외과병동 간호사의 수술후 통증에 대한 지식과 태도

정선화,최미혜 중앙대학교 의과대학 간호학과 간호과학연구소 2002 중앙간호논문집 Vol.6 No.2

Postoperative pain is most important problem for operated patient, who may experience severe pain and unsatisfactory. This study analyzed surgical nurses' knowledge and attitudes on postoperative pain, so try to research is from 18th Feb, 2002 to 28th Feb, 2002 and the subjects are 360 surgical nurses who are working in the major medical center in Seoul. We used a modified method which is invented by Watt-Watson(1992) as method of study. The questionnaires included 24 questions for knowledge of postoperative pain and 25 questions for the using of analgesics. We used the modified Hur, Hea Kung's questionnaires which is based on (Wilder-Smith & Schuler, 1992; Wilson et al., 1992), for attitudes of nurses on postoperative pain. This study is composed 7 questions of general characteristics of nurses and 21 questions of nurses' attitudes on postoperative pain. The data was analyzed by descriptive statistics, analysis of variance, t-test, one way ANOVA using SPSS statistical package. The results of this study are as follows. 1. The average of collect answer is 69.99% for the knowldge of postoperative pain and average of collect answer is 43.3% for the using of analgesics. 2. In the nurses' attitudes on postoperative pain, 83.3% of operated patient experienced severe pain and 95.2% of operated patient thought to need postoperative pain control, and 61.9% of patient was answered to use enough analgesics for the postoperative pain control after surgery. 3. The attitudes of postoperative pain is related with the age of nurses (p=0.002), married or unmarried(p=0.021). The knowledge of the using analgesics is related with the age of nurses(p=0.000), married or unmarried(p=0.001), religion(p=0.006), working ime(p=0.000), official responsibility(p=0.035). 4. The nurses' attitudes on postoperative pain are related with the nurses degree of final education(p=0.000). This research are showing us, generally the lack of nurses knowledge of postoperative pain especially on using analgesics. Attitudes of nurses on postoperative pain is valuable elements for the effective postoperative pain control. Therefore We should developed our proper program for the structured, continuous posto-perative pain control.

Beyond measurement: a deep dive into the commonly used pain scales for postoperative pain assessment

Seungeun Choi,Soo-Hyuk Yoon,Ho-Jin Lee 대한통증학회 2024 The Korean Journal of Pain Vol.37 No.3

This review explores the essential methodologies for effective postoperative pain management, focusing on the need for thorough pain assessment tools, as underscored in various existing guidelines. Herein, the strengths and weaknesses of commonly used pain scales for postoperative pain—the Visual Analog Scale, Numeric Rating Scale, Verbal Rating Scale, and Faces Pain Scale—are evaluated, highlighting the importance of selecting appropriate assessment tools based on factors influencing their effectiveness in surgical contexts. By emphasizing the need to comprehend the minimal clinically important difference (MCID) for these scales in evaluating new analgesic interventions and monitoring pain trajectories over time, this review advocates recognizing the limitations of common pain scales to improve pain assessment strategies, ultimately enhancing postoperative pain management. Finally, five recommendations for pain assessment in research on postoperative pain are provided: first, selecting an appropriate pain scale tailored to the patient group, considering the strengths and weaknesses of each scale; second, simultaneously assessing the intensity of postoperative pain at rest and during movement; third, conducting evaluations at specific time points and monitoring trends over time; fourth, extending the focus beyond the intensity of postoperative pain to include its impact on postoperative functional recovery; and lastly, interpreting the findings while considering the MCID, ensuring that it is clinically significant for the chosen pain scale. These recommendations broaden our understanding of postoperative pain and provide insights that contribute to more effective pain management strategies, thereby enhancing patient care outcomes.

