Liposomal Bupivacaine Experiment

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.

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.

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

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

The interventions will be aimed at reducing as far as possible all factors that decrease the threshold and promote those that increase it. It is of no use to judge the pain of others. Nursing care should recognize the presence of the painful experience of the patient, listen carefully and evaluate the factors that condition. Assess the response to analgesics as important as identifying the intensity of pain at the start of the intervention, it is reassessing its evolution time and under the treatment plan is implemented. In hospitalized patients should ask about pain at frequent intervals, every four hours or at least once per shift, and always after administration extra to check their adequacy and effectiveness dose. What drug it was effective and what dose is information that should not be left to memory for later transmission. Its systematic registration history is essential for inter-coordination. Moreover, the patient transmits real interest on the part of professionals and reinforces the therapeutic relationship and

This paper will examine the the nurses and pain assessment in the hospitalized patient. The paper will focus on pain and pain management and the need to assess pain. How much percentage of the population in the U.S. are experienced pain, and how much of the population abuse the pain medications. There are many barriers which hinder nurses from perform accurate pain assessment. These barriers are nurses experience, competence, perception and manipulation. Pain is subjective, but pain assessment tools and nurses’ perception may contraindicate with what the patients stated. Thus, the paper will try to find solution to accurate pain assessment during hospitalization, especially with abuse of opioid.

They started by getting an overview of what was already being done to assess pain. “Only 60% of patients (n=923) were evaluated by a nurse using an accepted pain scale during their visit.” Surprised by the lack of pain assessment, they began the protocol in a community hospital. The beginning results were lower than most people want to see; only one third of the patients who had gone to the emergency room for pain related reasons got treated. Since there was a lack of pain documentation and

These may include multimodal analgesics, opioids, repositioning, and

Multimodal pain management strategy using liposomal bupivacaine (EXPERAL) in Knee Arthroplasty for better postsurgical analgesic outcome and economic benefits.

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.

(REARDON, ANGER & SZUMITA, 2015.). There are two ways to assess pain which they have been used for long time. The first way is Visual analog Scale. The second way is Numeric Rating Scale which means patient should rate their pain in scale of (0-10) zero is no pain and 10 is the worst pain. REARDON, D. P., ANGER, K. E., & SZUMITA, P. M. (2015). However, “the nurse also judged patiens’ pain based on their appearance and mobility, and investigated any potential complications by conducting physical examination. The nurses often rechecked the pain levels in order to clarify and ensure that the recorded pain levels corresponded to the causes of the pain and suffering” (Chatchumni, Namvongprom, Eriksson, & Mazaheri, 2016) patients also may report no improvement for their pain even though with high dose of opioid and ask for high dose of opioid while the nurses noticed them sleeping or

-use a self-report pain tool to identify current pain intensity level and establish a comfort-functioning goal by the end of the shift.

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).

The current practice in my hospital for assessing the level of pain on a scale of 1-10 with 10 being the worst pain is part of the vital sign procedure. The inpatients are asked to rate their pain and are documented in the electronic health record. If the patient says he/ she is in pain, the first step is to detect the characteristics, by asking when the pain started, the area, what make it worse and how strong the pain is and charting the results. In addition a physical assessment- head to toe-will be conducted by means of inspection, auscultation, palpation, and percussion and notifying the provider about the patient’s condition.

The problem statement for this article is alluded to in the background section of the article abstract. The researcher acknowledges that pain continues to be a common problem for the older, hospitalized patient, but little