A review of the literature on cancer pain revealed that many persons with cancer receive inadequate analgesia for pain control, due in part to a lack of knowledge of the control of cancer pain by both physicians and nurses. This study is composed of two parts : one is to train nurses to change their knowledge of and attitude toward the pain management of patients having cancer and to evaluate the effectiveness of this training in comparison with other non-trained group ; the other is to test the applicability of the pain management method knowledge and attitude in the levels of pain of oncology patients. General characteristics of nurses such as age, education, educational experiences of cancer pain management were not different in both groups except the clinical experience. General characteristics of cancer patients and pain-related variables such as pain, sleep, daily activities, treatment modalities, causes of pain were not different in both groups except the educational levels of patients. After an eight-hour educational program given to the experimental nurse group, the knowledge and attitude about assessment of cancer pain, pain medication, and pharmacological knowledge were significantly higher in the experimental group than in the control group, while knowledge about classification of analgesics was not significantly different. The amount of analgesics, measured by the morphine equivalent doses, used in the experimental group was significantly lower than in the control group in the first and the last days. The experimental group used more systematic ways of drug changes from non-narcotic analgesics to narcotic analgesics than the control group. This indicated that the control group used fentanyl patches more commonly than in the control group. Cancer pain scores of both group of patients were measured on an hourly bases for a week in both groups. The patients' pain scores of the first day of measurement in experimental group were not significantly higher than those of control group of patients, while those of the last day were significantly higher than those of the control group. This study supports the need for educational program for the management of cancer pain to the nurses and the doctors.
Analgesia ; Analgesics ; Analgesics, Non-Narcotic ; Classification ; Education ; Fentanyl ; Humans ; Morphine ; Narcotics ; Pain Management*

PURPOSE: To assess the effectiveness of a care map for a fast-track discharge program after colorectal cancer surgery. METHODS: Ninety-nine patients who underwent colorectal surgery were retrospectively analyzed: 45 patients who were placed in a conventional program (January 3 to March 13, 2013) and 44 patients who were placed in a fast-track program using the care map (July 26 to September 24, 2014). Patients in the fast-track program started eating on postoperative day 1, while those in the conventional program started eating on post-operative day 2. complications, and pain were compared between the two groups. RESULTS: A slight decrease in the average duration of hospitalization was observed for the fast-track group (5.31+/-0.98 days) compared to the conventional group (5.38+/-2.80 days), although this difference was not statistically significant. All other outcomes for the fast-track group were scored as 0. Furthermore, there was no statistically significant differences between pain, narcotics administration, and non-narcotic analgesics (aside from patient-controlled analgesia). CONCLUSION: The care map for the colorectal surgery fast-track program was effective and program validation and supplementation of the active standardization early recovery program should be performed using multi-disciplinary research.
Analgesics, Non-Narcotic ; Colorectal Neoplasms* ; Colorectal Surgery ; Eating ; Hospitalization ; Humans ; Narcotics ; Retrospective Studies

Background: Surgical injury produces nociception, inflammation and hyperalgesia. Non-steroidal anti-inflammatory drugs (NSAIDs) if present at the site of surgical injury may retard or even inhibit the inflammatory response in the tissue. Meloxicam, a COX 2 preferential NSAID was chosen as the study drug because of its long elimination half life and its good tolerability with respect to local and systemic reactions Objectives: To compare the postoperative analgesia provided by a single dose oblique muscle infiltration of 15 mg Meloxicam with Meloxicam 15 mg/IM over the vastus lateralis muscle at the anterolateral thigh for patients undergoing emergency appendectomy and to determine whether there was any difference in the requirements for postoperative analgesia between the two groups Methods: 40 ASA I-II patients aged 18-65 years old with acute appendicitis scheduled for emergency appendectomy through a McBurneys incision under spinal anesthesia were included in this randomized prospective blinded study. Right after peritoneal closure, patients in DWI group (N=21) received local infiltration of meloxicam 15 mg while patients in the ATI group (N=19) received meloxicam 15 mg over the anterolateral thigh. VAS scores at different time intervals were noted at rest, upon movement by raising the shoulders off the bed, and upon coughing. A rescue dose of 10 mg/IV Nalbuphine was given as needed by the patient Results: There was no significant difference in the demographic variables between the two groups. Only the VAS scores upon movement showed statistically different results between the DWI group and the ATI group (RMANOVA, p0.05, Significant). The proportion of those patients who requested rescue analgesics and the mean amount of rescue analgesic was also statistically different between the two groups. Patients in the ATI group required rescue analgesics earlier than those in the DWI group (p0.05, Significant) Conclusion: Intramuscular wound infiltration with Meloxicam 15 mg resulted in lower VAS scores upon movement, less requirement for rescue analgesics, and longer time interval needed before the rescue analgesic is given. (Author)
Human ; Aged ; Middle Aged ; Adult ; Young Adult ; ANALGESIA ; APPENDECTOMY ; ANTI-INFLAMMATORY AGENTS ; NON-STEROIDAL ; ANALGESICS ; ANALGESICS ; NON-NARCOTICS ; INTRAOPERATIVE COMPLICATIONS

