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APPENDICES
APPENDIX A
PATIENTS INFORMATION SHEET WHAT IS THE STUDY ABOUT?
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The study is aimed at determining the effects of epidural analgesia using two methods of administration continuous infusion or intermittent bolus to manage postoperative pain. If you agree to participate, you will be expected to answer questions using a proforma.
In the theatre before surgery bupivacaine solution for epidural analgesia will be administered via an epidural catheter sited at your back. To site the epidural catheter you will be requested to sit-up and curl up tightly over your abdomen to give anaesthesiologist the best view of your spine. An area of your back will be cleaned with antiseptic solution and numbed with a local anaesthetic to minimize the pain from actual epidural needle insertion. Occasionally the needle will touch a nerve causing movement of your legs or a feeling of shooting pain. A test dose will be given after the epidural is sited to confirm correct catheter placement. You will be requested to communicate your feeling when this is done. After initiation of analgesia you will be advised to lie on your back as this may help prevent drop in blood pressure. After surgery the epidural will be left on your back for postoperative pain management for up to 24hrs, during this time you may still experience some weakness on your leg. After the removal of catheter, you may still experience numbness in your leg for up to 4 hours. Bupivacaine is a local anaesthetic commonly used for regional analgesia; the drug is safe for you especially the dose as in the study. The cost of procuring the drugs and the infusion pump for the postoperative pain management will be borne solely by the researcher.
The Risk
The risk of epidural include: a drop in your blood pressure which can usually be treated by medication or position change; back pain; headache (inadvertent postdural puncture);
shivering; urinary retention.
Withdrawal
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Your participation is voluntary and you may withdraw at any phase of the study. Your refusal to participate will in no way affect the quality of care you will receive.
CONFIDENTIALITY
The information collected from you will be treated in absolute confidence. I owe it a duty to keep your records absolutely secret.
BENEFIT OF PARTICIPATION
Immediate postoperative period is usually painful and unpleasant for many but, with epidural analgesia this period should be rendered painless and thus comfortable for you.
Epidural analgesia is expected to provide excellent pain relief in the immediate postoperative period.
APPENDIX B CONSENT FORM
Having been properly informed about the study, the drug to be used, the mode of delivery of epidural analgesia and that:-
1. The study is for a research purpose.
2. The information collected will be made confidential.
3. The study will be beneficial to mankind.
4. The drugs are free and safe.
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5. The study is voluntary and I can withdraw from the study at any phase if I so desire.
I hereby give my consent to participate in the study.
Initial of participant. Signature/thumbprint Signature of witness and date.
Of participant and date.
Signature of Researcher____________________________Date
APPENDIX C
PROFORMA Date:……..…. Time:….……
Initials of participant:-
Hospital No:-
Age (yrs):-
Sex:-
Weight(kg):-
Height(m):-
BMI(kg/m2):-
Marital Status:-
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Parity:-
Any previous anaesthesia Yes ( ) No ( )
Any complication from previous anaesthesia Yes ( ) No ( )
ASA score:- ASAI, ASAII
APPENDIX D
INRAOPERATIVE MONITORING CHART TIME:……….
Parameters Base line
5min 10min 15min 20min 25min 30min 1rh 2hrs 3hrs 4hrs
Pulse rate SBP DBP MAP Sensory level to cold
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Pain score (Verbal rating scale) Bromage score Surgery Time
Top-up (ml) given
hourly
SBP – Systolic Blood Pressure DBP - Diastolic Blood Pressure MAP - Mean Arterial Pressure
APPENDIX E
POST OPERATIVE ANALGESIC MONITORING CHART
DATE:………. TIME:………
PARA METERS
BASE LINE
4hrs 8hrs 12hrs 16hrs 20hrs 24hrs
Pulse rate SBP DBP MAP VRS
Bromage Score Nausea & Vomiting
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Headache
Respiratory Depression Morphine
Satisfaction;_____ (appendix 9):
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APPENDIX F.
MODIFIED BROMAGE SCORE
Parameter Score
Can raise extended legs off bed 0
Can bend knees 1
Can bend ankles 2
Unable to bend knees and ankles 3
APPENDIX G
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VERBAL RATING SCALE (VRS) AND LOCAL LANGUAGE (YORUBA) TRANSLATION37
NO PAIN KOSI IRORA 0
MILD PAIN IRORA DIE 1
MODERATE PAIN IRORA PUPO 2
SEVERE PAIN IRORA GA 3
EXCRUCIATING PAIN IRORA TO KOJA IFARADA 4
APPENDIX H
Some complications of bupivacaine Epidural analgesia/ anaesthesia and their management
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Complications Management
Hypotension i.v fluids, titrated doses of ephedrine (3-6mg) Stop infusion or withhold bolus administration for 10min.
Bradycardia Atropine (0.1-0.6mg increments) i.v
Shivering Humidified Oxygen administration, cover patient with blanket, warm intravenous fluids.
Nausea & vomiting. Iv/im metoclopramide 10mg stat.
Ondansetron 4 mg (when persistent)
Headache (IPDPH) Conservative: recumbent position, analgesic
(acetaminophine 1g qds PO or slow I.V, NSAIDS e.g.
ibuprofen 400mg qds PO), i.v fluids, caffeine-stimulate csf production, stool softerners& soft diet minimises valsava straining. Blood patch.
Backache Acetaminophine, NSAIDS, doses as above. Warm or
cold compresses.
Urinary retention Urinary bladder catheterization.
APPENDIX I
PATIENT SATISFACTION WITH PAIN MEDICATION AFTER 24HRS Very satisfied [ 4 ]
Satisfied [ 3 ]
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Neutrally satisfied [ 2 ]
Dissatisfied [ 1 ]
Very dissatisfied [ 0 ]
APPENDIX J
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APPENDIX K