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F601 SURVEY OF PATIENTS IN LABOR ON CONTINUOUS EPIDURAL ANALGESIA WHIT BOLUS ADMINISTERED BY THE PHYSICIAN VS PATIENT-CONTROLLED ANALGESIA
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
CRPS diagnosis; this was integrated into their systems to assist primary care clinicians manage CRPS more effectively. Disclosure: None declared
F536 WHICH LEGAL CONSEQUENCES FOR THOSE WHO CAUSE INFANTS TO SUFFER PAIN? C.V. Bellieni *, G. Buonocore, S. Perrone, M. Gabbrielli. University of Siena, Siena, Italy Background and Aims: The advances in perinatal care have led to a significant increase in neonatal survival rate but also to the rise of the number of invasive procedures. Several scientific studies show that newborns are able to feel pain more intensely than adults. Despite this evidence, neonatal pain and the right to an appropriate analgesia are systematically underestimated, ignoring ethical and moral principles of beneficence and non-maleficence. Infants are more susceptible to pain and the prolonged exposure to painful sensations can alter the neural development and the response to pain causing hyperalgesia. Anyone who caused pain without using any analgesic procedure due to negligence or incompetence, should be severely punished. Methods: We examined the current Italian law for this purpose. Results: The right to analgesia, fundamental principle, is fully incorporated in the Italian code of Medical deontology (article 3). The doctor who does not use analgesia for newborns’ treatment can be indicted by the Italian penal code (articles 582 and 583), aggravated by being the victim an infant, who is unable to defend himself. Conclusions: To avoid penal consequences, a careful education and attention are needed: “pediatric analgesia” should become a basic teaching in Universities and in specialization schools; analgesic treatments should be mandatory and annotated in the patient’s file even for minor potentially painful procedures. Disclosure: None declared
F537 OBSTACLES TO IMPROVING PATIENT SAFETY IN A MULTIDISCIPLINARY CHRONIC PAIN SERVICE BASED ON FOUR SITES T. Vemmer1 *, S. Duttagupta2 , K. Farooq3 . 1 Pain Management Unit, Montagu Hospital, Mexborough, 2 Pain Clinic, Bassetlaw Hospital, Worksop, 3 Pain Clinic, Barnsley District General Hospital, Barnsley, UK Background and Aims: The anaesthetic safety culture does not fit ambulatory chronic pain management in a bio-psycho-social approach. Methods: Outpatient pain services in the UK. Observational study: Introduction of comprehensive patient safety programme [3]: • Physician leadership • Physicians listen to all team members, e.g. auxiliaries • Nurse telephone triage of problems/complications • Team training in problem recognition/management • Regular audit involving whole team • “No-blame” root cause analysis • Good communication with primary care Results: Main obstacles: • No mortality benefit (no mortality before and after) • Cooperation across professional boundaries difficult in local culture [1] • Incremental, bottom-up approach difficult in hierarchical organization • Varying safety cultures of different team members [2] • Clearly defined, auditable adverse outcomes in pharmacotherapy and interventions only, not in psychology or physiotherapy. • ‘Reinvent the wheel’ at each hospital What worked well: 1. Many near-misses learned from. 2. Regular audit involving multidisciplinary team
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3. High standard of hospital infection control 4. Auxiliaries tell physicians about concerns 5. Communication with primary care improved 6. Safety programme helpful in service negotiations Conclusions: Improving patient safety in a multidisciplinary setting is feasible. Reference(s) [1] C Barnett. The Lost Victory. London, 1996. [2] F W Guldenmund. Saf-Sci, 34:215–57, 2000. [3] I Modak, et al. J-Gen-Intern-Med, 22:1–5, 2007. Disclosure: None declared
