- Email: [email protected]
S530 ACUTE PAIN SERVICE AT AARHUS UNIVERSITY HOSPITAL, DENMARK
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
problem that requires attention, both from the administrative and medical standpoints, because prolonged stay causes annoyance and irritability of the patients. Patients’ irate behavior may distract the medical staff from effectively performing their duties and may interfere with optimal medical care of patients in the PACU. Disclosure: None declared
S529 BENEFITS ACCRUED ONE YEAR AFTER THE IMPLEMENTATION OF AN ACUTE PAIN SERVICE FOR CARDIAC SURGERY J. Cogan1 *, G. Vargas2 , Z. Yegin3 , A. Rochon1 , A. Deschamps1 , J.-S. Lebon1 , C. Ayoub1 , P. Couture1 , A. Denault1 , S. Belisle1 . 1 Anesthesia, Institut de Cardiologie de Montr´eal, Universit´e de Montr´eal, Montreal, 2 Anesthesiology, Pain Clinic, Hˆ otel Dieu, Universit´e de Montr´eal, 3 Nursing, Institut de Cardiologie de Montr´eal, Universit´e de Montr´eal, Montr´eal, QC, Canada Background and Aims: Rawal notes that the creation of an Acute Pain Service (APS) can result in decreased pain levels, decreased nausea and vomiting, and increased patient satisfaction. We report our results one year after the instauration of a nurse based, anesthesia supervised APS. Methods: In November 2009 we began to systematically follow all patients on days 1 through 4 after cardiac surgery to evaluate their level of pain and adjust their medication accordingly. Pain is measured using NRS of 0 to 10 both at rest and with movement and all scores are entered into a computerized database daily. The creation of the data base is ethics approved and every individual use of the database (for research purposes) is approved separately. Results: Between February 2010 and January 2011 the proportion of patients who were pain free remained unchanged on days one through four, however the pain scores upon movement decreased by almost 1 full point as follows: Day 1: 5.3 to 4.5, Day 2: 4.9 to 3.8, Day 3: 4.5 to 3.3 and Day 4: 4.6 to 4.0. The trend was similar for pain at rest. Many of the common side effects also decreased: nausea decreased from 46%, to 44%, nightmares decreased 16% to 6% and dizziness decreased from 14 to 12%. Conclusion: The committed efforts of the members of three departments: anesthesiology, nursing and pharmacy have contributed to the significant lowering of pain scores after cardiac surgery. We hope to integrate PCA pumps to our service next year. Disclosure: None declared
S530 ACUTE PAIN SERVICE AT AARHUS UNIVERSITY HOSPITAL, DENMARK C.F. Poulsen1,2 *, N. Strange3 . 1 Dept. of Anaestesiology, 2 Aarhus University Hospital, 3 Anaestesiology, Aarhus University Hospital, Aarhus, Denmark Background and Aims: The incidence of pain among hospitalised patients is high. In a recent survey including 1490 patients, 41% reported of moderate or severe pain postoperatively (Sommer et al. 2008). Acute pain services only exist at about 1/3 of hospitals (Benhamou et al. 2008). We want to describe the Acute Pain Service at Aarhus University Hospital in order to inspire colleagues to implement acute pain services at their hospitals. Methods: In 1996 Aarhus University Hospital, established an acute pain service which gradually has expanded. We are now two anaesthesiologists, four nurses and a project nurse. We offer specialised pain treatment to hospitalised patients, with complex pain problems and draw up individual treatment plans. The majority off our patients suffers from postoperative pain but we also attend to other cases. We see pain patients with complex non malignant or/and malignant diseases including palliative patients. We organise lessons in pain management for nurses, for medical colleagues, and educate specialist trainee in anaesthesiology in pain treatment approximately 95 days a year.