Acute Postoperative Pain after Ureteroscopic Removal of Stone: Incidence and Risk Factors

안순태,김재헌,박재영,문두건,배재현 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.1

Purpose: Ureteroscopic removal of stones (URS) has been widely used to treat ureteral stones because it is comparatively safe, has a high success rate, and enables patients to rapidly return to their daily routines. However, some patients experience pain after URS, but the incidence of acute post-URS pain remains largely unknown. This study aimed to investigate the incidence of acute postoperative pain after URS and the associated risk factors. Materials and Methods: Data for 143 consecutive patients who underwent URS from June 2008 to December 2010 were collected. After excluding 8 patients who developed intraoperative complications, the patients were divided into two groups according to postoperative pain on the first postoperative day. Acute postoperative pain was defined as a pain score greater than 4 on a visual analogue pain scale (normal range, 0 to 10). Various factors were analyzed to identify the risk factors that could predict acute postoperative pain after URS. Results: The stone-free rate without URS intraoperative complications was 95.5%. A total of 21 (14.6%) patients experienced postoperative pain on the first postoperative day. Young age, psychiatric illness, history of urinary tract infection, use of a stone basket, large stone size, and prolonged operation time were identified as risk factors for acute postoperative pain. Conclusions: The incidence of acute postoperative pain is not that low and should not be overlooked, because it is associated with postoperative complications that could result in an unscheduled hospital admission or visit. Active pain control should be contemplated after URS in young patients and in those with a history of urinary tract infection, psychiatric illness, large stone size, and prolonged operation time.

Postoperative pain after endodontic treatment of necrotic teeth with large intentional foraminal enlargement

Machado Ricardo,Comparin Daniel,Ignácio Sérgio Aparecido,Silva Neto Ulisses Xavier da 대한치과보존학회 2021 Restorative Dentistry & Endodontics Vol.46 No.3

Objectives To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE. Objectives To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE.

후방 척추 감압술을 시행한 척추관 협착증 환자에서 수술 후 통증조절 방법간의 효과 비교

송우석,이영상,박병학,김정묵,변찬웅 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.3

Study Design: Prospective study. Objectives: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression. Summary of Literature Review: Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary. Materials and Methods: To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively. Results: The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p<0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p<0.05). Conclusions: Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression. 연구 계획: 전향적 연구목적: 본 연구에서는 요추부 협착증으로 후방 척추 감압술을 시행 받은 환자에게 경막외강 내 및 정맥 내 경로를 통한 3가지 통증조절방법을 적용한 뒤각 방법간의 통증조절효과 및 구역감, 구토감(postoperative nausea and vomiting (PONV))을 비교하고자 하였다. 선행 연구문헌의 요약: 척추 수술은 수술 후 심한 통증을 유발하므로 통증관리를 위한 효율적이고 안전한 통증조절방법은 필수적이다. 대상 및 방법: 술 후 임상증상 및 통증의 호전여부를 판단하기 위하여 단분절 후방 척추 감압술을 시행 받은 52명의 환자를 무작위로 총 3군으로 나누어 18명에게 전신 마취 후 수술 시작 직전 경막외강 내 일회 약물 투여, 16명에게 술 후 지속성 경막외강 내 약물 투여장치를 적용, 18명에게 술 후 정맥내 자가통증조절장치를 적용하였다. 수술 직후, 4시간 후, 12시간 후, 1일 후, 2일 후 환자가 호소하는 통증 정도를 시각통증등급 (Visual Analogue Scale [VAS[)를 이용하여 평가하였고, 통증조절약물 투여 후 환자가 호소하는 구역감, 구토감의 횟수와 정도를 조사하였다. 결과: 통증조절효과의 비교에서 지속성 경막외강 내 약물 투여(CEI) 군이 유의하게 좋았고, 일회성 경막외강 내 약물 투여(SEI) 군과 정맥 내 통증자가조절장치(IV-PCA) 군이 뒤를 이었다(p<0.05). 술 후 통증조절에 따른 PONV는 PCA 군에서 다른 두 군보다 발생빈도가 높았다(p<0.05). 결론: 지속성 경막외강 내 약물투여(CEI)는 후방 척추 감압술 후 통증 조절에 효과적이며 PONV의 발생을 최소화한다. 약칭 제목: 후방 척추 감압술을 시행한 척추관 협착증 환자에서 수술 후 통증조절 방법간의 효과 비교

