ผลของการใช้แนวปฏิบัติการบริหารยาฉีดอีน็อกซาพารินทางชั้นใต้ผิวหนังต่อความปวดและ รอยช้ำในผู้ป่วยโรคอ้วนที่ผ่าตัดลดขนาดกระเพาะอาหารผ่านการส่องกล้อง: การวิจัยแบบสุ่มและมีกลุ่มควบคุม

Kanchanarat Promkaew; ๋๋Jutirat Makmingjuan; Wipawadee Wongwaranon; Siranan Janchum; Archa Billah; Kamthorn Yolsuriyanwong

Authors

Kanchanarat Promkaew Songklanagarind Hospital
๋๋Jutirat Makmingjuan Songklanagarind Hospital
Wipawadee Wongwaranon Songklanagarind Hospital
Siranan Janchum Songklanagarind Hospital
Archa Billah Songklanagarind Hospital
Kamthorn Yolsuriyanwong Faculty of Medicine, Prince of Songkhla University

Keywords:

bruising, enoxaparin, pain

Abstract

A randomized, controlled trial was conducted to evaluate the effectiveness of an improved subcutaneous enoxaparin administration guideline compared to the traditional guidelines in managing pain and bruising among obese patients. A total of 48 obese patients undergoing Laparoscopic Sleeve Gastrectomy at Songklanagarind Hospital in 2025, were recruited and allocated into either a control group (n=24) or an experimental group (n=24); through matched sampling. The control group received enoxaparin according to the traditional guidelines; whereas, the experimental group received the intervention based on the newly developed guideline. Data was collected using a personal information and medical history questionnaire, a pain assessment scale, a bruising assessment, and a patient satisfaction questionnaire. Data were analyzed using descriptive statistics, Fisher's Exact Tests, and the Mann-Whitney U Test.

Results: Patients in the experimental group reported significantly lower mean pain scores (M = 1.96) than those in the control group (M = 2.92). However, there were no statistically significant differences in the extent of bruising at 24 and 48 hours post-injection between the two groups Furthermore, the experimental group demonstrated a significantly higher level of satisfaction compared to the control group. The results of this study show the effectiveness of using the newly developed guideline for evidence based practice for pain management and patient centered care. However, as to bruising, there was no statistically significant differences from the traditional guideline. A study, with either a larger or multiple sample groups should be conducted.

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References

World Health Organization. Obesity and overweight. [Internet] .2018; [cited 2023 Jan 30]. Available From:https:// www. Who.int/new-room/fact-sheets/detail/obesity-and-overweight

Department of disease control. Controlling diseases and Thai people’s health: A perspective on Reductive “Obesity” health issues 2023. Nonthaburi: Department of disease; 2023. (in Thai)

Songklanagarind Hospital, Medical Statistics Unit. Report on the number of patients in the female surgical ward who received ecstasy enoxaparin statistics 2021 to 2023. Songkhla: Songklanagarind Hospital; 2023. (in Thai)

Angrisani L, Vitiello A, Santonicola A, Hasani A, De Luca M, Iovino P. Roux-en-Y gastric bypass versus sleeve gastrectomy as revisional procedures after adjustable gastric gand: 5-year outcomes. Obesity Surgery. 2017;27(6):1430-7. doi: 10.1007/s11695-016-2502-8.

Gambhir S, Inaba CS, Alizadah RF, Namias J, Hinojosa M, Smith BR, et al. Venous Thromboembolism risk for the contemporary bariatric surgeon. Surgical Endoscopy. 2020;34(8):3521-6. doi: 10.1007/s00464-019-07134-w.

Albertsen IE, Lyhne NM, Larsen TB, Nielsen PB. Incidence of venous thromboembolism following head and neck surgery. European Archives of Oto-rhino-laryngology. 2023;280:5081-9. doi: 10.1007/s00405-023-08112-8.

Jones A, Al-Horani RA. Venous thromboembolism prophylaxis in major orthopedic surgeries and factor XIa Inhibitors. Medical Science (Basel). 2023;11:49. doi: 10.3390/medsci11030049.

De Souza APC, Gabriel FC, Fontes-Mota GCH, Silva MS, Ribeiro E. Evidence-bases pharmacological prophylaxis recommendations for venous thromboembolism in hospitalized acutely ill medical patients: A systematic review of clinical practice guidelines. Jornal Vascular Brasileiro. 2023;22:1-9. doi: 10.1590/1677-5449.20230672.

