Caíque Jordan Nunes Ribeiro

Glucose solution is more effective in relieving pain in neonates than non‐nutritive sucking: A randomized clinical trial

Few studies have compared the analgesic effect of 25% glucose and non‐nutritive sucking. We compared the analgesic effect of 25% glucose and non‐nutritive sucking in newborns undergoing hepatitis B vaccination. Our hypothesis is that 25% glucose is more effective in relieving pain than non‐nutritive sucking.

Factors associated with the humanization of care in a public maternity

RESUMO Objetivo : identificar fatores associados a humanizacao da assistencia durante o trabalho de parto, parto e nascimento. Metodo : estudo quanti-qualitativo, transversal, descritivo, realizado em uma maternidade publica. Foi utilizado formulario para a coleta de dados. Os dados foram analisados por meio de estatistica simples e testes de associacao e pela tecnica de Analise de conteudo. Resultados : participaram do estudo 373 puerperas com idade media de 26 anos, pardas, com baixa escolaridade e baixa renda. Houve associacao significante entre a presenca do acompanhante e liberdade para fazer perguntas; baixa escolaridade e menor informacao; parto vaginal e desrespeito por parte dos profissionais; mulheres brancas e presenca do acompanhante com maior satisfacao. Quanto a percepcao para melhoria da assistencia, emergiram as categorias: ambiencia, privacidade, informacao, respeito, garantia do acompanhante e desejo pela cirurgia cesariana. Conclusao : a adequada estrutura fisica e dimensionamento de pessoal qualificado sao necessarios para garantir a assistencia baseada em evidencias, centrada na mulher, visando a garantia dos seus direitos. Descritores : Satisfacao do Paciente; Assistencia a Saude; Humanizacao da Assistencia; Maternidades; Parto; Enfermagem Obstetrica. ABSTRACT Objective : To identify factors associated with the humanization of care during labor, delivery and birth. Method : this is a quantitative, cross-sectional, descriptive study carried out in a public maternity hospital. A form for data collection was used. Data were analyzed using simple statistics and association tests and by the Content Analysis technique. Results : there were 373 postpartum women with a mean age of 26 years old, with low educational level and low income participating in the study. There was a significant association between the presence of the companion and the freedom to ask questions; low education level and less information; vaginal delivery and disrespect by the professionals; white women and presence of the companion with greater satisfaction. Concerning the perception for better care, the following categories emerged: ambience, privacy, information, respect, the right of a companion, and desire for cesarean surgery. Conclusion : Adequate physical structure and skilled staffing are needed to ensure evidence-based, women-centered assistance to ensure their rights. Descriptors : Patient Satisfaction; Delivery of Health Care; Humanization of assistance; Hospitals, Maternity; Parturition; Obstetric Nursing. RESUMEN Objetivo : identificar factores asociados a la humanizacion de la asistencia durante el trabajo de parto, parto y nacimiento. Metodo : estudio cuanti-cualitativo, transversal, descriptivo, realizado en una maternidad publica. Fue utilizado um formulario para la recoleccion de datos. Los datos fueron analizados por medio de estadistica simple y tests de asociacion y por la tecnica de Analisis de contenido. Resultados : participaron del estudio 373 puerperas con edad media 26 anos, pardas, con baja escolaridad y baja renta. Hubo asociacion significante entre la presencia del acompanante y libertad para hacer preguntas; baja escolaridad y menor informacion; parto vaginal y falta de respeto por parte de los profesionales; mujeres blancas y presencia del acompanante con mayor satisfaccion. Sobre la percepcion para mejoria de la asistencia, surgieron las categorias: ambiente, privacidad, informacion, respeto, garantia del acompanante y deseo por la cirugia de cesaria. Conclusion : la adecuada estructura fisica y dimensionamiento de personal calificado son necesarios para garantizar la asistencia basada en evidencias, centrada en la mujer, visando la garantia de sus derechos. Descriptores : Satisfaccion del Paciente; Prestacion de Atencion de Salud; Humanizacion de la Atencion; Maternidades; Parto; Enfermeria Obstetrica.

Pain relief strategies during immunization

BACKGROUND AND OBJECTIVES: Vaccine is the most common source of pain in childhood, which can lead to the non-acceptance of immunization. Given that, healthcare professionals must use strategies to manage pain in their practice. The objective of this study was to analyze the non-pharmacological therapies used in clinical trials to manage pain during children’s immunization. CONTENTS: In this integrative review, we searched the LILACS, Medline, BDENF and Pubmed databases, using the keywords “Clinical trial,” “Pain management” and “Immunization,” with the Boolean operator AND. After searching and reading, eight articles were included in this review. The studies analyzed showed different techniques to manage pain, such as the use of movies, toys, facilitated position and parents’ training. CONCLUSION: The interventions studied proved to be beneficial to manage pain, and they can be performed by a professional or by the parents themselves, supporting the professionals in implementing it in their clinical practice.