Conservative Treatment F601 SURVEY OF PATIENTS IN LABOR ON CONTINUOUS EPIDURAL ANALGESIA WHIT BOLUS ADMINISTERED BY THE PHYSICIAN VS PATIENT-CONTROLLED ANALGESIA P.R. Licameli Castelli1 *, M. Lopez de Garayo1 , A. Hernandez Martinez2 . 1 Department of Anesthesiology, 2 Departament Obstetric, Complejo Hospitalario La Mancha Centro, Alcazar de San Juan, Spain Background: It is very important to the acceptance of any analgesia techniques for labor. The opinion of patients about the technique is important to reinforce the information we have of each. Methods: 100 patients were selected in labor, and underwent a survey, which asked him what he would prefer epidural technique, a continuous epidural bolus administered by a doctor or an epidural bolus where administered by sheself. Subsequently, and depending on the response were given, 5 reasons why they preferred each other. Results: 60% prefer a continuous epidural bolus administered by the doctor. 34% have more trust in physicians, 20% are afraid of overexposure and 6% due to ignorance of the art. 40% agree with the PCA, where 24% have confidence in the technique and 16% would like to have control of their analgesia. Conclusions: The Patient-Controlled analgesia is a good alternative for labor analgesia. Disclosure: None declared
F602 CONTINUOUS EPIDURAL ANALGESIA VS PATIENT-CONTROLLED ANALGESIA IN LABOR P.R. Licameli Castelli1 *, M. Lopez de Garayo1 , A. Hernandez Martinez2 . 1 Departament Anaesthesiology, 2 Departament Obstetric, Complejo Hospitalario La Mancha Centro, Alcazar de San Juan, Spain Background and objectives: Continuous epidural Analgesia and Patient-Controlled Analgesia (PCA) are used in our hospital, as a routine technique. The study aims to compare these two forms of labor analgesia. Methods: This is an observational, informed consent of the patient, which divided the patients in two groups: A, which were given an epidural analgesia, and after loading bolus was with ropivacaine 2%, 20 mg, were continued analgesia by continuous infusion of ropivacaine 0.1% plus fentanyl, 1 micrograms/ml, a rate of 14 ml/hour. In group B, after the loading dose, the analgesia, were continued through PCA on demand, with infusion pumps Gem Star® , Hospira® , scheduled to deliver two bolus of 7 ml, with a closing 30 minutes, with a maximum of 2 gigs in an hour, 0.1% ropivacaine plus fentanyl 1 micrograms/ml. Results: The local anesthetic consumption was higher in group A than in B. Satisfaction was higher in group B than in A. Conclusions: The Patient-Controlled Analgesi, (PCA) bolus on demand, reduce consumption of anesthetic used and produce more satisfying for the mother. Disclosure: Hospira
CRPS diagnosis; this was integrated into their systems to assist primary care clinicians manage CRPS more effectively. Disclosure: None declared
F536 WHICH LEGAL CONSEQUENCES FOR THOSE WHO CAUSE INFANTS TO SUFFER PAIN? C.V. Bellieni *, G. Buonocore, S. Perrone, M. Gabbrielli. University of Siena, Siena, Italy Background and Aims: The advances in perinatal care have led to a significant increase in neonatal survival rate but also to the rise of the number of invasive procedures. Several scientific studies show that newborns are able to feel pain more intensely than adults. Despite this evidence, neonatal pain and the right to an appropriate analgesia are systematically underestimated, ignoring ethical and moral principles of beneficence and non-maleficence. Infants are more susceptible to pain and the prolonged exposure to painful sensations can alter the neural development and the response to pain causing hyperalgesia. Anyone who caused pain without using any analgesic procedure due to negligence or incompetence, should be severely punished. Methods: We examined the current Italian law for this purpose. Results: The right to analgesia, fundamental principle, is fully incorporated in the Italian code of Medical deontology (article 3). The doctor who does not use analgesia for newborns’ treatment can be indicted by the Italian penal code (articles 582 and 583), aggravated by being the victim an infant, who is unable to defend himself. Conclusions: To avoid penal consequences, a careful education and attention are needed: “pediatric analgesia” should become a basic teaching in Universities and in specialization schools; analgesic treatments should be mandatory and annotated in the patient’s file even for minor potentially painful procedures. Disclosure: None declared
