THE ROLE OF Kv 7 POTASSIUM CHANNELS IN CENTRAL ANTINOCICEPTION INDUCED BY DICLOFENAC AND ETODOLAC

Background: Pain is one of the most common symptoms experienced by patients after surgeries. Inadequate postoperative pain management is an international problem and the need to improve its management is well documented. Objective: The aim of the study was to assess nursing reports related to the patients’ pain intensity and quality, concomitant symptoms, use of scales in pain assessment, and compliance with the national guideline after surgery. Design: This study was a retrospective cohort. Three hundred and eighty five medical records were analyzed using a pain management check list. Participants and setting: Samples were nurse records of patients in general, orthopedic, ENT and urology wards who had elective surgery with no history of diabetes and cancer according to the hospital statics and documentation database department in Imam Khomaini Hospital of Jiroft from April to September 2012. Result: Only 6% of the patients’ pain records included pain intensity which was not measured with standard scales. Parenteral analgesic was administered in 310 cases and more than half of all injections were opioid analgesic which is in contrast to the guidelines of the Iranian Ministry of Health. Pain assessment was higher in women and by nurses with more than 15 years of working experience. There was a negative relationship between the time of pain expression and reporting concomitant symptoms, meaning that reports were lower at night shifts. Conclusion: to conclude, the patients’ pain was not assessed properly in terms of intensity, quality, and associated symptoms. Therefore, training and motivating nurses is very important in this context and should be incorporated in nurses’ academic and continuous educational courses. Keyword: nursing, pain, patient records, postoperative HOW DO HEALTHCARE PROFESSIONALS PERCEIVE THE CONCEPT OF PAIN? A SYSTEMATIC REVIEW Aim: The manner by which healthcare professionals perceive the concept of pain has been identified as a influencing factor in the chosen pain assessment and management interventions. This review aimed to synthesise all relevant literature pertaining to healthcare professionals' perceptions of the concept of pain and how it influences treatment. Method: Systematic reviews and meta-analysis are a key element of evidence based healthcare. To ensure a comprehensive review was conducted the following five key steps were undertaken: the research question was framed, relevant publications were identified (inclusive of quantitative and qualitative study designs), study quality was assessed by two reviewers, findings were interpreted and synthesised by two researchers. Conclusions and relevance. The review focuses on healthcare professionals' perceptions of pain and how such perceptions impact on the care being provided to patients in pain. Personal perceptions of key health related concepts, such as pain, very often have been moulded by life experiences prior to an individual entering a medical or nursing degree programme. Such perceptions are so embedded we are not aware of them. Thus developing a degree of selfawareness is vital to gaining an appreciation for ones own perceptions and how such perceptions influence actions in clinical environments. Whilst numerous studies have explored various aspects of pain and pain management, there has not, as yet been a systematic review that has specifically focused on healthcare professionals personal perceptions of the concept of pain. Thus this review addresses an important gap in our knowledge and will contribute to the evidence based literature on pain Presenter: Nathan Carlin-Rosanio email: nathanrosanio@gmail.com address: Apt 80, 150 Howth Road, Clontarf, Dublin 2 Co-Presenter: Dr. Joy Conlon, School of Nursing and Human Sciences, Dublin City University. Poster Presentation Abstracts THE IMPACT OF HYPNOSIS ON THE AFFECTIVE DIMENSION OF PAIN: A LITERATURE REVIEW AND METAANALYSIS C. Dondaş and I. Dafinoiu Address correspondence to Corina Dondaş, Department of Psychology, Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University of Iaşi, 3 Toma Cozma Street, Romania. E-mail: corinadondas@gmail.com Interest in hypnotic treatment for pain conditions seems to be on the rise and recent evidence shows that hypnotic analgesia interventions result in substantial cost savings following medical procedures (Lang et al., 2000). Experimental studies suggest that hypnosis can differentially modulate the sensory or affective dimension of pain depending on the nature of the suggestions (Rainville, Carrier, Hofbauer, Bushnell & Duncan, 1999). However, there have been few systematic approaches to quantifying this effect across literature and less attention has been given to the specific procedures and suggestions used in hypnotic treatment in research. The present literature review and meta-analysis evaluates the magnitude of the effect of hypnosis on the affective component of