Pain during tracheal aspiration in patients with traumatic brain injury undergoing mechanical ventilation

Vitimas de traumatismo cranioencefalico, internadas em unidades de terapia intensiva, frequentemente experienciam dor. A aspiracao traqueal e um procedimento com potencial nociceptivo realizado rotineiramente nesses pacientes. O objetivo deste estudo foi avaliar a dor durante a aspiracao traqueal em vitimas de traumatismo cranioencefalico submetidos a ventilacao mecânica. Estudo prospectivo realizado em duas unidades de terapia intensiva de um hospital geral publico em Aracaju, Sergipe, Brasil. Foram realizadas 300 observacoes em 20 vitimas de traumatismo cranioencefalico durante tres dias. A dor foi ava- liada por meio da versao brasileira da Behavioral Pain Scale e os parâmetros fisiologicos de frequencia cardiaca e pressao arterial (sistolica e diastolica). A profundidade da sedacao foi mensurada pelos escores de Ramsay e da Richmond Agitation Sedation Scale O teste de Friedman, ANOVA e pos-teste de Bonferroni foram utilizados para verificar a existencia de diferenca dos escores de dor e parâmetros fisiologicos nos diferentes momentos da avaliacao. Foi admitida significância estatistica de 5%. A amostra foi composta predominantemente por homens, jovens, do interior do estado, sem comorbidades e com traumatismo cranioencefalico grave. Fentanil e midazolam foram os farmacos mais utilizados para sedacao e analgesia. Houve alta prevalencia de dor (70,0-85,5%), os escores de dor foram significativamente mais altos durante a aspiracao traqueal e os parâmetros fisiologicos nao apresentaram elevacao estatisticamente significativa. Escalas comportamentais validas e confiaveis, como a Behavioral Pain Scale, devem ser incorporadas a rotina das unidades de terapia intensiva para nortear o manuseio da analgesia e sedacao, sobretudo, para prevencao de sofrimento durante procedimentos dolorosos.

Postoperative pain and analgesia in patients submitted to unruptured brain aneurysm clamping

BACKGROUND AND OBJECTIVES: Adequate postoperative pain evaluation and management are priorities for quality assistance, especially after neurological surgeries. This study aimed at evaluating postoperative pain of neurosurgical patients submitted to unruptured brain aneurysm clamping. METHODS: Prospective and descriptive study carried out in a charity hospital of the city of Aracaju, Sergipe, Brazil. Sample was made up of 28 patients submitted to elective craniotomy for unruptured brain aneurysm clamping. Mann-Whitney, Kruskal-Wallis and Dunn-Bonferroni tests were used for inferential analysis. Significance level was 5% throughout the study. RESULTS: Most patients (78.6%) were females, 64.0% had postoperative pain. There has been significant difference in the number of days with postoperative pain among patients with associated comorbidities (p=0.04) and previous surgery (p=0.01). Most patients had moderate and throbbing headache. There were no adequate pain records and most frequent analgesics were simple analgesics. Opioids prescription was incipient. CONCLUSION: Systematic pain evaluation should be part of multiprofessional assistance, in compliance with international and national pain institutions recommendations.

Cefaleia pré-operatória em pacientes submetidos a pinçamento de aneurisma cerebral não roto

JUSTIFICATIVA E OBJETIVOS: A cefaleia e um dos principais sintomas referidos por pacientes com aneurisma cerebral. Como outras dores sao, frequentemente, ignoradas pela equipe multiprofissional. Apesar de importante, a avaliacao da cefaleia no pre-operatorio de pincamento de aneurisma cerebral e um desafio para a equipe de saude. O objetivo deste estudo foi avaliar a cefaleia pre-operatoria em pacientes submetidos a pincamento de aneurisma nao roto. METODOS: Estudo descritivo, exploratorio, de abordagem quantitativa, realizado entre setembro de 2014 e maio de 2015 no setor de neurocirurgia e na unidade de terapia intensiva de um hospital de medio porte. A casuistica foi constituida por 28 pacientes no pre-operatorio de craniotomia eletiva para o tratamento de aneurisma cerebral nao roto. Utilizaram-se os testes de Mann-Whitney, Kruskal-Wallis e Exato de Fisher e adotou-se nivel de significância de 5%. RESULTADOS: Demonstrou-se que 78,6% dos pacientes eram do genero feminino com media de idade de 46,7 anos. A cefaleia pulsatil de localizacao frontal e intensidade moderada foi a dor mais prevalente. Nauseas e vomitos tambem estiveram presentes, assim como a dor no globo ocular. A dor piorou com o esforco fisico e balanceio da cabeca. Houve diferenca estatisticamente significativa para as variaveis: recorrencia da dor e dor em globo ocular. CONCLUSAO: Este estudo esclarece os principais itens a serem investigados na avaliacao da cefaleia do paciente com aneurisma cerebral e suas caracteristicas a fim de facilitar o diagnostico precoce e a melhora antecipada na recuperacao neurologica.BACKGROUND AND OBJECTIVES: Headache is a major symptom referred by patients with brain aneurysm. As other types of pain, it is often ignored by the multiprofessional team. Although important, headache evaluation in the preoperative period of brain aneurysm clamping is a challenge for the health team. This study aimed at evaluating preoperative headache of patients submitted to unrupted aneurysm clamping. METHODS: This is a descriptive, exploratory and quantitative study carried out between September 2014 and May 2015 in the neurosurgery sector and the intensive care unit of a medium-sized hospital. Sample was made up of 28 patients in the preoperative period of elective craniotomy to treat unrupted brain aneurysm. Mann-Whitney, Kruskal-Wallis and Fisher Exact tests were used with significance level of 5%. RESULTS: It was observed that 78.6% of patients were females with mean age of 46.7 years. Moderate pulsing and frontal headache was the most prevalent pain. Nausea and vomiting were also present, as well as pain in the eye. Pain has worsened with physical effort and shaking the head. There has been statistically significant difference for the variables pain recurrence and pain in the eye. CONCLUSION: This article clarifies major items to be investigated to evaluate headache of brain aneurysm patients and its characteristics to help early diagnosis and better neurologic recovery.