Perioperative Factors Associated with Severe Pain in Post-Anesthesia Care Unit after Thoracolumbar Spine Surgery: A Retrospective Case-Control Study

Paweenus Rungwattanakit,Tarnkamon Sondtiruk,Akarin Nimmannit,Busara Sirivanasandha 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: A retrospective case-control study. Purpose: To evaluate the effect of nitrous oxide and anesthetic and operative factors associated with severe pain in the early postoperative period after thoracolumbar spine surgery. Overview of Literature: Thoracolumbar spine surgery is the most common procedure in spine surgery, and up to 50% of the patients suffer from moderate to severe pain. Nitrous oxide has analgesic, anxiolytic, and anesthetic effects; nevertheless, its benefits for early postoperative pain control and opioid consumption remain to be established. Methods: The medical records of eligible participants who underwent thoracolumbar spine surgery between July 2016 and February 2017 were reviewed. Enrolment was performed consecutively until reaching 90 patients for the case (severe pain) group (patients with a pain score of >7 out of 10 at least once during the post-anesthesia care unit [PACU] admission), and 90 patients for the control (mild-to-moderate pain) group (patients with a pain score of <7 in every PACU assessment). The data collected comprised patient factors, anesthetic factors, surgical factors, PACU pain score, and PACU pain management. Results: A total of 197 patients underwent thoracolumbar spine surgery with an incidence of early postoperative severe pain of 53.3%. The case-control study revealed no differences in the factors related to pain intensity. A subgroup analysis was performed for failed back surgery syndrome (FBSS), spinal stenosis, and spondylolisthesis. After multivariate analyses, only the age group of 19–65 years and the baseline Oswestry Disability Index (ODI) were found to be significant risk factors for early postoperative severe pain in the PACU (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.32–6.25; OR, 1.03; 95% CI, 1.01–1.05, respectively). Conclusions: Nitrous oxide, anesthetic agents, and surgical techniques did not affect the early postoperative pain severity. Age under 66 years and the baseline ODI were the significant risk factors for pain intensity during the early postoperative period of the FBSS, spinal stenosis, and spondylolisthesis subgroups.

Analysis of Photoplethysmography-Based Surgical Pain Severity Assessment Markers

Ryu Gayeon,Choi Jae Moon,Lee Jaehyung,Seok Hyeon Seok,Shin Hangsik,Choi Byung-Moon 대한전기학회 2024 Journal of Electrical Engineering & Technology Vol.19 No.6

We investigated the use of photoplethysmography (PPG) features to assess the severity of both intraoperative and postoperative pain. PPG data was collected from 386 patients undergoing routine surgery. We extracted 180 pain assessment features based on PPG waveform characteristics identifi ed in previous studies. Pain assessment involves a two-step process. First, we evaluated the presence of pain using the extracted features. If signifi cant pain was detected, we then conducted a severity analysis. Pain severity was categorized into three groups: no pain, moderate, and severe. Intraoperative and postoperative pain labeling were based on clinical judgment and numerical rating scale criteria, respectively. For intraoperative pain presence, we performed statistical tests to identify signifi cant changes in features before and after both intubation and skin incision. Postoperative pain presence analysis compared preoperative and postoperative periods. Statistical analysis revealed 106 and 124 features signifi cant for intraoperative and postoperative pain presence, respectively. Among the pain-related features, 27 related to PPG amplitude, area, and slope were signifi cant for all severity comparisons (no pain vs. moderate, no pain vs. severe, and moderate vs. severe) during intraoperative assessment. Postoperative severity assessment identifi ed 12 signifi cant features related to PPG amplitude, area, and pulse interval. These results suggest the potential of PPG-based features for assessing pain severity.

