Postoperative Pain Assessment and Analgesic Administration in Native American Patients Undergoing Laparoscopic Cholecystectomy
(Impact Factor: 3.94).
01/2013; 148(1):91-3. DOI: 10.1001/jamasurg.2013.682
Ethnic disparities in pain assessment and analgesic administration following surgery have received little attention in the surgery literature. We noted that our Native American patients were less likely than others to complain of pain. A retrospective chart review of 21 Native American patients and a control group who underwent outpatient, elective laparoscopic cholecystectomy was performed. Native American patients had a statistically lower numeric pain score (mean, 6.5; 95% CI, 3.6-9.4) than non-Native American patients (mean, 8.1; 95% CI, 6.3-9.9; t38 = 2.63; P < .05). Native American patients also received less postsurgical analgesic (mean, 7.4; 95% CI, 4.0-10.8) than non-Native American patients (mean, 11.2; 95% CI, 7.2-15.2; t38 = 3.07; P < .01). Medical staff attending Native American patients should be aware that response to some scales to assess pain may not reflect accurately the degree of pain experienced.
Available from: Staja Booker
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Pain continues to be a significant problem for older adults worldwide and a challenge for health care clinicians and researchers in assuring accurate identification and tailored treatment approaches. Attention has been devoted in recent years to development of pain assessment tools that are reliable and valid for use with older adults, including self-report scales and pain observation tools. Methods and DesignThis integrative review examines face, content, and construct validity relative to the research development, linguistic translation, and clinical implementation of self-report pain assessment tools in culturally diverse older adults. ResultsMany self-report pain assessment tools have not been tested and validated in many older adults of diverse cultures. As a result, self-report tools are limited in their accuracy and ability to capture the cultural distinctions that impact pain intensity ratings. Conclusion
The multiculturalism of health care and the use of existing pain assessment tools globally require that clinicians and researchers consider tool validity that incorporates the individual's cultural system in order to provide quality pain assessment. This article addresses one aspect of tool development and application across populations, the validation of self-report pain assessment tools for culturally diverse older adults. Recommendations for each the research and clinician are provided to assist in development, translation, and use of various self-report pain assessment tools.
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Measurement of postoperative pain scores on arrival to the postanesthesia care unit (PACU) is a potential quality metric for supervising anesthesiologists. Our goal in this study was to determine whether rank-ordering by initial PACU numeric rating scale (NRS) pain score, as collected by nurses in a nonresearch clinical setting, could be used to compare anesthesiologists after adjusting for confounding factors.
For a large population of adult patients, the admission PACU NRS pain scores (0-10) were evaluated using proportional odds mixed effects models. Fixed effects included age, gender, race, opioids in the preoperative medication list, American Society of Anesthesiologists (ASA) physical status classification, emergency surgery, laparoscopic approach, outpatient status, anesthesiologist, and PACU nurse; surgeon and surgical procedure were included as random effects.
A total of 26,680 initial PACU pain scores were analyzed. The PACU nurse had the largest observed association with initial PACU pain score. Compared with the nurse with the median covariate adjusted NRS score, the odds ratio (OR) for an increased reported pain score ranged from 0.16 (95% confidence interval [CI] 0.11 to 0.24) to 2.95 (95% CI 2.43 to 3.59). For anesthesiologists, the ORs for an increase in reported pain ranged from 0.60 (95% CI 0.37 to 0.99) to 1.44 (95% CI 0.98 to 2.11). Factors associated with increased pain scores were preoperative opioids, female gender, and ASA physical status 2 and 3. Lower pain scores were associated with outpatient surgery, laparoscopy, African American race, and older patients.
There is little to no evidence to suggest that supervising anesthesiologists can be compared with one another effectively using admission PACU NRS pain scores. The confounding association of the PACU nurse eliciting the admission pain score greatly exceeded the contribution by the anesthesiologist.
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ABSTRACT: Sedative and analgesic medications have been used routinely for decades to provide patient comfort, reduce procedure time, and improve examination quality during colonoscopy.
To evaluate trends of sedation during colonoscopy in the United States.
Endoscopic data repository of U.S. gastroenterology practices (Clinical Outcomes Research Initiative, CORI database from 2000 until 2013).
The study population was made up of patients undergoing a total of 1,385,436 colonoscopies.
Colonoscopy without any intervention or with mucosal biopsy, polypectomy, various means of hemostasis, luminal dilation, stent placement, or ablation.
Dose of midazolam, diazepam, fentanyl, meperidine, diphenhydramine, promethazine, and propofol used for sedation during colonoscopy.
During the past 14 years, midazolam, fentanyl, and propofol have become the most commonly used sedatives for colonoscopy. Except for benzodiazepines, which were dosed higher in women than men, equal doses of sedation were given to female and male patients. White patients were given higher doses than other ethnic groups undergoing sedation for colonoscopy. Except for histamine-1 receptor antagonists, all sedative medications were given at lower doses to patients with increasing age. The dose of sedatives was higher in colonoscopies associated with procedural interventions or of long duration.
Potential for incomplete or incorrect documentation in the database.
The findings reflect on colonoscopy practice in the United States during the last 14 years and provide an incentive for future research on how sex and ethnicity influence sedation practices.
Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
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