Li Y, Dong S, Wang P, Sun J, Jiang H, Liu F. Influence of low molecular weight heparin Injection sites on local bruising and pain: A systematic review and meta analysis. Journal of Clinical Pharmacology Therapeutics. 2021;46:688-97. doi: 10.1111/jcpt.13323.

Peng S, Zhang M, Jin J, MacCormick AD. The effectiveness of venous thromboembolism prophylaxis interventions in trauma patients: A systematic review and network meta- analysis. Injury. 2023;54(12):111078. doi: 10.1016/j.injury.2023.111078.

Babaieast F, Yovandi H, Moosazadeh M, Kheradmand M. Low-molecular weight heparin and complication of subcutaneous injection: How important is injection site selection?. Medsurg Nursing. 2018;27(3):191-201.

Altawil E, Alkofide H, Almohaini H, Albeed A, Alhossan A. The use of enoxaparin as venous Thromboembolism prophylaxis in bariatric surgery: A retrospective cohort study. Saudi Pharmaceutical Journal. 2022;30(10):1473-8. doi: 10.1016/j. jsps.2022.07.008.

Poursafar Z, Jafroudi S, Baghaei M, Kazemnezhad Leyli E, Zarrizei M. Incidence and extent of bruising after subcutaneous injection of enoxaparin sodium sodiumsodium in patient hospitalized at coronary care units. Journal Holistic Nursing and Midwifery. 2019;29:90-6. doi: 10.32598/JHNM.29.2.90.

Jueakaew S, Piancharoensin R, Pinkesorn N, Thippayrom S, Sermsathanasawadi N. Novel low-molecular-weight heparin injection technique to reduce post-injection bruising. Phlebology 2019;34:399-405. doi: 10.1177/0268355518813512.

Karadag S, Aydinli A, Yilmaz C, Tutar N. Effect of cold application and compression on pain and bruising in subcutaneous heparin injection. Journal of Vascular Nursing. 2023;41:22-6. doi: 10.1016/j.jvn.2023.01.002.

Sarani H, Navidion A, Tabas EE, Medi AA. Comparing the effect of durationh and site of subcutaneous injection of enoxaparin sodium on pain and bruising size in patients admitted to cardiac care units. the Horizon of Medical Sciences. 2020;26(4):348-63. doi: 10.32598/hms.26.4.3308.2.

Jareno-Collado R, Sanchez-Sanchez MM, Fraile-Gano MP, Garcia-Crespo N, Barba- Aragon S, Bermaejo-Garcia H, et al. Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient. Enfermeria Intensiva (Engl Ed) 2018;29:4-13. doi: 10.1016/j.enfi.2017.11.001.

Mohammady M, Sadeghi N. Effect of cold application on bruising and pain following heparin subcutaneous injection: A systematic review and meta-analysis. Journal of Nursing Scholarship. 2020;52(6):634-42. doi: 10.1111/jnu.12598.

Yılmaz D, Ayhan D, Yılmaz DU, Düzgün F. Effect of the coughing technique during. subcutaneous heparin injection on pain severity and individual satisfaction. Revista Latino -Americana de Enfermagem. 2023;31:1-11. doi: 10.1590/1518-8345.6504.3923.

Rushing J. Administering an enoxaparin sodium sodiuminjection. Nursing. 2008;38:19. doi: 10.1097/01.NURSE. 0000312604.60149.84.

Sendir M, Buyukyilmaz F, Celik Z, Taskopru I. Comparison of three methods to prevent pain and bruising after subcutaneous heparin administration. Clinical Nurse Specialist. 2015;29:174-80. doi: 10.1097/NUR.0000000000000129

Isik MT, Öztunç G. Effects of subcutaneous injection after coolant spray on pain, hematoma, and ecchymosis in three different regions. Nursing Forum. 2021;57:352-7. doi: 10.1111/nuf.12688.

Alasmari FA, Hazazi MA, Ebrahim EA, Thazha MT, Alkouz HY, et al. Best practice for administering low molecular weight heparin (LMWH) Injection: An evidence-based practice project. Evidence-Based Nursing Research 2023;5:44-7. doi: 10.47104/ebnrojs3.v5i1.277.

Taghili F, Kiapour A, Zavardeh Nia ME. Effect of localized cold compress on pain with subcutaneous injection of enoxaparin sodium sodiumrandomized controlled trial. Jounal Kermashah. University of Medical Sciences. 2021;25:1-5. doi: 10.5812/jkums.110984.

Amaniyan S, Ghobadi A, Vaismoradi M. Cold application on bruising at the Subcutaneous Heparin Injection site: A Systematic Review and Meta-Analysis. SAGE Open Nursing. 2020;6:1-10. doi: 10.1177/2377960820901370.