Mechanisms of postoperative pain

강신영,Timothy J. Brennan 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3

Good pain control after surgery is important to facilitate overall recovery, improve patient satisfaction, decrease morbidity, and reduce health care cost. However, despite heightened awareness and development of new guidelines in recent decades, we have failed to make major improvements in postoperative pain control. Currently available analgesic therapies have limited efficacy, and pain after surgery continues to be a significant clinical problem. Our goal is to develop more effective and safer clinical strategies that will eliminate or greatly reduce postoperative pain, and a better understanding of the mechanisms of pain induced by surgery would be essential to achieve this goal. Evidence suggests that the pathophysiological mechanisms and optimal treatment of postoperative pain are different from many other painful conditions. Recognizing the necessity and importance of relevant pre-clinical models, we have developed and characterized rodent incision models that have close similarities to postoperative pain in patients. Previous studies have demonstrated the clinical relevance and translatability of these pre-clinical models of postoperative pain. In this review, we describe the rodent incision pain models, and summarized our current understanding of the mechanisms of postoperative pain, highlighting key findings from our previous studies using these models.

Association between Postoperative Neck Pain and Intraoperative Transcranial Motor-Evoked Potential Waveforms of the Trapezius Muscles in Patients with Cervical Myelopathy Who Underwent Cervical Laminoplasty

Ito Sadayuki,Sakai Yoshihito,Ando Kei,Nakashima Hiroaki,Machino Masaaki,Segi Naoki,Tomita Hiroyuki,Koshimizu Hiroyuki,Hida Tetsuro,Ito Kenyu,Harada Atsushi,Imagama Shiro 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.2

Study Design: Retrospective study.Purpose: Cervical laminoplasty is safe and effective for treating cervical myelopathy but has a higher frequency of postoperative axial pain compared to other methods. Several studies have reported on the causes of postoperative axial pain, but none have fully elucidated them. This study aimed to investigate the association between postoperative neck pain and intraoperative transcranial motor-evoked potential (MEP) waveforms of the trapezius muscles using transcranial MEPs.Overview of Literature: Few studies have investigated the association between postoperative neck pain and intraoperative transcranial MEP waveforms of the trapezius muscles in patients with cervical laminoplasty.Methods: A total of 79 patients with cervical myelopathy who underwent cervical laminoplasty at our facility between June 2010 and March 2013 were included in this study. Intraoperative control and final waveform were evaluated based on the trapezius muscle MEPs by measuring the latency and amplitude. A neck pain group comprised patients with higher neck pain Visual Analog Scale scores from preoperative value to 1 year postoperatively. The cross-sectional areas of the trapezius muscles and the MEP latencies and amplitudes were compared between patients with and without neck pain.Results: The latency and amplitude of the control waveforms were not significantly different between groups. The neck pain group had a significantly shorter final waveform latency (neck pain: 23.6±2.5, no neck pain: 25.8±4.5; p =0.019) and significantly larger amplitude (neck pain: 2,125±1,077, no neck pain: 1,630±966; p =0.041) than the no neck pain group.Conclusions: Postoperative neck pain was associated with the final waveform latency and amplitude of the trapezius muscle MEPs during cervical laminoplasty. Intraoperative electrophysiological trapezius muscle abnormalities could cause postoperative neck pain.

Association of preoperative pain in knee and external to knee with postoperative pain outcome after total knee arthroplasty

오탁규,장종범,신현정,한성희,도상환,조현희,황정원 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.4

Background: Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee. Methods: We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0–3 was assessed using a multivariable generalized linear model. Results: In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0–3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0–3 were not significantly different between the two groups (P > 0.05). Conclusions: This study showed that there was an increase of morphine equivalent consumption during POD 0–3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.