Analgesic efficacy of 10% lidocaine spray during nasoenteral catheterization: Randomized triple-blind trial

Mitigating intubation stress, mucosa injury, and inflammatory response in nasogastric tube intubation via suppression of the NF-κB signaling pathway by engineering a hydration lubrication coating

Nasogastric tube (NGT) intubation is a common yet critical clinical procedure. However, complications arising from tube friction result in awful pain and morbidity. Here, we report a straightforward surface modification of slender NGT utilizing highly hydrated micelles that were composed of hyaluronic acid and Pluronic. The strong intermolecular hydrogen bonding facilitated the assembly of the micelles on NGT via a one-step dip coating process. The micelle coating conferred excellent hydrophilic, lubrication, anti-protein adhesive, and biocompatible properties. The in vivo efficacy of the micelle coating in alleviating catheterization irritation and mucosal injury was demonstrated using an NGT intubation model of rabbits. More importantly, compared to the paraffin oil coating (the current clinical means), the micelle coating possessed superior capability to reduce the inflammatory reaction caused by NGT intubation. The underlying mechanism was attributed to the suppression of the TLR4-IKBα-NF-κB inflammatory signaling pathway. This work provides a promising solution for developing lubricant medical coatings.

Management of Infections in Palliative Care Patients at the End-of-Life and Active Process of Death: A Brazilian Retrospective Study

Background

There is a lack of specific studies on the management of infections in patients receiving palliative care (PC) in the final stages of life and during the active process of death, related to specific nursing care. There is clinical and social importance as patients in PC represent a vulnerable population, and adequate management of infections is crucial to improve quality of life and the experience of comfort.

Objective

This study analyzed how infections are managed in patients undergoing PC at the end-of-life and in the active process of death in two hospital health services.

Design

This is an observational, analytical, and retrospective study.

Settings

Data collection took place in two hospitals that assist individuals who are hospitalized under PC, located in Brazil, in a city in the interior of the state of São Paulo.

Measurements and Results

The sample consisted of 113 medical records, in which the oncological diagnosis was the most prevalent. There was a predominance of infection diagnoses based on the patient's clinical symptoms, the main focus being the pulmonary, in individuals at the end-of-life. The management of infection in the study sample occurred through care and procedures that generate physical discomfort, however aiming at relieving symptoms. Such findings must be documented, as they invite us to reflect on our practical attitudes and what it means to be comfortable for these people, making it possible to incorporate this information into the design of interventions focused on enhancing the experience of comfort.

Effectiveness of Gel from Andaliman Fruit (Zanthoxylum acanthopodium DC.) Extract on Wound Inflammation

<b>Background and Objective:</b> Pain is caused by damaged tissue on the outside or inside of an organ and it is regulated by chemicals. Synthetic drugs are used to ease pain because they are analgesics in the field of medicine. Traditional medicine is known to help people all over the world, in both rich and developing nations. The Andaliman fruit, or <i>Zanthoxylum acanthopodium</i> DC., comes from a spice plant that grows naturally in Toba Regency, North Sumatra, Indonesia. This study aims to determine the formulation of the nanoherbal analgesic spray gel preparation of Andaliman fruit (<i>Zanthoxylum acanthopodium</i> DC.) in terms of its effectiveness as a pain reliever. <b>Materials and Methods:</b> There were three amounts of spray gel made, namely 5, 10 and 15% and tests were done to see how well they worked. <i>Staphylococcus aureus</i> bacteria were used in the bacterial blocking test. To test how well painkillers worked, five groups of mice were used. Using a hot iron, tests for anti-inflammatory activity and wound healing were done. The tissue was then watched for 14 days and analysed using Hematoxylin and Eosin (H&E) stains. <b>Results:</b> The 15% concentration reduces pain and the time it takes for the body to respond to it. The clear zone size is the same as (K⁺) and it can lower the number of inflammatory cells and help wounds heal by adding fibroblast and collagen cells. These findings are supported by significant data results (p<0.05, p = 0.018). <b>Conclusion:</b> Finally, analgesic gel spray made from the Andaliman fruit at a 15% concentration can help with pain and also be antibacterial, reduce inflammation and help wounds heal.</p>.

