Maria do Carmo de Oliveira Ribeiro

Immediate post-craniotomy headache.

Introduction Headache is the most common adverse event immediately following craniotomy and is due to the surgical procedure and meningeal irritation. Objectives The aim of this study was to investigate the prevalence of headache during the first week after a craniotomy, as well as headache intensity, whether pain was registered in the patients medical records, the use of analgesics and predictors of headache. Methods Ninety-one patients who underwent craniotomy were evaluated from the first to the seventh post-operative day. The variables analysed were gender, age, medical history, indication for craniotomy, surgery, occurrence of headache, pain registration in the medical records, length of hospital stay and analgesics consumption. Results On the second post-operative day, 29.2% of patients had a headache and there was under-reporting of this pain in the patients’ records. The analgesics used were non-steroidal anti-inflammatory in 75% of cases. An age of <45 years (odds ratio = 3.0, p = 0.041) and surgery duration lasting >4 hours (odds ratio = 3.7, p = 0.019) were associated with the occurrence of immediate post-craniotomy headache. Conclusion Further training should be provided to professionals caring for patients undergoing craniotomy to better manage post-operative headache.

Knowledge of doctors and nurses on pain in patients undergoing craniotomy

The study objectives were to characterize the profile of the doctors and nurses caring for patients in the craniotomy postoperative period, checking pain assessment methods and to identify the existence of analgesia protocols. Cross-sectional and analytical study. The casuistry is constituted of 30 doctors and 30 nurses. The results revealed that 83.3 % of the nurses were female, 63.3% knew pain scales, and 16.6% said that analgesia protocols exist. Regarding doctors 60% were male, 70% knew the pain scales, 3.3% had specialization in pain treatment, 13.3% they stated that there are analgesia protocols. The ignorance on the part of doctors and nurses about the assessment scales and pain assessment methods reveals the need for the creation of institutional policies on controlling pain, the use of instruments for the measurement of the pain phenomenon and analgesia protocols in the institution.The study objectives were to characterize the profile of the doctors and nurses caring for patients in the craniotomy postoperative period, checking pain assessment methods and to identify the existence of analgesia protocols. Cross-sectional and analytical study. The casuistry is constituted of 30 doctors and 30 nurses. The results revealed that 83.3 % of the nurses were female, 63.3% knew pain scales, and 16.6% said that analgesia protocols exist. Regarding doctors 60% were male, 70% knew the pain scales, 3.3% had specialization in pain treatment, 13.3% they stated that there are analgesia protocols. The ignorance on the part of doctors and nurses about the assessment scales and pain assessment methods reveals the need for the creation of institutional policies on controlling pain, the use of instruments for the measurement of the pain phenomenon and analgesia protocols in the institution.

Quality of life of victims of traumatic brain injury six months after the trauma

OBJECTIVE to describe the quality of life of victims of traumatic brain injury six months after the event and to show the relationship between the results observed and the clinical, sociodemographic and return to productivity data. METHOD data were analyzed from 47 victims assisted in a trauma reference hospital in the municipality of Aracaju and monitored in an outpatient neurosurgery clinic. The data were obtained through analysis of the patient records and structured interviews, with the application of the World Health Organization Quality of Life, brief version, questionnaire. RESULTS the victims presented positive perceptions of their quality of life, and the physical domain presented the highest mean value (68.4±22.9). Among the sociodemographic characteristics, a statistically significant correlation was found between marital status and the psychological domain. However, the return to productivity was related to all the domains. CONCLUSION the return to productivity was an important factor for the quality of life of the victims of traumatic brain injury and should direct the public policies in promoting the health of these victims.OBJETIVOS: descrever a qualidade de vida das vitimas de trauma craniencefalico, apos seis meses do evento, e mostrar a relacao entre os resultados observados e os dados clinicos, sociodemograficos e retorno a produtividade. METODO: foram analisados dados de 47 vitimas assistidas em hospital referencia ao trauma, no municipio de Aracaju, SE, e acompanhadas em ambulatorio de neurocirurgia. Os dados foram obtidos pela analise dos prontuarios e entrevistas estruturadas, com aplicacao do questionario World Health Organization Quality of Life, versao breve. RESULTADOS: as vitimas apresentaram percepcao positiva de sua qualidade de vida e o dominio fisico (68,4±22,9) apresentou o maior valor medio. Entre as caracteristicas sociodemograficas, correlacao estatisticamente significante foi verificada entre estado civil e o dominio psicologico. Entretanto, o retorno a produtividade se relacionou com todos os dominios. CONCLUSAO: o retorno a produtividade foi fator importante para a qualidade de vida das vitimas de trauma craniencefalico e deve direcionar as politicas publicas na promocao a saude dessas vitimas.

