Suprascapular Nerve Block Report

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.

Patient was encouraged to continue with heat, followed by his home exercise program and ice. He will continue with his transcutaneous electrical nerve unit (TENS). Patient was given an ice pack to use, to reduce pain. He was given a 60 mg Toradol injection on this visit.

S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care as instructed at home. The TM reports her pain is 4/10, and the pain is described as aching type pain; the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help to decrease her pain to 2-3/10. TM denies any loss of ROM or sensation of the right arm; denies any tingling or numbness.

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.

Numerous studies have been conducted on the use of local anesthetic agents with adjuvants such as clonidine (a partial α2-adrenoreceptor agonist) and tramadol3, 4 for a brachial plexus block to improve the quality and duration of anesthesia, and these studies have shown that the adjuvants may prolong anesthesia and analgesia. Moreover, dexmedetomidine is a α2-receptor agonist that has more selectivity than clonidine and has analgesic and sedative properties.5, 6 Although several studies have described the effects of dexmedetomidine on neuroaxial and peripheral nerve blocks,7, 8, 9 to date, there is only 1 study available, performed by Esmaoglu et al,10 on the effect of adding dexmedetomidine to levobupivacaine for an axillary brachial plexus block. In view of the idea that decreasing the dose of dexmedetomidine may help to reduce side effects such as bradycardia and hypotension, we wanted to evaluate the effect of dexmedetomidine at a lower dose than that used in their study and the results. We think that more studies on this issue are needed.

The reality, however, is that the pain experienced by most of these patients is relatively low. The worst soreness will occur in the first three days after your procedure, and some patients can recuperate with minimal help from pain killers, while others may require much stronger medication to cope.

Opioid-free anesthesia, as the name indicates, is the avoidance of opioids in pain treatment pre-operatively, intra-operatively, and post-operatively in an attempt to reduce opioid-induced respiratory complications without sacrificing patient comfort. Some of the reasons to avoid opioids, besides respiratory depression, include: “muscle weakness, excessive somnolence, post-operative nausea and vomiting, ileus and constipation, urinary retention, dizziness, obstructive breathing, negative inotropism, and the possibility of tolerance and addiction” (Mulier, 2012). Post-operatively, the patient’s respiratory system may be too depressed to pass extubation criteria. If able to extubate, early mobilization may be difficult if the patient is too

DOI: 2/24/2016. Patient is a 46-year-old male production technician who sustained injury while he was lifting a heavy door when he felt immediate pain in his right shoulder. Per OMNI, he was initially diagnosed with right shoulder strain.

Jae-Hwang Song et al. divided 336 patients undergoing foot and ankle surgery under sciatic or femoral-sciatic nerve block into treatment and control groups Based on the date of surgery. All the patients received a nerve block preoperatively. The block was established with mixture of lidocaine and ropivacaine injection. In the postanesthesia recovery room, a transdermal patch of fentanyl was applied to the chest of the patients with intravenous midazolam in the treatment group. The primary outcome measure was the difference in the number of requests for additional postoperative pain medication. The secondary outcome of interest was the degree of postoperative pain using a visual analog scale (VAS). also, complications noticed. Metoclopramide was given to nauseated patients (6).

DIAGNOSIS: Impingement syndrome, right shoulder; full-thickness rotator cuff tear with retraction, right shoulder; adhesive capsulites, right shoulder; post-op pain, right shoulder; Right elbow strain/sprain; Right wrist strain/sprain; Right upper extremity overuse syndrome.

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).

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 onset of a state of total anaesthesia was measured, along with the amount required to induce such a state. Researchers found there was a significant increase in the time required to reach total anaesthesia for opioid-tolerant patients. Further, the amount of local anaesthesia required to reach this state was significantly higher for opioid-tolerant patients than for non opioid-tolerant patients.

combination of low dose opioid anesthesia combined with a rapid extubation protocol post operatively is shown to decrease the time on

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.