Application Effect of Somatostatin Combined with Transnasal Ileus Catheterization in Patients with Acute Intestinal Obstruction and Advanced Gastric Cancer

Objective: To explore the application of somatostatin combined with nasal plug catheterization in patients with advanced gastric cancer and acute intestinal obstruction. Methods. This study included 94 cases of patients with acute intestinal obstruction and advanced gastric cancer, and according to the length of hospital stay, the patients were randomly divided into two groups: the control group and the study group, with 47 cases in each group. Based on the observations made by the team in the control group given somatostatin combined treatment, we observed two groups of patients with gastrointestinal function, serum index, quality of life, therapeutic effect, and adverse reactions. Results. Abdominal distention, abdominal pain duration, and normal exhaust time were significantly shorter in the study group than in the control group. The study group was higher than the control group in terms of gastrointestinal decompression volume, drainage volume, and abdominal circumference reduction within 24 hours (P < 0.05). After treatment, the levels of CRP, IgA, LPS, and FABP were lower than before, and the levels of CRP, IgA, LPS, and FABP in the former group were much lower than those in the latter group (P < 0.05). Compared with before treatment, the former GIQLI scale score was significantly higher than the latter (P < 0.05). After treatment, the efficiency is much higher than the latter (P < 0.05). After treatment, the former significantly lowers the incidence of postoperative complications of the latter (P < 0.05). Conclusion. For patients with advanced gastric cancer and acute intestinal obstruction, it is safe and feasible to use somatostatin combined with transnasal intestinal obstruction catheterization to restore gastrointestinal function, improve inflammatory response, and promote the improvement of quality of life with high safety and feasibility.

Effectiveness of lidocaine spray on radial arterial puncture pain: A randomized double-blind placebo controlled trial

OBJECTIVE

Radial arterial puncture is a painful procedure. The aim of this study was to evaluate the effect of lidocaine spray (10%) on pain associated with radial artery blood withdrawal for arterial blood gas analysis.

METHODS

This randomized, controlled, double-blind study was performed between December 2018 and September 2019. Before radial arterial puncture, 10% lidocaine or placebo spray was applied to each patient by the attending physician, who was blinded with regard to random assignment. The spray was administered six times on the site from a distance of 5 cm. After waiting for 5 min, a radial arterial puncture was performed routinely. The pain levels of patients during radial arterial puncture and 5 min after puncture were evaluated with the visual analog scale (VAS). The Wilcoxon test was used to compare pain scores during puncture.

RESULTS

The research was performed with 67 patients (34 patients in the lidocaine group, 33 patients in the placebo group) who were admitted to the emergency department and required ABG analysis. Forty-three patients were men, and 24 were women. The ages of the patients ranged between 19 and 86 years, and the mean (± standard deviation) age was 56.3 ± 16.6 years. Pain levels, as measured by VAS, were significantly lower in the lidocaine group (24.00 mm IQR:[14.75-33.75]) compared with the placebo group (33.00 mm IQR:[22.00-61.50]) during radial arterial puncture (p = 0.011).

CONCLUSIONS

The level of pain perceived during radial arterial puncture was significantly lower in those who were administered lidocaine spray. Lidocaine spray application can be used in pain management related to radial arterial puncture.

Less Exposure for Health Care Workers, More Comfort for Patients During COVID-19 Swab Testing

BACKGROUND

Nasopharyngeal (NP) and oropharyngeal (OP) swab sampling for coronavirus disease 2019 (COVID-19) diagnosis may lead to droplet and/or airborne particle transmission and increase the exposure risk for health care workers (HCWs). However, there is limited evidence for effective methods to reduce occupational exposure from NP and OP swab sampling. This study aimed to reduce droplet-forming responses (DFRs) and the related exposure risk of NP and OP swab sampling by administering 10% lidocaine spray (LS) to the NP and OP areas prior to conducting swab tests.

METHODS

This quasi-experimental study was conducted with 100 patients who presented to our tertiary care hospital with symptoms of COVID-19 between December 1 and 15, 2020. First, NP and OP swabbings were performed on each patient. Thereafter, LS was applied to the OP and NP regions, and the swab samples were taken once again. Frequency of DFRs and real-time polymerase chain reaction (RT-PCR) test results before and after LS application were recorded for comparison. In addition, the cycle threshold (Ct) was used as a proxy indicator for SARS-CoV-2 viral load in COVID-19 positive cases.

FINDINGS

Significant differences in OP DFR frequencies before and after LS intervention were found (37% and 9%, respectively), as well as before and after NP DFR (31% and 18%, respectively). The mean Ct values for the positive samples did not differ before and after applying LS.

CONCLUSION

Our results suggest that applying LS to the OP and NP area prior to swab testing reduces DFR frequencies without affecting (RT-PCR) test results for SARS-CoV-2 and may increase patient and practitioner comfort.