Kılıç E, Midilli TS. Effects of cold application on pain and bruising complications associated with subcutaneous heparin in intensive care patients. International Journal of Health Science and Research. 2017;7(9):173-83.

Wang H, Guan J, Zhang X, Wang X, Ji T, Hou D, et al. Effect of cold application on pain and bruising in patient with subcutaneous injection of low-molecular-weight heparin: A meta-analysis. Clinical and Applied Thrombsis/ Hemostasis. 2020;26:1-10. doi: 10.1177/1076029620905349.

Elrefaey NMM, Hamed LA, Elsayed SM. Effectiveness of thumb manual pressure on pain, bruising and satisfaction associated with anticoagulant aubcutaneous injection. Egyptian Journal of health Care. 2023;14(1):1199-211. doi: 10.21608/ejhc.2023.297307

Sohail A, Naqvi J, Wilson P. Spontaneous rectus sheath and retroperitoneal haemorrhage secondary to Enoxaparin sodium sodiuminjections. Journal of Surgical Case Reports 2023;23:1-3. doi: 10.1093/jscr/rjad482.

Chung KT. Intra-abdominal hematoma following Enoxaparin sodium sodiumInjection. Clinical Medicine Insights: Case Reports. 2016;9:35-8. doi: 10.4137/CCRep.S17881.

Mackiewicz-Milewska M, Cisowska-Adamiak M, Szymkuć-Bukowska I, Sakwinka K, Domarecka I, Lewandowska A, Głowacka-Mrotek I. Intramuscular hematomas in patients receiving prophylaxis or anticoagulant treatment after spinal cord injury (SCI)-A rare complication: Description of seven cases and a literature analysis. Biomedicines. 2023;11:1142. doi: 10.3390/biomedicines11041142.

National Health and Medical Research Council. [NMRC]. A guide to the developmental, implementation and evaluation of clinical practice guidelines. [Internet]. 1999 [cited 2024 Jan 30], Available from: http://nhmrc.gov.au/_files_nhmrc/film/publication/synopses/cp30pdf

Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods. 2009;41(4):1149-60. doi: 10.3758/BRM.41.4.1149.

Zaki WE, Hassan MS, Mourad AH, Abd Elnany HA. Effect of cold application on local problems among patients receiving subcutaneous Enoxaparin sodium. Egyptian Journal of Health Care. 2020; 11(1):219-33. doi: 10.21608/EJHC.2020.74784.

Thanakittummakul N. Nursing care for reducing bruising in patients receiving enoxaparin sodium. Journal of Nurses Association of Thailand Northern Office. 2021;27(1):38-49. (in Thai)

Amaniyan S, Varaei S, Vaismoradi M, Haghani H, Sieloff C. Effect of local cold and hot pack on the bruising of enoxaparin sodium injection site: A randomized controlled trial. Contemporary Nurse. 2016;52(1):30-41. doi: 10.1080/10376178.2016.1190289.

Quinlan P, Davis J, Fields K, Madamba P, Colman L, Tinca D, Cannon Drake R. Effects of localized cold therapy on pain in postoperative spinal fusion patients: A randomized control trial. Orthopedic Nurses. 2017;36(5):344-9. doi: 10.1097/NOR.0000000000000382.

Thjs E, Schotanus MGM, Bemelmans YFL, Kort NP. Reduced opiate use after total knee arthroplasty using computer-assisted cryotherapy. Knee Surgery Sports Traumatology Arthroscopy. 2019;27(4):1204-12. doi: 10.1007/s00167-018-4962-y.

Unal N, Tosun B, Aslan O, Tunay S. Effects of vapocoolant spray prior to SC LMWH injection: An experimental study. Clinical Nursing Research. 2021;30(2):127-34. doi: 10.1177/1054773818825486.

Prommanee P, Pitayavatanachai Y, Tappha J. Concepts of job satisfaction questionnaire. APHEIT Journal. 2020;26(1):59-66. (in Thai)

Kullathum P, Sakkawong S, Yuanjai A. The role of nurses in the caring of patients receiving enoxaparin Sodium injections. Thai Red Cross Nursing Journal. 2023;16(1):12-25. (in Thai)

Aghakhani N, Ghaderi B, Alinezhad V, Baghaei R, Hazrati M. Effect of enoxaparin injection duration on it Myocardial infarction patients. Internal Medicine Today. 2023;29(1):27-33. doi: 10.32592/intj.2023.29.1.27