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We offer guidance, instruction and bedside teaching on a daily basis. We do research work and elaborate instructions and guidance to pain management. Results: In 2010 we had contact with 823 patients and made 3708 visits. The report from patients and our colleagues is that our effort is greatly appreciated and enables advanced surgery. Conclusion: Acute pain services should be established at all institutions in order to secure effective management of pain in hospitalized patients. Disclosure: None declared
S531 EFFECT OF HUMOR ON PAIN OF PATIENT WITH FEMUR FRACTURE R. Ghafouri *. Rajaaee Hospital, Qazvin, Iran Background and Aims: Pain is major problem in fracture exactly femur fracture. Humor will be a suitable way with less complication for decreasing pain. The aim of this study was to assess the effect of humor on pain of patient with femur fracture: Methods: In this clinical trial, 40 men with femur fracture that they had spinal anesthesia and internal reduction with nail participated. They randomized in two groups. Humor was performed during the surgery and 1 hour in day after surgery for intervention group. Data was collected with NPI for assessment of pain. Data was analyzed with SPSS 16. Results: Data analyze showed that intervention group significantly had less than pain from second group and they got less analgesic drug. Conclusions: Humor is good way for management of fracture pain. Disclosure: None declared
Conservative Treatment S601 EFFICACY AND SAFETY OF A SUBCUTANEOUS DICLOFENAC FORMULATION IN THE MANAGEMENT OF ACUTE PAIN: A RANDOMISED, DOUBLE-BLIND TRIAL 3 T. Dietrich1 *, R. Leeson2 , B. Zielinska-Ka ´ zmierska ´ , M. Opadczuk4 , E. Kozieł5 , B. Miklaszewski6 . 1 The School of Dentistry, University of Birmingham, Birmingham, 2 Eastman Dental Institute, University College London, London, UK; 3 NZOZ Polimedica, Zgierz, 4 Centrum Leczenia Chor´ ob Cywilizacyjnych, 5 Niepubliczny Zakład Opieki Zdrowotnej, Warszawa, 6 Gabinet Stomatologiczny Bartek, Wolomin, Poland Background and Aims: A new formulation containing diclofenac sodium and hydroxypropyl b-cyclodextrin (as a solubility enhancer), suitable for subcutaneous (s.c.) injection, has been developed in three different dosages: 25 mg (D25), 50 mg (D50) and 75 mg (D75) in 1 ml of water for injection. The analgesic efficacy and safety of a single s.c. injection of diclofenac 25 mg/ml and 50 mg/ml was evaluated in a validated acute pain model. Methods: Patients with acute moderate-to-severe post-surgical pain were randomly assigned to a single s.c. injection of diclofenac (D25, D50 or D75) or to the matched placebo (PBO). The primary endpoint was superiority of D25 and D50 to PBO in terms of pain intensity difference (PID) at 1.5 hours post-dose. PID was derived by subtracting each pain intensity (PI) score from the baseline PI (pre-treatment). Results: Both D25 and D50 produced a significantly higher pain relief compared to PBO (p < 0.001 in both comparisons). Considering PID at all time-points up to 8 hours, all diclofenac doses produced a significantly higher pain relief compared to PBO (p < 0.001 in all comparisons), while no significant difference between diclofenac doses was observed. No difference in AE reporting was detected
problem that requires attention, both from the administrative and medical standpoints, because prolonged stay causes annoyance and irritability of the patients. Patients’ irate behavior may distract the medical staff from effectively performing their duties and may interfere with optimal medical care of patients in the PACU. Disclosure: None declared
S529 BENEFITS ACCRUED ONE YEAR AFTER THE IMPLEMENTATION OF AN ACUTE PAIN SERVICE FOR CARDIAC SURGERY J. Cogan1 *, G. Vargas2 , Z. Yegin3 , A. Rochon1 , A. Deschamps1 , J.-S. Lebon1 , C. Ayoub1 , P. Couture1 , A. Denault1 , S. Belisle1 . 1 Anesthesia, Institut de Cardiologie de Montr´eal, Universit´e de Montr´eal, Montreal, 2 Anesthesiology, Pain Clinic, Hˆ otel Dieu, Universit´e de Montr´eal, 3 Nursing, Institut de Cardiologie de Montr´eal, Universit´e de Montr´eal, Montr´eal, QC, Canada Background and Aims: Rawal notes that the creation of an Acute Pain Service (APS) can result in decreased pain levels, decreased nausea and vomiting, and increased patient satisfaction. We report our results one year after the instauration of a nurse based, anesthesia supervised APS. Methods: In November 2009 we began to systematically follow all patients on days 1 through 4 after cardiac surgery to evaluate their level of pain and adjust their medication accordingly. Pain is measured using NRS of 0 to 10 both at rest and with movement and all scores are entered into a computerized database daily. The creation of the data base is ethics approved and every individual use of the database (for research purposes) is approved separately. Results: Between February 2010 and January 2011 the proportion of patients who were pain free remained unchanged on days one through four, however the pain scores upon movement decreased by almost 1 full point as follows: Day 1: 5.3 to 4.5, Day 2: 4.9 to 3.8, Day 3: 4.5 to 3.3 and Day 4: 4.6 to 4.0. The trend was similar for pain at rest. Many of the common side effects also decreased: nausea decreased from 46%, to 44%, nightmares decreased 16% to 6% and dizziness decreased from 14 to 12%. Conclusion: The committed efforts of the members of three departments: anesthesiology, nursing and pharmacy have contributed to the significant lowering of pain scores after cardiac surgery. We hope to integrate PCA pumps to our service next year. Disclosure: None declared
S530 ACUTE PAIN SERVICE AT AARHUS UNIVERSITY HOSPITAL, DENMARK C.F. Poulsen1,2 *, N. Strange3 . 1 Dept. of Anaestesiology, 2 Aarhus University Hospital, 3 Anaestesiology, Aarhus University Hospital, Aarhus, Denmark Background and Aims: The incidence of pain among hospitalised patients is high. In a recent survey including 1490 patients, 41% reported of moderate or severe pain postoperatively (Sommer et al. 2008). Acute pain services only exist at about 1/3 of hospitals (Benhamou et al. 2008). We want to describe the Acute Pain Service at Aarhus University Hospital in order to inspire colleagues to implement acute pain services at their hospitals. Methods: In 1996 Aarhus University Hospital, established an acute pain service which gradually has expanded. We are now two anaesthesiologists, four nurses and a project nurse. We offer specialised pain treatment to hospitalised patients, with complex pain problems and draw up individual treatment plans. The majority off our patients suffers from postoperative pain but we also attend to other cases. We see pain patients with complex non malignant or/and malignant diseases including palliative patients. We organise lessons in pain management for nurses, for medical colleagues, and educate specialist trainee in anaesthesiology in pain treatment approximately 95 days a year.
