Postoperative Pain after Reconstructive Surgery Essay
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Postoperative Pain after Reconstructive Surgery Essay
Running head: POSTOPERATIVE PAIN 1
POSTOPERATIVE PAIN 3
Postoperative Pain after Reconstructive Surgery
Carla S. Garcia
Nicole Wertheim College of Nursing and Health Sciences
Author Note
Carla S. Garcia, Nicole Wertheim College of Nursing and Health Sciences, Florida International University
Correspondence concerning this article should be addressed to Carla Garcia, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL 33199. Contact: cgarc573@fiu.edu
Abstract
Postoperative pain is common for most patients who have undergone reconstructive surgery after a burn. The American Society of Pain (ASP) has devised methods of dealing with postoperative pain since most patients report the incident and only half of them were reported to have recovered from it. The use of local anesthetic-based peripheral regional analgesic technique is an efficient way of reducing postoperative pain, as well as the multi-modal approach for pain management, which has been used for patients after a forty-eight-hour post operative period. The American Society of Regional Anesthesia (ASRA) has approved these methods, and through research, has prepared organizational plans that assist surgical and outpatients with postoperative pain management. Measures such as preoperative education, preoperative pain management and pharmacological and non-pharmacological modalities have been recommended. Evidence shows that multi-modal methods of dealing with postoperative pain have been used for most of the cases. This paper will explore the evidence of postoperative pain management after burn reconstruction surgery and include the comparison between the uses of local anesthetic to the use of multi-modal methods in dealing with postoperative pain. In adition, the paper will look at the use of these postoperative methods both in the United States of America (USA) and other countries, and how these methods impact patient outcome.
Keywords: Evidence-Based, Research, Nursing Research, Postoperative, Patient Response.
Significance and Background
Burn reconstruction is a common experience for patients both in the USA and other countries in the world. Postoperative pain is expected after a burn reconstruction, hence the incorporation of methods such as the use of local anesthesia and multi-modal techniques in dealing with pain are recommended. The inquiry is whether the use of local anesthetics is more effective than the multi-modal method in dealing with postoperative pain in adult patients recovering from reconstructive surgery within a forthy-eight-hour time frame.
During a study composed of members of the ASP with help from the American Society of Anesthesiologists (ASA), they assembled in a meeting where members with expertise in anesthesia or pain medicine were put in a research panel (Fuzaylov & Kelly, 2015). The panel’s objective was to review the evidence presented to them and recommend on ways of managing postoperative pain. The target audience of the study were clinicians who managed chronic pain, acute surgical pain, dental pain, and traumatic pain. Over 858 studies were included in the research making it a very effective research (Fuzaylov & Kelly, 2015).
Purpose
The pain experienced after the surgical procedure can be managed in different ways. One way is through the subcutaneous infusion of local anesthetics. Skin burns are accompanied by a burning sensation that can be very irritating to the victim. This method of subcutaneous infusion of local anesthetic admission reduces that unpleasant burning feeling. For adolescents, the anaesthetic is administered in different dosage for those of 13-18 years, adults 19-44 years and adults between 45-64 years to both male and female (Poulsen, 2019). The anesthetic is administered in small amounts over the course of healing and the use of multi-modal techniques is not required.
Most countries especially the developing ones do not have adequate clinical equipment to perform multi-modal methods of dealing with postoperative pain. In some countries, skin reconstruction procedures are not available to burn victims, thus, most people are forced to remain with healing scars. The lack of resources has been the down side of many countries without the necessary equipment (Poulsen, 2019). Victims are left with no choice but to receive local anesthesia and wait for the pruritic burns to resolve in time.
The administration of local anesthesia is introduced depending on the patients consent. A multi-modal approach of dealing with postoperative pain is widely practiced in the USA since most clinicians are assigned to the task of reducing pain after surgery (Poulsen, 2019). Therapeutic exercise and constant skin stretches are recommended by the ASP in the postoperative period for pain control.
