analgesics than the control group (P = 0.112, Fisher's exact test). CONCLUSION: Transcutaneous electrical nerve stimulation is effective for pain relief in patients receiving hemorrhoidectomy. Its efficacy and safety could assist outpatient pain management after hemorrhoidectomy.
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