269
We offer guidance, instruction and bedside teaching on a daily basis. We do research work and elaborate instructions and guidance to pain management. Results: In 2010 we had contact with 823 patients and made 3708 visits. The report from patients and our colleagues is that our effort is greatly appreciated and enables advanced surgery. Conclusion: Acute pain services should be established at all institutions in order to secure effective management of pain in hospitalized patients. Disclosure: None declared
S531 EFFECT OF HUMOR ON PAIN OF PATIENT WITH FEMUR FRACTURE R. Ghafouri *. Rajaaee Hospital, Qazvin, Iran Background and Aims: Pain is major problem in fracture exactly femur fracture. Humor will be a suitable way with less complication for decreasing pain. The aim of this study was to assess the effect of humor on pain of patient with femur fracture: Methods: In this clinical trial, 40 men with femur fracture that they had spinal anesthesia and internal reduction with nail participated. They randomized in two groups. Humor was performed during the surgery and 1 hour in day after surgery for intervention group. Data was collected with NPI for assessment of pain. Data was analyzed with SPSS 16. Results: Data analyze showed that intervention group significantly had less than pain from second group and they got less analgesic drug. Conclusions: Humor is good way for management of fracture pain. Disclosure: None declared
Conservative Treatment S601 EFFICACY AND SAFETY OF A SUBCUTANEOUS DICLOFENAC FORMULATION IN THE MANAGEMENT OF ACUTE PAIN: A RANDOMISED, DOUBLE-BLIND TRIAL 3 T. Dietrich1 *, R. Leeson2 , B. Zielinska-Ka ´ zmierska ´ , M. Opadczuk4 , E. Kozieł5 , B. Miklaszewski6 . 1 The School of Dentistry, University of Birmingham, Birmingham, 2 Eastman Dental Institute, University College London, London, UK; 3 NZOZ Polimedica, Zgierz, 4 Centrum Leczenia Chor´ ob Cywilizacyjnych, 5 Niepubliczny Zakład Opieki Zdrowotnej, Warszawa, 6 Gabinet Stomatologiczny Bartek, Wolomin, Poland Background and Aims: A new formulation containing diclofenac sodium and hydroxypropyl b-cyclodextrin (as a solubility enhancer), suitable for subcutaneous (s.c.) injection, has been developed in three different dosages: 25 mg (D25), 50 mg (D50) and 75 mg (D75) in 1 ml of water for injection. The analgesic efficacy and safety of a single s.c. injection of diclofenac 25 mg/ml and 50 mg/ml was evaluated in a validated acute pain model. Methods: Patients with acute moderate-to-severe post-surgical pain were randomly assigned to a single s.c. injection of diclofenac (D25, D50 or D75) or to the matched placebo (PBO). The primary endpoint was superiority of D25 and D50 to PBO in terms of pain intensity difference (PID) at 1.5 hours post-dose. PID was derived by subtracting each pain intensity (PI) score from the baseline PI (pre-treatment). Results: Both D25 and D50 produced a significantly higher pain relief compared to PBO (p < 0.001 in both comparisons). Considering PID at all time-points up to 8 hours, all diclofenac doses produced a significantly higher pain relief compared to PBO (p < 0.001 in all comparisons), while no significant difference between diclofenac doses was observed. No difference in AE reporting was detected