Study #1: Nursing Research Study in the USA
The APS and the ASA have joined hands to handle the research being done in the USA (Poulsen, 2019). Preoperative education and preoperative pain management planning has been one key recommendation of these societies. Clinicians are advised to brief the family and the patient on the surgical procedure to be performed and how the postoperative pain experience will be managed. The method of checking is based on tracking patient’s response to postoperative pain treatment and change the treatment plan if the need arises (Poulsen, 2019). Cognitive behavioral modalities are recommended by the societies in order to access the patient’s response to surgery and ascertain whether they are still in their right set of mind. The panel neither recommends nor stops the use of other therapeutic method to control pain such as acupuncture and massage therapy (Poulsen, 2019). The choice is left entirely to the clinician assigned the task of managing the patient’s postoperative pain.
The use of systematic pharmacological therapies have also been recommended by the societies. The use of oral methods over the intravenous administration of opioids for patients after surgery are highly recommended to those who can receive the drugs orally (Chou & Gordon, 2016). The intramuscular route should be avoided at all costs since patients are not very stable after surgery and the injection can become lethal to them, especially within burn victims. The use of gabapentin and pregabalin is recommended among multi-modal analgesia.
For adults, intravenous ketamine should be used as a form of multi-modal analgesia but it is not a strict recommendation since research evidence was based on moderate quality evidence (Poulsen, 2019). Therefore, in the USA, nursing research has been spearheaded by medical societies that have made it easier to be able to apply both the local anesthetic methods and the multi-modal technics in an effective manner. Medical societies have shaped down the nursing sector and all clinicians are subjected to a study session where they learn how to manage postoperative pain. In addition, specific clinicians in health centers are given the task of evaluating the outcomes.
Study #2: Nursing Research Study Non-USA
The nursing research modality in foreign countries is totally different from that of the USA. The differences are brought about by different government policies that are used to control the medical space. The policies in different countries enable the study to be carried out in a very fast and effective manner. While some other counties lack the necessary resources in order to make the research a success (Cooney, 2016). Time has shown that research needs to be taken seriously with the result being studied on a daily basis and ensuring that patients are the sole beneficiaries of the programs.
For example, in a study of burned victims conducted in Ukraine, the results obtained were different since clinic resources were limited and patients were numerous. Therefore, clinicians had to administer small dosages of medicication to a total of 109 patients present and then observe the results. A group of 64 patients received the standard postoperative drug of metamizole 1g or ketorolac 3%-30mg by the nursing staff (Chou & Gordon, 2016). The other 45 patients received a different type of dosage and then the researchers had to wait and observe the patients.
From the presented case, it is clear that the hospital in which the study was being performed had inadequate resources; Thus, researchers were forced to maintain spare supplies for future use to avoid depletion (Fuzaylov & Kelly, 2015). Organizational structure, policies and procedures have been laid down by societies on the placement of surgery platforms for safe and effective delivery of postoperative pain control (Chou & Gordon, 2016). For example, surgical rooms should be full of clinicians that have specialized in pain management. Facilities in which neuraxial analgesia and continuous peripheral blocks are conducted have procedures for safe delivery and trained individuals to manage those procedures.
Study #3: Postoperative pain management: clinical practice guidelines. Journal of Paranesthesia Nursing.
Postoperative pain has been reported by patients with 80% of them reporting on acute pain and 75% of them reporting on moderate pain (Cooney, 2016). Lack of proper pain control can lead to decreased function, impaired recovery and reduced quality of life. Many organizations have published guidelines on how to use methods to control patient’s postoperative pain. These organizations comprise of American Society of Pain Management, American Society of Perinesthesia and the ASA. The ASA published its first guideline in 2012 (Cooney, 2016). In addition, the APS in parftenrship with the ASA and the ASRA published other effective methods of dealing with postoperative pain. The guidelines in these publications included the preoperative education, planning for preoperative pain management, organizational policies and procedures of dealing with postoperative pain and the transition to outpatient care.