Lower back pain is one of the major health problems in the general population. The causes of lower back pain are heterogeneous and its treatment is complicated. The administration of oral analgesics is the basic step in the treatment of acute somatic pain. Most physicians advocate the three step analgesic ladder method, and NSAIDs are a mainstay of therapy for both acute and chronic lower back pain. Among the patients with chronic pain narcotics with psychotropic drugs have a better efficacy especially in the patients with neuropathic pain. Successful long-term analgesia is a challenge for physicians. The administration of a single agent or a combination of the above drugs to the specifically individualized patients could improve the function and quality of life and achieve the last goal of treatment of chronic lower back pain.
Analgesia ; Analgesics* ; Anti-Inflammatory Agents, Non-Steroidal ; Chronic Pain ; Humans ; Low Back Pain* ; Narcotics ; Neuralgia ; Nociceptive Pain ; Psychotropic Drugs ; Quality of Life

PURPOSE: The incidence of adverse drug reactions (ADRs) is increasing. However, studies on the prevalence of ADRs in children are rare. The aim of this study was to investigate the causative drugs and clinical features of ADRs for children in a tertiary university hospital of Korea. METHODS: We retrospectively collected ADRs by a computerized self-reporting system in Asan Medical Center. ADRs of children under the age 18 were collected from January 2005 to August 2015, and we analyzed only ADRs containing current symptoms among total ADR data. RESULTS: A total of 1,408 ADR cases were reported, There were 764 male (54.3%) and 644 female patients (45.7%), and the mean age was 11.5±5.8 years (range, 0–18 years). Antibiotics (n=479, 34.0%) were the most common causative drugs, followed by tramadol (n=173, 12.3%), nonsteroidal anti-inflammatory agents (NSAIDs) and acetylsalicylic acid (n=103, 7.3%), narcotics (n=91, 6.5%), antineoplastics (n=87, 6.2%), and sedatives (n=82, 5.8%). The most common clinical features were skin manifestations (n=500, 34.4%). Gastrointestinal symptoms (n=435, 29.9%) were the second most common clinical features, followed by neuropsychiatric symptoms (n=155, 10.7%) and respiratory symptoms (n=123, 8.5%). Among antibiotics, glycopeptides (n=110, 23.0%), third-generation cephalosporins (n=83, 17.3%), and penicillin/β-lactamase inhibitors (n=60, 12.7%) were the most frequently reported causative drugs. CONCLUSION: Antibiotics were the most reported common causative drugs of ADRs in children, followed by tramadol, NSAID, and narcortics. Compared with adults, the prevalence of contrast medium-induced ADR was lower in children with a higher prevalence of sedative-associated ADR. Greater attention to possible ADRs in children is needed among medical personnel.
Adult ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Antineoplastic Agents ; Aspirin ; Cephalosporins ; Child ; Chungcheongnam-do ; Drug-Related Side Effects and Adverse Reactions* ; Female ; Glycopeptides ; Humans ; Hypnotics and Sedatives ; Incidence ; Korea ; Male ; Narcotics ; Prevalence ; Retrospective Studies ; Skin Manifestations ; Tramadol

