Acute Pain Post-Op And Misuse Of Pca In An Elderly With

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.

Ward also touches on other groups of patients who may need to be treated postoperatively. These patients include, the elderly, patients who have a tolerance, patients with persistent pain, and patients with sleep apnea. The author is able to create an easy to follow model that guides a person who is dosing these patients. For instance, the model helps to see if a patient needs to have a decreased dose due to a limitation or if they may need a stronger dose due to a

A great deal of investment in terms of research has yielded copious information regarding the individual phenomena of sleep and pain. These two subjects have even been studied to a substantial degree in specific populations, the older adult population being one of these. However, study of the interaction between these two phenomena has only recently begun to be of great notice. This interaction, though lately established in the literature, has not been adequately studied in many populations. In particular this inadequacy is notable for the older adult population. A search of the database Academic Onefile using keywords “older adults”, “sleep” and “pain” produced no literature involving all three. The literature used in this review was found with individual searches of “sleep” and “pain”, “older adults” and “sleep”, and “older adults” and “pain”. This issue is of great importance to nurses and other clinicians due to the increasing age of the patient population seen in practice (Berman, Snyder, Kozier, & Erb, 2012), and due to the pervasive difficulties with sleep and pain faced by older adults.

Mrs Abu has had a considerable change in her vital signs (blood pressure lowered, her pulse is rapid, her respirations increased and temperature has dropped) form the baseline taken before surgery. These findings alone would be reported to the Registered Nurse and monitored. But because of the changes in vital sings, coupled with Mrs Abu reporting light-headedness and

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,

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.

A 35-year-old male patient with history of drug abuse who is experiencing severe post-operative pain.

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 &

this, moderate-to-severe postoperative pain impaired a range of necessary daily functioning activities as walking ability, general daily activity, motivation, social relationships,

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

Postoperative pain is the most undesired sequence of surgery, and if not treated properly, can lead to increased hospital stay and delayed return to daily activities (10).

Multimodal or balanced analgesic techniques involving the use of smaller doses of opioids in combination with non-opioid analgesic drugs (eg, local anesthetics, ketamine, acetaminophen, and NSAIDs) are becoming increasingly popular approaches to preventing pain after surgery [36]. There is evidence showing the benefits of multimodal analgesic techniques, but major surveys have reported that these techniques are underused in clinical practice [37]. Multimodal analgesia is achieved by combining different analgesics that act by different mechanisms at different sites in the nervous system, reducing the incidence of side effects owing to the lower doses of the individual drugs. In our study from all the prescribed analgesics only 23 (19.2%) charts were done according to the multimodal pain management for postoperative pain where as the remaining 97 (80.8%) prescriptions were not in accordance with MAPP (Table

Outcome: Consistent pain monitoring and reevaluating. Pain management through opioid medication and non-medication methods. We attempted to use ice packs as pain relief. Patient was unreceptive to the use of pain medication because it did not help his pain. Opioid medication relieved pain for this patient, however pain was consistently rated as 8.

A prospective randomized, blinded clinical trial was performed by Schroer W.C. to evaluate the efficacy of liposomal bupivacaine for better pain control against bupivacaine HCL. Patients (n= 111) undergoing TKAs were randomized to receive liposomal bupivacaine vs bupivacaine HCL. 58 patients received 266mg (20cc) liposomal bupivacaine mixed with 75mg (30cc) 0.25% bupivacaine, and 53 patients received 150mg (60cc) 0.25% bupivacaine. A result of the study was generated by accessing visual analog pain (VAS) scores and narcotic use post-operatively. There were no VAS pain score differences between study group patients vs control group. As on POD1: 4.5/4.6 (P=0.73); POD2: 4.4/4.8 (P=0.27); and POD3: 3.5/3.7 (P=0.58). Narcotic use was similar during