Evidence Based Practice: Lidocaine Infusion Therapy

Dr Karyn Fowler, who was acting as interim Chief Medical Officer for SSM St. Joseph Health Center in St. Charles, MO filed a complaint after concerns were raised by staff that cared for two patients suffering cardiac arrest after undergoing pain injection treatments while in Dr. Holloway's office.

According to the systematic review covered by Apfel, Turan, Souza, Pergolizzi & Hornuss, 2013 there is a significant reduction in postoperative nausea and vomiting and opioid use when using intravenous acetaminophen. The reviewers used Medline and Cochrane databases to conduct their search along with a hand search of abstracts to identify randomized-controlled trials using intravenous acetaminophen. The review was to determine if the acetaminophen was going to have a significant decline in nausea and vomiting following surgical procedures as

Discussion: The onset of sensory and motor block was faster and time taken to attain complete sensory and motor block to occur was shorter in the nalbuphine group as compared to bupivacaine group. Postoperative regression of both sensory and motor block was significantly slower in group N than in group B and the first rescue analgesic requirement in group N was significantly late than in group B. 0.8mg intrathecal nalbuphine as an adjunct to spinal bupivacaine prolongs the postoperative analgesia with minimal side effects and with desirable sedation intraoperatively which helps in taking care of psychological impact of operation theatre environment. Rawal et al found that nalbuphine was the least irritating to neural tissue even when used in large doses and was associated with minor behavioral and EEG changes

The most common use is for cough syrup (4). There are many controversies surrounding the topic of codeine, including using an alternative for post-surgery recovery (6). However, when studies were done, it was found that the effects of codeine when compared to nonsteroidal anti-inflammatory drugs containing caffeine were significantly more effective in reducing pain. Although, after 3 days, caffeine was found to reduce more swelling (6). Therefore codeine is more efficient for reducing pain because the opioid painkillers act like endorphins, natural pain-reducing chemicals, found in the brain and spinal cord (6). Codeine can be found in liquid form in cough syrups or in solid form as painkiller

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

Some major components of postoperative pain investigations are often asked and recognizing that most patients, who suffer from postoperative pain, relieve it by verbal grievances or nonverbal behaviors after surgery. IV Ketorolac (Toradol) and IV Acetaminophen (Tylenol) are two non-opioid medications, whose administration combined with analgesics addresses multimodal therapy. By understanding what their pharmacologic profiles are, analgesic potentials, combinations with opioids, their limitations and the considerations such as the ease of administrations postoperative pain relief outcomes can be effective and controlled.

Results: The four groups were comparable for patient characteristics, preoperative NRS pain scores and operating time. The mean LOS for the entire cohort was 2.3 nights (1-6), adequate pain relief was achieved in all patients before discharge. GEE analysis revealed a significant difference between group A and B (p = 0.021) with group B experiencing higher pain scores post-operatively than group A. No differences between group A and C (p=0.451) and group A and D were found (p=0.059). Secondly there was a significant difference between group A and B using rescue medication found with GEE (p = 0.003) with group B using more medication. No differences regarding LOS, adverse effects, wound leakage, operating time and destination of discharge were found between the four groups.

The situation that was chosen for this pharmacological intervention assignment is the case of Patient X, a 35 year-old male with a history of recurrent sigmoid diverticulitis who has opted for elective laparoscopic sigmoid hemicolectomy. In conjunction with his surgery, he will be starting a regimen of alvimopan (Entereg) to prevent the development of postoperative ileus. His situation fits into the perioperative clinical focus of nursing practice because the dosing recommendations for alvimopan include beginning the first dose preoperatively, 30 minutes to 5 hours prior to surgery (Erwele, 2008). This assignment will include an assessment of the patient, the establishment of a broad behavioral outcome and specific behavioral objectives

The method adopted was quantitative in nature, using a randomized controlled trial. In order to achieve this, 71 adult patients were assessed for eligibility and among this 59 met the given criteria. They were randomly categorized into treatment groups consisting of 29 patients and a control group consisting of 27 patients. The randomization was done by the same nurse who recruited the patients for

This significant difference (p=0.07) in pain score is more noticeable during POD0 (FNB=2.91; liposomal bupivacaine=3.84), but over the next 24 hours after surgery it diminishes to identical. ROM showed improved flexion in the FNB group (FNB=101 degrees Passive flexion vs: liposomal bupivacaine group=94 degrees passive flexion).This result was statistically significant (P = 0.001). The amount of flexion between the two groups did appear to level out after the first 24 hours of surgery. No statistically significant differences in nausea (P = 0.17) and vomiting (P = 0.64) between the FNB and liposomal bupivacaine groups. Surprisingly, the patient in FNB group on POD0 required significantly fewer opioids than the liposomal bupivacaine group (13.9 mg vs 25.5 mg, respectively) but on POD 1 the liposomal bupivacaine group patients required

recorded. Nausea levels were assessed using 11-point verbal rat-ing scale (VRS) (0 = no nausea and 10 = the worst nausea

In today’s health care a major problem is the management of pain after surgical procedures. The purpose of this paper is to improve the quality of pain management for post-operative patients by integrating more non-pharmacological and holistic techniques. Gélinas, Arbour, Michaud, Robar, and Côté described non-pharmacological interventions as interventions that do not involve the use of medications to relieve pain (2013). Pain is a subjective experience. Gélinas et al. found that pain often goes undertreated in patients which can contribute to physical, emotional, and psychological distress (2013). This distress increases anxiety and can interfere with the healing process. Pain is often worsened by anxiety and fear (Comeaux & Steele-Moses, 2013). Therefore, reducing anxiety can also aid in reducing pain. The most often used intervention for pain management is the use of drug therapy. However, drug therapy alone is not effective. For example, on the South 3 West unit of Holyoke Medical Center patients still report pain levels of 9 and 10 on the numerical pain scale even after receiving pain medication. There are also risks to relying solely on drug therapy. Prolonged use of analgesics can cause harmful side effects to the patient, such as decreased respiratory rate. Non-pharmacological interventions could decrease the need for medications. Adding non-pharmacological interventions to pain therapy is effective and reliable because the interventions are safe and relatively

Background: Propofol is a widely used intravenous anesthetic drug. One of its side effects is pain during injection. We investigate the effects of intravenous ondansetron, lidocaine, and their combination on pain reduction of intravenous propofol.

Nerve stimulating guided technique was used to administer bilateral PVB at level T5-6 with GA (Agarwal et al., 2012). In the postoperative period, both groups received Patient Controlled Analgesia (PCA) morphine. In the following 2, 6, 12, and 24 hours’ postoperative period, patients who received the PVB, required less morphine use at each time interval. Upon completion of the study, findings revealed increased postoperative nausea vomiting (PONV), higher at rest VAS, and increased occurrence of immediate postoperative pain with coughing and deep breathing in those who received TEA. Results indicated that the opioid sparing technique through the use of a PVB, may be beneficial for laparoscopic cholecystectomies (Agarwal et al.,

Working as a team in the perioperative care of the patient is essential in managing surgical pain. In perioperative journey, the team should ensure that every role is agreed to get the best care as possible until the patient is discharge (Audit Commission 1997). The treatment should favour patients’ own needs. McQuay and colleagues mentioned the level of pain relief is achieved when choosing the safest and simplest techniques. Also, by using WHO Analgesic Ladder, the nurse or ODP will determine the appropriate analgesics from mild pain to severe pain. The method of analgesia and combination of other techniques should control the overall pain. And lastly, the patient should receive postoperative nausea medication to prevent