PURPOSE: Postoperative nausea and vomiting (PONV) is very common among postoperative orthopedic surgical patients with patient-controlled analgesia (PCA), especially for narcotics. Therefore, the purpose of this study was to investigate the effects of an evidence-based PONV management protocol on nursing and patient outcomes. METHODS: A methodological study was conducted to develop PONV protocol and a quasi-experimental study to evaluate the effectiveness of protocol. The preliminary PONV protocol was drawn by conducting a systematic review and by reviewing clinical guidelines and best practice recommendations. Validation of the content was done by expert clinicians, and the clinical applicability was evaluated by staff nurses and patients. The effect was evaluated in clinical outcomes associated with PONV and nursing outcomes. RESULTS: In the experimental group, the occurrence of vomiting (z=2.147) was significantly decreased, the maintenance PCA (χ²=4.212) and the satisfaction of patients (z=5.007) were significantly higher. In the outcomes of nurses, the PONV knowledge of nursing care (z=3.791), awareness (z=2.982) and self-efficacy (z=2.745) were higher in the experimental group. The attitude towards evidence-based nursing practice (z=2.446) was significantly positive. CONCLUSION: The results show that an evidence-based approach to the implementation of PONV care is effective in improving patient clinical outcomes and quality of care.
Analgesia, Patient-Controlled ; Clinical Protocols ; Evidence-Based Nursing* ; Humans ; Methods ; Narcotics ; Non-Randomized Controlled Trials as Topic ; Nursing ; Nursing Care ; Orthopedics ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting* ; Practice Guidelines as Topic ; Program Development ; Program Evaluation ; Vomiting

BACKGROUND/AIMS: The recent introduction of computerized surveillance systems has promoted the monitoring of adverse drug reactions (ADRs), a feature that facilitates voluntary reports and enables prompt feedback. To investigate the causative agents and severity of ADRs that occurred in a single hospital, we analyzed the features of 980 ADRs that occurred over 14 months after developing a computerized ADR reporting system in Hallym Sacred Heart Hospital. METHODS: ADR data collected prospectively from September 2007 to October 2008 by a computerized reporting system were analyzed. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria were used to determinate causality for each ADR. RESULTS: The number of ADR cases reported voluntarily increased rapidly since the introduction of the computerized ADR reporting system. Of the 980 cases, antibiotics (34.5%) were the most common causative drugs, followed by analgesics such as tramadol and its compound (15.2%), radiocontrast media (7.0%), narcotics (5.9%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (5.5%). Fifty-nine (6.0%) and 206 (21.0%) cases were classified as severe and moderate reactions, respectively. The mean age was older in patients with severe ADRs than in patients with non-severe ADRs. The most common clinical features were skin manifestations, such as pruritus, skin eruptions, and urticaria. Gastrointestinal symptoms including nausea, vomiting, and diarrhea were the second most frequently reported ADRs. Among antibiotics, first-generation cephalosporins were the most frequently reported causative drugs, followed by second-generation cephalosporins, penicillin/beta-lactamase inhibitors, and third-generation cephalosporins. While 11.6% of ADRs related to penicillin/beta-lactamase inhibitors were classified as severe, there was only one severe ADR (1.1%) for first-generation cephalosporins. Most ADRs were reported equally in men and women, although female cases constituted about two thirds of ADRs associated with tramadol and NSAIDs. CONCLUSIONS: We believe that a computerized reporting and replying system promoted the monitoring of ADRs. Antibiotics were reported most frequently as the causative agent of ADRs. Elderly patients seemed to be more susceptible to severe ADRs. With the voluntary reporting system, skin manifestations and gastrointestinal symptoms were detected successfully, while laboratory abnormalities without prominent symptoms seemed to be overlooked. Further efforts to screen for automated ADR signals are required.
Aged ; Analgesics ; Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Cephalosporins ; Contrast Media ; Diarrhea ; Drug Toxicity ; Electronics ; Electrons ; Female ; Heart ; Humans ; Male ; Narcotics ; Nausea ; Prospective Studies ; Pruritus ; Skin ; Skin Manifestations ; Tramadol ; Urticaria ; Vomiting ; World Health ; World Health Organization

Long QT syndrome is a cardiac repolarization disorder and is associated with an increased risk of torsades de pointes. The acquired form is most often attributable to administration of specific medications and/or electrolyte imbalance. This review provides insights into the risk for QT prolongation associated with drugs frequently used in the treatment of chronic pain. In the field of pain medicine all the major drug classes (i.e. NSAIDs, opioids, anticonvulsive and antidepressant drugs, cannabinoids, muscle relaxants) contain agents that increase the risk of QT prolongation. Other substances, not used in the treatment of pain, such as proton pump inhibitors, antiemetics, and diuretics are also associated with long QT syndrome. When the possible benefits of therapy outweigh the associated risks, slow dose titration and electrocardiography monitoring are recommended.
Analgesics ; Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Anticonvulsants ; Antidepressive Agents ; Antiemetics ; Cannabinoids ; Chronic Pain ; Diuretics ; Electrocardiography ; Long QT Syndrome ; Muscle Relaxants, Central ; Narcotics ; Proton Pump Inhibitors ; Torsades de Pointes