pain. It also presents the scientific background and the usefulness of a hypnotic approach that uses emotion specific wording that would elicit prior positive experience to intervene at both the sensory and affective dimensions of pain. Such an approach would enable patients who cannot effectively dissociate from the sensation of pain, to diminish their affective response. The paper concludes with a discussion of the implications of the findings for future hypnosis research and for the clinical applications of hypnotic analgesia and it also emphasizes the utilization of positive state dependent learning (Rossi, 1986) advocated by Milton Erickson who advised practitioners to “discover their patterns of happiness” (Parsons-Fein, 2005). PERIPHERAL NERVE BLOCKS AND THE FRACTURED NECK OF FEMUR (NOF): A PAIN IN THE NOF? Dr P. Chinduluri, Dr T. Ellimah, Dr H. Lewis, Dr S. Qadri, Dr Toby Ashken (Barking, Havering and Redbridge University Trust) Core Anaesthetic Trainee (CT2), Consultant Anaesthetist Corresponding author: P. Chinduluri, 24a Green Lane, Purley, Surrey, CR8 3PG Background and Aims Patients with a fractured NOF represent one of the most challenging groups, in view of their decline in physiological status and co-morbid disease burden. They can suffer from significant pain and emotional distress, making the provision of sufficient analgesia throughout the hospital journey imperative. This necessitates input from experienced practitioners to ensure optimal pain management, whilst minimising the adverse effects of drugs, such as opioids. Consequently, the use of peripheral nerve blocks (PNB) has become increasingly popular as they can eliminate the need for additional analgesia for significant periods of time. This audit examines current practice at a busy district general hospital serving North London and Essex, and its adherence to the Anaesthesia Sprint Audit of Practice (2014) standards: 1. Peri-operative PNB should be offered to all patients 2. Spinal/epidural anaesthesia should be considered for all patients 3. A consultant anaesthetist, or an individual with level experience should anaesthetise all patients Methods 58 case-notes were reviewed retrospectively to ascertain modes of peri-operative analgesia delivered to patients who had NOF surgery over a 3-week period in May June 2014. Analgesic requirements, including opioid usage, were noted for each patient preand post-operatively. The use of PNB in the emergency department and in the operating theatres was also recorded, as was the mode of anaesthesia (i.e. general, neuroaxial block) and grade of anaesthetist. Results We found that no patients were offered a PNB pre-operatively; instead they were given a mixture of analgesics including strong opioids such as morphine and non-steroidal agents (NSAIDS). 10 patients (17%) received a PNB in theatres, 5 of which did not require strong opioids in the post-operative period. 93% of patients were anaesthetised by a consultant, or someone with similar experience (i.e. associate specialist), with an anaesthetic trainee present in only 31% of cases. 60% of patients received regional anaesthesia rather than general anaesthesia. Of note, 97% had no documented contraindications to a neuroaxial block. Conclusions The insufficient uptake of PNBs is most likely due to the clinician’s inadequate experience with performing this procedure. This audit has highlighted a unique learning opportunity within the hospital. The results reveal that senior anaesthetists run the majority of trauma theatre lists, but the absence of regular junior trainee anaesthetists denies them the chance to learn this key skill in a supported environment. Consequently, use of opioids in this patient group remains high, thus increasing the risk of side effects. A movement has been made within Queens Hospital to ensure that core anaesthetic trainees have a completed Certificate of Competence for performing fascia-iliaca blocks under ultrasound guidance, by the end of their trauma module. The results also demonstrate that many patients receive general anaesthesia despite having no documented contraindications to regional anaesthetic techniques, putting them at greater risk of post-operative confusion and higher analgesic requirements. In conclusion, by ensuring that junior anaesthetists receive the appropriate training to safely administer fasciailiaca blocks, there is the potential to revolutionise the pain services offered to fractured NOF patients in preoperatively. References • Royal College of Physicians, Association of Anaesthetists of Great Britain and Ireland (2014). The National Hip Fracture Database Anaesthetic Sprint Audit of Practice. London: Royal College of Physicians. • Association of Anaesthetists of Great Britain and Ireland (2012). Management of Proximal Femoral Fractures. London: Association of Anaesthetists of Great Britain and Ireland. • National Institute for Health and Care Excellence (2011). Hip fracture. The Management of Hip Fracture in Adults. [CG124]. London, Nati