Transcript pain score iii).

CUTANEOUS ANAESTHESIA
IN ESWL
PRESENTED BY
SRMC & RI
Dr.GOVINDARAJAN.
Dr.ABRHAM KURIEN.
Dr.SANJAY PANDEY.
Dr. R.P.RAJAN.
Dr.SANKARAN.
PAIN IN ESWL
• PAIN DURING THE PROCEDURE OF ESWL ARISES
FORM THE SKIN / SOFT TISSUES AND AT FOCAL
POINT OF THE SHOCK WAVE PATH.
• THIS PAIN NEEDS ALEVIATION FOR A SUCESSFUL
PROCEDURE.
• DEGREE OF PAIN PERCEIVED HAS INDIVIDUAL
VARIATIONS.
• PAIN RELIEF MEASURES ARE TO BE
INDIVIDUALISED FOR OPTIMAL BENEFIT.
VARIOUS PAIN RELIEF
OPTIONS
 NSAIDS
 PARENTAL SEDATIVES :
FORTWIN
ALFENTANIL
MIDAZOLAM
PROPOFOL
 TROPICAL AGENTS
PRILOCAINE & LIDOCAINE cream.
DISADV.OF SEDATIVES
• SEDATIVE EFFECT LONG AFTER THE
PROCEDURE IS OVER – NEED FOR A
LONGER DURATION OF HOSPITAL
STAY.
• INHERENT ADVERSE EFFECT OF THE
DRUG WITH LOW EFFICASY WHEN
USED ALONE(PARTICULARLY
NSAIDS).
CUTANEOUS ANAESTHETIC
AGENT
• OUR PROSPECTIVE STUDY USED
PRILOCAINE WITH LIDNOCVAINE A
EUTACTIC MIXTURE .
• THIS IN THE FORM OF A CREAM WAS
APPLIED LOCALLY 40 MTS BEFORE THE
PROCEDURE.
• IF NEEDED INTAVENOUS SEDATION IS
ADMINISTED DURING THE PROCEDURE.
STUDY MATERIALS
• PATIENTS UNDER GOING ESWL FOR
BOTH RENAL AND URETERIC
CALCULI AT SRMC & RI WERE
INCLUDED IN THE STUDY ON
RANDOM BASIS.
• A TOTAL OF 26 PATIENTS WERE
OBSERVED.
PAIN ASSESMENT
• ASSESMENT OF PAIN WAS BASED ON THE
PAIN CHART WHICH HAS PROVISION FOR
BOTH THE DOCTER AND THE PATIENT TO
GRADE PAIN AND MEAN OF THE TWO WAS
FINAL PAIN LEVEL
• THIS PICTORIAL CHART IS ACCEPTED TO
BE SUPERIOR THAN QUESTIONNAIRE
ASSESMENT.
RESULTS
•
IN 18 PATIENTS THIS WAS SUFFICAINT
PRIMARY PAIN CARE(two of them experienced
mild bearable pain).
• IN 6 PATIENTS SEDATIVE WAS NEEDED AS
ADJUVANT (INJ.FORTWIN UPTO 10 mg)
USED.
• TWO OF THE PATIENTS REQUIRED
SEDATIVE MORE THAN 10 mg(30mg ).
EFFICASY OF L.A.
• 7 PATIENTS TOLERATED WITHOUT
SUBJECTIVE/OBSERVER IDENTIFICATION OF
PAIN( UP TO INTENCITY 4).(PAIN SCORE – I)
• 9 PATIENTS THOUGH HAD MILD PAIN DID NOT
NEED ANY ADJUNCTIVE MEASURES.(PAIN SCORE
II).
• 2 PATIENTS EXPERIENCED MODERATE PAIN BUT
STILL DID NOT REQUIRE INTERVENTION.(PAIN
SCORE – III).
EFFICASY…CONT.
• 6 OF OUR PATIENTS REQUIRED IV
SEDATION-YOUNG AGE, HYPERDENSE
STONE , PROLONGED PROCEDURE.(PAIN
SCORE III).
• TWO OF OUR PATIENTS WERE ANXIOUS
AND REQUIRED IV SEDATION AT THE
BEGINNING OF THE PROCEDURE (PAIN
SCORE IV).
PAIN SCORE
25
20
15
10
5
0
SCORE I
SCORE II SCORE III SCORE IV SCORE V
CONCLUSION
• LOCAL ANEASTHETIC APPLICATION
ALONE IS SUFFICIENT PAIN CARE.
• IF SEDATION IS USED THEN THE DOSE OF
ITS ADMINISTRATION IS REDUCED.
• NO UNTOWAD SIDE EFFECTS NOTED.
• SIMPLE AND COMFORTABLE.
CONCLUSIONS
• RENAL MOVEMENT WITH RESPIRATION IS
OBVIOUS IN SOME CASES.
• ANXIOUS PATIENTS MIGHT NOT BE
COMFORTABLE DURING THE PROCEDURE.
• CALCULI RESISTANT TO FRAGMENTATION
MAY NEED ADDED IV
SEDATION(CYSTINE,WHELLELITE,BRUSHITE).
• THIN INDIVIDUALS HAVE MORE PAIN BECAUSE
OF MORE CONVERGENCE