A study was carried out to determine the nursing practice implications of care to patients with postoperative pain. The study was composed of 23 multi-disciplinary experts that came from different departments including: surgery, gynecology, primary care, physical therapy, nursing, anesthesia, hospital medicine and psychology (Cooney, 2016). The panel chosen to carry out the study was tasked with reviewing the evidence based on postoperative pain management. The panel was in charge of formulating conclusions and giving recommendations for effective, safe and evidence-based postoperative pain management for patients. The study was composed of over 107 systematic reviews and 858 primary studies that were evidence-based on the final report (Cooney, 2016). Reviewers from the Oregon Health Sciences ranked the strengths of the reports using the methods from the grading recommendation assessment and they found that using both the pharmacological methods and multi-modal methods all worked in reducing postoperative pain. Therefore, the combination of these methods was found to be the best way of treating the post-surgical pain.
Study #4: Music as a Postoperative Pain Management Intervention
The most common reported effect after surgical intervention is pain, and opioid therapy has been used to treat it. The use of opioids has been extensive because of its immediate effects in the central nervous system, ease of administration and multiple delivery forms. Nevertheless, it has been reported by the US Department of Health and Human Services that opioid’s side effects are detrimental (Poulsen, 2019). These side effects include opioid use disorder and even opioid related deaths; Hence, causing the medical community to reconsider the approach to pain management. Between the years 2016 and 2017, the United States Drug Enforcement Agency started restricting companies on producing opioid drugs. While in 2018 the commission from the organization of drug enforcement raised new standards which focused on improving pain management and implemented measures to improve opioid safety (Poulsen, 2019). In the new standards established, multi-modal therapies have been proposed. Citation here?
Ironically, one of the non-pharmacological methods for pain control, is the therapeutic use of music to reduce post-operative pain. Music has been discovered to reduce post-surgical pain in recent years. It is also a good method for nurses and patients since it requires no provider orders. A study utilized Positron Emission Tomography (PET) scan and functional magnetic resonance imaging (fMRI) to reveal that music arouses the caudate and nucleus acumens parts of the brain (Poulsen, 2019). These regions of the brain are responsible for the release of dopamine, inducing an euphoric state, producing pleasure that significantly reduces pain. Further research on a number of patients gave positive results that made music an alternative method of reducing postoperative pain.(source?) Therefore, music can be used as a multi-modal method of reducing post-surgical pain and can also be used in preoperative nursing practice.
Conclusion
Neither the local anesthetic analgesic techniques nor the multi-modal techniques can be dismissed. Both techniques target the same issue from different approaches to relieve postoperative pain. Pain manifests differently from person to person, and recovery is based on the person’s overall health, age, and comorbidities. For instance, a person who smokes chronicly, or has a long standing use of ilicit drugs may have more difficulty recovering after surgery as opposed to a person who has maintained a healthy life style and has no significant comorbidities.
The comparison between the local anesthetic-based peripheral regional analgesic techniques, with the use of a multi-modal approach for pain management alone differs in countries depending on the resources available (Cooney, 2016). The USA has shown to be better equipped with societies such as the APS managing the nursing sector and making sure that the required research is conducted properly.
Postoperative pain has been reported to persist for years in some patients. The nursing research team and any governmental policy that is aimed at helping research through funding, should prioritize this matter and establish evidence based guidelines, and create innovative methods to help patients who are experiencing postoperative surgical pain. A relief to the suffering of this patients should be provided, and the most accurate results come from research. Based on the presented review of studies, the use of local anesthetic-based peripheral regional analgesic techniques, and the use of multi-modal approaches should both be considered to provide fast and effective pain relief in recovering surgical patients.
References
Chou, R., Gordon, D. B. (2016). Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. The Journal of Pain.
Cooney, M. F. (2016). Postoperative pain management: clinical practice guidelines. Journal of Perianesthesia Nursing.
Fuzaylov, G., Kelly, T. L. (2015). Post-operative pain control for burn reconstructive surgery in a resource-restricted country with subcutaneous infusion of local anesthetics through a soaker catheter to the surgical site: Preliminary results. Burns.
Poulsen, M. J. (2019). Music as a Postoperative Pain Management Intervention. Journal of PeriAnesthesia Nursing.
RUBRIC
Excellent Quality
95-100%
Introduction 45-41 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Literature Support
91-84 points
The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.
Methodology
58-53 points
Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score
50-85%
40-38 points
More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.
83-76 points
Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.
52-49 points
Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality
0-45%
37-1 points
The background and/or significance are missing. No search history information is provided.
75-1 points
Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.
48-1 points
There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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