F537 OBSTACLES TO IMPROVING PATIENT SAFETY IN A MULTIDISCIPLINARY CHRONIC PAIN SERVICE BASED ON FOUR SITES T. Vemmer1 *, S. Duttagupta2 , K. Farooq3 . 1 Pain Management Unit, Montagu Hospital, Mexborough, 2 Pain Clinic, Bassetlaw Hospital, Worksop, 3 Pain Clinic, Barnsley District General Hospital, Barnsley, UK Background and Aims: The anaesthetic safety culture does not fit ambulatory chronic pain management in a bio-psycho-social approach. Methods: Outpatient pain services in the UK. Observational study: Introduction of comprehensive patient safety programme [3]: • Physician leadership • Physicians listen to all team members, e.g. auxiliaries • Nurse telephone triage of problems/complications • Team training in problem recognition/management • Regular audit involving whole team • “No-blame” root cause analysis • Good communication with primary care Results: Main obstacles: • No mortality benefit (no mortality before and after) • Cooperation across professional boundaries difficult in local culture [1] • Incremental, bottom-up approach difficult in hierarchical organization • Varying safety cultures of different team members [2] • Clearly defined, auditable adverse outcomes in pharmacotherapy and interventions only, not in psychology or physiotherapy. • ‘Reinvent the wheel’ at each hospital What worked well: 1. Many near-misses learned from. 2. Regular audit involving multidisciplinary team
169
3. High standard of hospital infection control 4. Auxiliaries tell physicians about concerns 5. Communication with primary care improved 6. Safety programme helpful in service negotiations Conclusions: Improving patient safety in a multidisciplinary setting is feasible. Reference(s) [1] C Barnett. The Lost Victory. London, 1996. [2] F W Guldenmund. Saf-Sci, 34:215–57, 2000. [3] I Modak, et al. J-Gen-Intern-Med, 22:1–5, 2007. Disclosure: None declared
Conservative Treatment F601 SURVEY OF PATIENTS IN LABOR ON CONTINUOUS EPIDURAL ANALGESIA WHIT BOLUS ADMINISTERED BY THE PHYSICIAN VS PATIENT-CONTROLLED ANALGESIA P.R. Licameli Castelli1 *, M. Lopez de Garayo1 , A. Hernandez Martinez2 . 1 Department of Anesthesiology, 2 Departament Obstetric, Complejo Hospitalario La Mancha Centro, Alcazar de San Juan, Spain Background: It is very important to the acceptance of any analgesia techniques for labor. The opinion of patients about the technique is important to reinforce the information we have of each. Methods: 100 patients were selected in labor, and underwent a survey, which asked him what he would prefer epidural technique, a continuous epidural bolus administered by a doctor or an epidural bolus where administered by sheself. Subsequently, and depending on the response were given, 5 reasons why they preferred each other. Results: 60% prefer a continuous epidural bolus administered by the doctor. 34% have more trust in physicians, 20% are afraid of overexposure and 6% due to ignorance of the art. 40% agree with the PCA, where 24% have confidence in the technique and 16% would like to have control of their analgesia. Conclusions: The Patient-Controlled analgesia is a good alternative for labor analgesia. Disclosure: None declared
F602 CONTINUOUS EPIDURAL ANALGESIA VS PATIENT-CONTROLLED ANALGESIA IN LABOR P.R. Licameli Castelli1 *, M. Lopez de Garayo1 , A. Hernandez Martinez2 . 1 Departament Anaesthesiology, 2 Departament Obstetric, Complejo Hospitalario La Mancha Centro, Alcazar de San Juan, Spain Background and objectives: Continuous epidural Analgesia and Patient-Controlled Analgesia (PCA) are used in our hospital, as a routine technique. The study aims to compare these two forms of labor analgesia. Methods: This is an observational, informed consent of the patient, which divided the patients in two groups: A, which were given an epidural analgesia, and after loading bolus was with ropivacaine 2%, 20 mg, were continued analgesia by continuous infusion of ropivacaine 0.1% plus fentanyl, 1 micrograms/ml, a rate of 14 ml/hour. In group B, after the loading dose, the analgesia, were continued through PCA on demand, with infusion pumps Gem Star® , Hospira® , scheduled to deliver two bolus of 7 ml, with a closing 30 minutes, with a maximum of 2 gigs in an hour, 0.1% ropivacaine plus fentanyl 1 micrograms/ml. Results: The local anesthetic consumption was higher in group A than in B. Satisfaction was higher in group B than in A. Conclusions: The Patient-Controlled Analgesi, (PCA) bolus on demand, reduce consumption of anesthetic used and produce more satisfying for the mother. Disclosure: Hospira