Characterization of victims of trauma treated in an emergency hospital

Objective: to describe the socio-demographic profile of victims of trauma treated in an emergency hospital in Sergipe, Brazil. Method: this is an ecological, retrospective, and quantitative study. The sample consisted of 301 medical records of patients treated between January 2006 and July 2008 at Hospital de Urgencia in Sergipe. The collection was carried out within the period from September to December 2008, after the approval by the Research Ethics Committee of Universidade Federal de Sergipe under the Protocol 2448.0.000.107-08. The variables under study were age, gender, external cause, the most severely affected body region, length of hospital stay, Glasgow Coma Scale, and outcome. The data were analyzed through the software Statistical Package for the Social Sciences (SPSS) version 16.0. Results: the average age was 27.8 years, with a prevalence of males (85.7%), individuals from Sergipe state towns, apart from the capital (56.2%), victims of traffic accidents (47.2%) and aggression (27.6%), predominance of cranioencephalic trauma (61.5%), between Friday and Monday (71.5%), average length of hospitalization of 10 days and hospital discharge (74.1%). Conclusion: the higher frequency of cranioencephalic trauma in male young adults, victims of weekend accidents, suggests the need for intensifying the traffic accident prevention strategies to minimize the occurrence and possible consequences related to trauma. Descriptors: wounds and injuries; mortality; accidents, traffic; external causes.

Pain in patients undergoing appendectomy

BACKGROUND AND OBJECTIVES:Pain is a subjective manifestation of unpleasant, personal and untransferable experience, produced by tissue injury involving physical and chemical body mechanisms. This study aimed at identifying the presence of acute pain in the postoperative period of appendectomy, at checking pain records, at describing postoperative complications and at comparing pain management and the adequacy of analgesia.METHODS:This is a transversal, descriptive and quantitative study. Sample was made up of 41 patients submitted to appendectomy. A semi-structured interview was carried out with information about use of analgesics, presence of postoperative pain, pain site, consequences of pain and visual analog scale. To evaluate pain management and the quality of analgesia, the Pain Management Index proposed by the World Health Organization was calculated.RESULTS:From total sample, 61% were males, mean age was 34.36±11.64 years, 70.7% were married and all patients have referred pain. In 90.2% of cases there was no pain recording in medical charts. Surgical incision was the major pain site and its primary consequence was impaired physical mobility. As to pain intensity, 22.2% of patients had moderate pain and were inadequately treated according to Pain Management Index.CONCLUSION:There has been considerable inadequacy of analgesia, pain recording in medical charts was scarce and no nursing professional has recorded pain. Surgical incision was major pain complaint site and impaired mobility was the primary complication. Our data bring about the need for investments in health professionals qualification with regard to pain management.

Traumatic Brain Injury: Consequences and Family Needs

Traumatic Brain Injury (TBI) is one of the most common injuries resulting from external causes and constitutes a global public health problem of great significance. TBI is mainly caused by traffic accidents, violence and falls, with a strong impact on the population’s morbidity and mortality. TBI is a complex injury caused by a cascade of changes in the brain and throughout the body. Its consequences, especially neuropsychiatric ones, do not appear immediately, a characteristic of a silent epidemic (Hampton, 2011). It is considered to be a chronic disease process, according to the World Health Organization, presenting one or more of the following characteristics: permanent, caused by nonreversible pathological alterations, requires special treatment to rehabilitate the patient, or a long period of observation, supervision and care (Masel & DeWitt, 2010). It affects people of all ages, with a higher incidence among those who are 15 to 24 years old and 75 years old or older. It occurs twice as frequently in men as in women, half of all cases are associated with alcohol and can result in physical, cognitive, and psychosocial disability. Due to the large number of cases with disabilities, prevention is of great importance (National Institutes Health [NIH], 1999). There is a worldwide concern to promote widespread awareness, warning people of all classes and ages about how serious a problem TBI is becoming. Good education, knowledge of risk factors and prevention reduces the incidence of trauma and its consequences.

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.

Profile Of Burn Victims Attended By An Emergency Unit

Objectives: to identify the sociodemographic and health profile of burn victims, knowing the characteristics of the events and detecting the major analgesics prescribed in the emergency department. Methods: descriptive, exploratory and quantitative study with 16 burn victims treated at a Burn Treatment Unit from October 2015 to May 2016. Results: the average age of participants was 31.8 years (± 14.1). Mostly, the subjects were male (62.5%), single (43.8%), brown (68.8%), economically active (75.0%) and coming from Aracaju and its surroundings (62.5%). Injuries from burns were mostly of second degree (93.8%) and reached the lower limbs (68.8%). The average burned body surface was 15.8% (± 11.5). The circumstances surrounding burns occurred mainly at home (50.0%), on Sundays (25.0%) and in the shifts morning (37.5%) and night (37.5%). The main etiological agent was alcohol (31.3%). All patients received analgesia in the emergency department, but the minority had pain documented (18.8%). The physician was the only professional who reported pain in their records, but did incompletely (18.8%). Conclusion: due to the negative effects of burns, it is crucial to adopt educational and preventive measures to change the current scenario of epidemiology of such trauma. Keywords: Burns; Epidemiology; Analgesia; Emergency.