Dor em pacientes atendidos na classificação de risco de um serviço de urgência

BACKGROUND AND OBJECTIVES: Pain is a major symptom responsible for the search for urgency care. This study aimed at checking the presence of pain in patients attending the risk classification. METHODS: This is a cross-sectional and descriptive study carried out at an urgency care unit, using a form with socio-demographic and clinical data, risk classification, analgesia and pain record on medical charts. Pain Management Index proposed by the World Health Organization was calculated. RESULTS: From 102 patients included in the study, 82 (80.2%) reported pain, 45 (54.9%) were females, 48 (58.5%) were married, most (62 - 75.6%) lived in Greater Aracaju, 28 (34.1%) were classified as yellow. Acute, severe to moderate pain was the most frequent. In 71 (86.6%) cases, continuous pain has motivated the search for urgency care. Pain recording was present in almost all medical charts, being 80.5% performed by physicians. Simple analgesics and non-steroid anti-inflammatory drugs were the most frequently prescribed analgesics (59 - 72%). Pain management was inadequate in 86.6% of cases and there has been wide variation between admission and administration of first analgesia (mean: 94.5 min; min-max: 8-360 min). CONCLUSION: The lack of analgesic protocols at risk classification may impair adequate pain management.BACKGROUND AND OBJECTIVES: Pain is a major symptom responsible for the search for urgency care. This study aimed at checking the presence of pain in patients attending the risk classification. METHODS: This is a cross-sectional and descriptive study carried out at an urgency care unit, using a form with socio-demographic and clinical data, risk classification, analgesia and pain record on medical charts. Pain Management Index proposed by the World Health Organization was calculated. RESULTS: From 102 patients included in the study, 82 (80.2%) reported pain, 45 (54.9%) were females, 48 (58.5%) were married, most (62 – 75.6%) lived in Greater Aracaju, 28 (34.1%) were classified as yellow. Acute, severe to moderate pain was the most frequent. In 71 (86.6%) cases, continuous pain has motivated the search for urgency care. Pain recording was present in almost all medical charts, being 80.5% performed by physicians. Simple analgesics and non-steroid anti-inflammatory drugs were the most frequently prescribed analgesics (59 – 72%). Pain management was inadequate in 86.6% of cases and there has been wide variation between admission and administration of first analgesia (mean: 94.5 min; min-max: 8-360 min). CONCLUSION: The lack of analgesic protocols at risk classification may impair adequate pain management.

Knowledge of health professionals about pain and analgesia

BACKGROUND AND OBJECTIVES: Pain relief is a basic human right and an ethical issue involving all health professionals. This study aimed at describing what professionals of a multidisciplinary hospital team know about pain and analgesia. METHODS: This is a descriptive, cross-sectional study with quantitative approach, carried out at the Teaching Hospital of the Federal University of Sergipe. Sample was made up of 33 physicians, 26 nurses, 10 physiotherapists, 8 pharmacists and 5 psychologists. Data collection tool was a self-applied questionnaire encompassing knowledge about definitions and types of pain, evaluation and measurement, pharmacological and non-pharmacological management, and professional qualification in pain. Data were analyzed by simple descriptive statistics and are presented as tables. RESULTS: Participants of the study were predominantly females (72.0%), young adults (40.2%), with residence as maximum qualification (53.7%). Pain was considered discomfort/unpleasant sensation (46.3%) and chronic pain was defined as a symptom 48.8%). Only one professional reported using multimodal treatment for pain relief. Most professionals stated having acquired knowledge about pain and analgesia after graduation (79.3%) and that they feel the need for specific qualification (70.7%). CONCLUSION: This study has provided a situational diagnosis of the knowledge of the multiprofessional team of the hospital, showing that there is inconsistency between participants’ theoretical basis and their role in handling pain and humanizing assistance.