• 임상간호연구
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• 제17권2호
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• pp.286-296
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• 2011

Purpose: This research was done to compare the pain relief effects of various nursing interventions, such as cold therapy, attention diversion and 10% Lidocaine spray during arteriovenous fistula needling for patients on hemodialysis, and also to identify and develop more effective nursing interventions for pain relief in these patients. Methods: This research was conducted from October 1, 2010 to January 31, 2011 with 8 hemodialysis patients, who were on regular dialysis (3 times a week) at K University Hospital in Seoul and had an arteriovenous fistula within the past 3 months. Each patient received the three nursing interventions (cold therapy, attention diversion and 10% Lidocaine spray therapy) prior to the arteriovenous fistula needling and applied in turn with the series being repeated 4 times. After each intervention, physiologic indexes, subjective and objective pain were measured at the time of needling. ANOVA was used with SPSS/WIN 12.0 to analyze pain scores and comparison of physiologic indexes (BP, pulse). Results: No significant differences were found for subjective pain (p=.574), objective pain (p=.562) and total pain (p=.506) among the 3 interventions. Systolic blood pressure (p=.689), diastolic blood pressure (p=.969) and pulse (p=.980) also showed no significant difference among the 3 interventions. Conclusion: These 3 interventions are all possible for pain relief during arteriovenous fistula needling for these patients. However, the only interventions that nurses can do independently are cold therapy and attention diversion so we recommend that these nursing interventions be used.

• 종양간호연구
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• 제12권4호
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• pp.323-330
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• 2012

Purpose: Gamma knife radiosurgery (GKR) requires frame positioning because the treatment target should be as close as possible to the center of the frame. The purpose of this study was to identify the level of pin-fixing (PFP) and removal pain (PRP), and the associated factors with the pain undergoing GKR. Methods: A total of 116 patients who underwent GKR for their brain tumor were recruited from C University hospital located in H city, J province. The level of pain was measured by the 10 cm VAS. Results: The level of PFP and PRP were 6.36 and 3.26 points, respectively. Step-wise multiple regressions found that the group who have not perceived numbness after applying 5% EMLA cream was the highest associated factor with PFP, following the time from lidocaine injection to pin-fixation, which explained 21% of total variance of the level of PFP. On the other hand, a group who did not perceive numbness after applying 10% lidocaine spray was the highest factor with PRP, among female patients, which explained 27% of total variance of the level of PRP. Conclusion: Both of PFP and PRP of the stereotactic frame were moderate so that nurses should consider diverse strategies to reduce pain among patients undergoing gamma knife radiosurgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.379-396
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• 2021

Background: Trigeminal neuralgia (TN) is characterized by brief, unilateral, sharp, stabbing, and shooting pain of the fifth cranial nerve. The objective of this systematic review with meta-analysis was to determine the effect of medications compared to placebo in adult patients with TN. Methods: Review authors identified randomized placebo-controlled trials (RCTs) from PubMed, Web of Science, Cochrane, and EMBASE up to February 2021. We assessed the inclusion and exclusion criteria as well as the risk of bias of the studies based on the Cochrane Handbook. A total of 324 unduplicated references were scanned independently and reduced to eight relevant RCTs, with 89 patients included. Medications investigated included oral carbamazepine, subcutaneous sumatriptan, lidocaine (intranasal, 8% spray on the oral mucosa or intravenous), buprenorphine (ganglionic local opioid analgesia), and oral Nav1.7, a selective sodium channel blocker. Results: Meta-analyses showed that overall patients receiving lidocaine reported a significantly lower post-treatment intensity of pain -3.8 points on a 0-10 scale (95% Cl = -4.653 to -2.873; P < 0.001). Patients who received lidocaine were 8.62 times more likely to have pain improvement than patients on placebo (P < 0.001). In one RCT, patients receiving oral carbamazepine showed a significant improvement in pain intensity of -32% compared to the placebo (P < 0.001). In one trial, patients receiving 3 mg subcutaneous sumatriptan had a significantly lower intensity of pain on average -6.1 points on a scale of 0-10 compared to placebo (P < 0.001) and a significant improvement in pain intensity of -75% compared to the improvement in the placebo group (P < 0.001). Patients who received subcutaneous sumatriptan were 10 times more likely to have pain improvement than those who received placebo (P = 0.001) in one study. Due to the unclear/high risk of bias and small sample size, the quality of the evidence for lidocaine in the treatment of TN was low. Conclusion: Further studies are needed for carbamazepine, sumatriptan, buprenorphine, and oral Nav1.7 sodium channel blockers, as only one study reported outcomes.

• 대한치과마취과학회지
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• 제10권2호
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• pp.190-196
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• 2010

Difficult airway management including difficult intubation, difficult ventilation and difficult mask ventilation is a life threatening issue during anesthesia care. A 23-year-old woman with Treacher Collins syndrome was scheduled for distraction osteogenesis. She had hypoplasia of mandible and malar bone, bilateral deformities of auricles with partial deafness and antimongoloid slant of the palpebral fissures. A 56-year-old woman with mandibular hypoplasia due to childhood trauma was scheduled for distraction osteogenesis. She had a history of difficult intubation. We anticipated a difficult intubation and ventilation. Fiberoptic bronchoscopic guided awake intubation was selected for anesthesia induction. After intravenous injection of midazolam and remifentanil, 10% lidocaine pump spray on the pharyngolarynx with a direct laryngoscope and on the nasal canal. However fiberoptic bronchoscopic guided awake intubation was failed due to severe gag reflex. After intravenous injection of propofol and remifentanil using the target controlled infusion (TCI), mask ventilation was easily performed and, after intravenous injection of vecuronium, fiberoptic bronchoscopic guided intubation was easily performed using a wire reinforced endotracheal tube. The operation was completed successfully without any adverse events.