Lesson of the week: postoperative pressure sores after epidural anaesthesia

Study on the effectiveness of modified colonoscopy nursing pads in colonoscopy

OBJECTIVE

To investigate the effect of modified colonoscopy nursing pads in colonoscopy.

METHODS

A total of 262 subjects who underwent colonoscopy at our endoscopy center between September 1, 2021 and February 28, 2022 were selected and randomly divided into a control group and an experimental group, with 131 cases in each group. The control group used conventional nursing pads, while the experimental group used modified nursing pads. The success rate of the first correct position, the time spent by the nurse to guide the correct position, the bed unit contamination rate, the contamination rate of the operator's protective equipment, the privacy protection of the examinees and the satisfaction degree after the examination were compared between the two groups.

RESULTS

The success rate of the first correct position of the examinees in the experimental group was significantly higher than that of the control group (P < 0.05), and the time spent by the nurses to guide the correct position in the experimental group was less than that of the control group (P < 0.05). The bed unit contamination rate and operator's protective equipment contamination rate of the experimental group were lower than those of the control group, and the satisfaction degree of the examinees was higher in the experimental group than in the control group, and the differences were statistically significant (P < 0.05).

CONCLUSION

The modified colonoscopy nursing pad can save the time of correct colonoscopy positioning of examinees, improve the efficiency of colonoscopy, reduce the workload of nursing staff, effectively protect the privacy of patients, reduce the bed unit contamination and protective equipment contamination, and then improve the comfort and satisfaction of patients.

Regional anaesthesia in trauma

Regional anaesthesia is very effective in alleviating pain due to trauma, and is also used to provide anaesthesia for trauma surgery. It has the advantage of producing localized but complete pain relief, whilst avoiding the side effects of systemic analgesics or anaesthetics. However, regional anaesthetic drugs and techniques have potentially life-threatening complications, which the practitioner must be able to manage. This article discusses the use of regional anaesthesia, and the benefits and disadvantages of specific regional techniques in various traumatic conditions.

Heel damage and epidural analgesia: is there a connection?

OBJECTIVE

To determine heel pressure injury prevalence in surgical patients prescribed epidural analgesia and identify intrinsic and extrinsic factors associated with heel damage in this patient cohort.

METHOD

A descriptive study was used to investigate intrinsic and extrinsic variables associated with recorded heel observations at a private hospital in Victoria, Australia. We recruited a sample of 29 consecutive non-emergency participants undergoing general anaesthesia for major surgery, who were prescribed epidural analgesia postoperatively. A total of 58 heel observations were made.

RESULTS

Heel damage prevalence in the study sample was 13.8% (n=8).

CONCLUSION

Intrinsic factors associated with this complication included intra- and postoperative hypotension, vascular disease, smoking, chronic obstructive pulmonary disease, and multiple disease burdens. Extrinsic factors associated with heel damage included thromboembolic deterrent stockings and the postoperative ward use of heel protectors designed for use in operating theatres. It is hoped that the study findings will assist improvements in the assessment of heel damage risk and promote the pressure prevention strategies required by this patient cohort.

Postoperative pulmonary infections

INTRODUCTION

Postoperative pulmonary infections are associated with cough, phlegm, shortness of breath, chest pain, temperature above 38 degrees C, and pulse rate above 100 a minute. Up to half of people may have asymptomatic chest signs after surgery, and up to a quarter develop symptomatic disease. The main risk factor is the type of surgery, with higher risks associated with surgery to the chest, abdomen, and head and neck compared with other operations. Other risk factors include age over 50 years, chronic obstructive pulmonary disease (COPD), smoking, hypoalbuminemia, and being functionally dependent.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to prevent postoperative pulmonary infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: advice to stop smoking preoperatively, anaesthesia, lung expansion techniques, and postoperative nasogastric decompression.

The decubitus ulcer: many questions but few definitive answers

Decubitus ulcers appear to be associated with insidious trauma. Differential diagnosis can be tricky, and etiology is controversial with sustained localized pressure which plays a significant role. Sustained pressure can stretch soft tissues and blood vessels, causing multiple microthrombi around the point of maximum compression. This leads to prolonged ischemia and produces a plaque of dead tissue surrounded by microthrombi. Prevention often includes regular movement or supports that move the patient. Good nutrition is important, but the adverse effects of fever should not be overlooked. Anti-thrombotic agents should be considered. Occlusive dressings can be used for existing ulcers, while traditional treatments are less appropriate. Pressure and other stresses theoretically should be relieved.

Perioperative analgesia: a factor in the development of heel pressure ulcers?

This article presents the incidence of heel pressure ulcers after an elective hip or a knee replacement. The majority of patients in the authors' institute receive either a neuraxial block (epidural and/or spinal) or peripheral nerve blocks (femoral and sciatic), depending on the anaesthetist's and surgeon's preference, and the patient's physical status. The past few years have seen increasing use of peripheral nerve blocks for knee replacement surgery. Patients with either the central or peripheral nerve blockade are at an increased risk of developing heel pressure ulcers. This article describes the experience at a tertiary referral centre and, in particular, highlights the risk of developing heel ulcers in patients receiving peripheral nerve blocks. Medical and nursing staff looking after these patients should be made aware of this complication and appropriate measures should be taken to prevent this avoidable complication.

Heel and Calf Capillary-Support Pressure in Lithotomy Positions

A three-part analysis was undertaken to increase understanding of the occurrence of pressure ulcers in lithotomy positions. An innovative measuring device was used to determine capillary pressure. Ankle blood pressure was measured compared to ankle height in 11 participants. Ankle systolic and diastolic pressure decreased approximately 20 mmHg per foot of elevation. Calf and heel capillary-support pressures were measured in 15 participants in the standard lithotomy position. Capillary-support pressure for the calf was substantially less than for the heel. Heel capillary-support pressures were measured in 16 participants in the high lithotomy position. As heel height increased, capillary-support pressure also increased.

Pressure Sore as a Complication of Labor Epidural Analgesia

Lumbar epidural analgesia has become a common mode of pain control for laboring patients. Side effects, such as hypotension, motor blockade, respiratory depression, dural puncture, and urinary retention, are well described. Although pressure sores have been thought of as a complication limited to elderly, emaciated, unconscious, or bedridden patients, we describe the occurrence of pressure sores in a young and healthy parturient after lumbar epidural analgesia.

IMPLICATIONS

We report a pressure sore that resulted from lumbar epidural analgesia for labor.