Essay On Postoperative Pain

On 01/27/2016, I observed about 22 patients in Postanesthesia Care Unit. Some of the patients were observed after surgeries while others were observed after endoscopy. During my shift, I observed patients awaiting recovery for removal of kidney stones, malignant melanoma (removal of moles), Endometrial Biopsy (EBX), superficial femoral artery (SFA), Hernia repair, Oophorectomy (ovary removal surgery), Cardiorrhaphy (Ventricular repair), Cystolithalopaxy (bladder stone removal), gall stone removal, Ectopic pregnancy surgery, and leg surgery.

The pre-operative stage is an important phase in patient’s surgery process. This is the time where the patients is experiencing a lot of anxiety issues and have questions regarding the impending procedure. To help ensure good patient outcomes, it is imperative to provide complete preoperative instructions and discharge instructions (Allison & George, 2014). It is the nurses’ duty to safe guard and protects the patient’s welfare during the surgical experience. Effective preoperative preparation is known to enhance postoperative pain management and recovery. Health professionals need to be cognizant of the contextual factors that influence patients’ preoperative experiences and give context appropriate care (Aziato & Adejumo, 2014).

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

The peer reviewed journal article, A Decision Tree Model for Postoperative pain Management, is an article describing postoperative pain management regimens using evidence-based practice. This article’s author has created a guide for prescribers who are managing postoperative pain levels for patients. This article is using evidence-based practice to help future patients have adequate pain relief, but not have the serious ramifications that can occur from the wrong dose or wrong medication for said patient.

Despite recent advances in information regarding perioperative care, postoperative pain continues to go undermanaged. Postoperative pain is the pain patients experience after a surgical procedure. According to Gan, 80% of all people who undergo surgeries experience postoperative pain, and 75% of them rate their pain at a moderate, severe, or extreme level (as cited by Cooney, 2016). Furthermore, inadequately managed pain can lead to patient dissatisfaction, decreased patient outcomes, and overall higher cost of care (Penprase, Brunetto, Dahmani, Forthoffer & Kapoor, 2015). In order to provide higher quality pain management,

It is a challenge to manage pain in older adults. The course of action, effect and

Postoperative surgical pain can often be moderate to severe leaving the client in a state of discomfort that requires the administration of opioid analgesic medications. Morphine intravenous (IV) patient-controlled analgesia (PCA) is commonly provided through a pump to treat postoperative surgical pain, but with advances in the medication administration field, a fentanyl iontophoretic transdermal system (ITS) has become another popular method (Lindley, Pestano, & Gargiulo, 2009). Morphine and fentanyl are similar medications in that they are both opioid analgesics and are both equally effective to reduce pain, but they offer differences through their administration techniques, comfort for the client, and providing care in a timely manner by the nurse. The nurse must take into consideration these differences to choose the proper medication for their specific client.

Ketamine may be used for postoperative pain management. Low doses of ketamine reduce morphine use and nausea and vomiting after surgery. High quality evidence in acute pain is insufficient to determine if ketamine is useful in this

Chronic, acute, somatic and oncologic are all types pain - each with their own symptoms, reliefs, and evaluations. As pain has been explored, we have learned more about it; however, it remains an anomaly. In the postoperative setting, nurses are the first line of pain management. Their assessments of the patient’s pain, including questions and scaling is imperative when dosing medications and evaluating the patient. Studies continue to determine that healthcare providers undertreat and mismanage pain control and assessment. According, to the American Society of Interventional Pain Physicians, “80% to 90% of physicians have had no formal training in prescribing controlled substances, and only five out of one hundred thirty-three medical schools in the U.S. have required courses on pain management” (Glowacki, p. 37). The American Nurse Credentialing Center reported that “as of 2013, only one thousand six hundred seventy two registered nurses in the U.S. were certified in pain management” (Glowacki, p. 37). According to the CDC, about 50% of postoperative patients report unrelieved pain (Centers for Disease Control and Prevention, 2013). Effective postoperative pain control is necessary for successful care and treatment. Inadequate relief of postoperative pain can contribute to postoperative complications such as atelectasis, deep vein thrombosis, and delayed wound healing (Francis &

According to Hah et al. (2017), several studies have shown that nerve blockade of the central nervous system (neuraxial anesthesia) or peripheral nerves (regional anesthesia) reduce the need for opioids in the immediate postoperative phase. There are two mechanisms through which nerve blockade reduces persistent opioid use. First, nerve blockade works by impeding the transmission of pain during the perioperative phase and thereby stopping central sensitization and chronic neuropathic pain. Second, nerve blocks are effective in treating postoperative pain and are good predictor of persistent opioid use. Similarly, studies found that intravenous local anesthetic such as lidocaine reduces perioperative opioid

This feature also enables the use of this technique into the postoperative period for analgesia, using lower concentrations of local anaesthetic drugs or in combination with different agents.

The major concepts of this theory are defined theoretically since the use of these definitions is from a broader theoretic concept. Therefore, an operational concept could be developed from them. There is consistency in the use of these concepts throughout the theory of acute pain management with examples given using the same language as well as maintaining the integrity of the concepts.

According to John Hopkins Medicine (n.d.), pain is an uncomfortable feeling that tells you something may be wrong. It can be fixed, throbbing, stabbing, aching, pinching, or described in many other ways. Pain is categorized as either acute or chronic. Acute pain is usually severe and brief, and is often a signal that your body has been injured. Chronic pain can vary from mild to severe and is there for long periods of time (John Hopkins Medicine, n.d). This paper will discuss a scenario that entails which person is experiencing the most pain, how two people can have the same procedure experience different levels of pain, factors that contribute to each person’s pain level, and two complementary/alternative methods of pain control.

Pain can be categorised as either acute pain or chronic pain. Acute pain is short lasting and will commonly subside once healing has taken place (Mac Lellan 2006). It is often a sudden onset and usually lasts less than 6 months. The main example of acute pain would be the pain experienced post surgery. Chronic pain on the other hand is a prolonged and persistent pain that remains long after the normal healing process of 3- 6 months. A common example of such a pain would be chronic back pain (Mac Lellan 2006). For the purpose of this assignment, the management of acute pain post surgery will be discussed with reference to a particular scenario, which followed the care and pain management given to a patient post appendectomy.

Engwall (2009) defined pain as a "symptom and a warning that something is wrong in an organism” (p 370). Rathmell et al., (2006) maintained that fear of uncontrolled pain can be a traumatic situation for a patient undergoing surgery. Moreover, Pellino, et al (2005) sustained that “pain is a multidimensional experience, consisting of not only physical stimuli but also psychological interpretations of pain” (p. 182). Alleviating peri-operative pain is traditionally achieved with the use of pharmacological interventions. analgesia can incur undesirable side-effects like drowsiness, nausea and vomiting. Controlling the pain by complimenting analgesics with the use of non-pharmacological interventions, might ameliorate patients’ response to pain with fewer resultant side-effects. Thus, the need to evaluate the effect of non-pharmacological measures such as music, relaxation, hypnosis and others is highly solicited in the evolving heath system (Pyati & Gan, 2007).