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Post-operative pain management (Essay Sample)


Literature review on Post-operative pain management with People Who Have Had Total Knee Replacement Surgery.

Running head: Post-operative pain management
Post-Operative Pain Management with People Who Have Had Total Knee Replacement Surgery
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Insert Grade Course Insert Tutor’s Name February 20, 2014
Post-Operative Pain Management with People Who Have Had Total Knee Replacement Surgery
Various illnesses are associated with some pain that necessitate the use of analgesics in the nursing practice. Pain management becomes one of the essential practices in nursing (Alfred, 2007). Pain occurs during and after surgical operations for patients with health complications that require these interventions. Proper pain management for the patients that have undergone such surgical operations is essential to ensure that the patients do not become more distressed to lead to further complications that may impede the recovery process. Postoperative pains that are unrelieved can interfere with the process of returning to normal bodily functions recorded before the surgery alongside other complications in mobility (Alfred, 2007). Different measures are applicable in the post-operative pain management. These include the use of pharmacological measures where some nurses traditionally use opioids as sedatives, whereas other non-pharmacological measures such as listening to music are also applicable (Alfred, 2007).
Vadivelu, Urman, and Hines (2011) observe that different acupuncture techniques can be appropriate in the management of acute postoperative pain. If these acupuncture techniques are applied effectively before the induction of an anesthesia, they are sufficient to reduce postoperative pain, nausea, and vomiting (Vadivelu, Urman, and Hines, 2011, p.356). The dire importance of postoperative pain management has called for the attention of scholars and researchers on this area of study. This paper focuses on the available literatures that address the concept of postoperative pain management; its importance, the available methods, and the possible consequences of ignoring this intervention are all examined in the paper.
Literature review
General overview of postoperative pain management
Pain management is one of the routine practices in nursing or medicine. There is need for postoperative pain management for patients who have undergone some surgical operations to help them recover their normal bodily functions. Nonetheless, poor postoperative pain management often occurs in the nursing centers, which may be attributed to poor clarity of the different pain management approaches and strategies (Eccleston, 2011). It is worth noting that the failure by the nursing professionals to provide proper measures to manage postoperative pain amounts to huge losses for the patient and the society. Poor management of acute postoperative pain is likely to lead to chronic pains and other forms of disability that becomes a burden to the society (Eccleston, 2011). Various methods are applicable in the management of postoperative pains with a variety of drugs tried in the process. Different scholars have focused their works on the current practices in the postoperative pain management with the purpose of initiating changes in the practices in order to improve the care provided to the patients.
Mackintosh (2007) observed that several studies conducted earlier showed that there were poor clinical practices in the assessment and management of postoperative pain, even though the number of patients complaining of such pains is relatively low. The researches indicated that there had been no significant advances in the tools used for pain management in the hospitals. Increased focus on postoperative pain management has resulted in the development of various standards and recommendations for acute pain management in hospitals across different countries (Hartog et al, 2009; European Society of Regional Anesthesia and Pain Therapy, 2005). These include the use of standardized pain assessment tools, the training of specialist clinical nurses to become part of the multidisciplinary pain teams, and the use of modern technology in pain management (Mackintosh, 2007). The use of high technology based pain management approaches such as patient controlled analgesia (PCA) pumps and epidural functions have been common in the recent past. Nonetheless, the ideal management of pain is yet to be attained and more efforts have to be put towards that objective. Resource-based factors and psychological obstacles are some of the factors hindering proper delivery of these effective pain management tool (Hartog et al, 2009). A qualitative research based in Iran also identified factors like poor communication, bad policies, poor relationship between nurses and patients, and time constraints as some of the barriers to effective pain management following surgical operations (Rejeh et al, 2008). Another research conducted in Italy on the level of postoperative pain management indicated that the use of postoperative analgesic treatment in the country was still below the optimal level (Tofano et al, 2012). A larger fraction of the patients continued to suffer these pains.
Post operative pain management for TKA patients
Total knee arthroplasty is increasingly becoming essential in nursing and medicine since it is appropriate for patients with poor response to non-surgical treatment approaches. It is effective in improving the functions of ‘patients who suffer joint failure from osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, or osteonecrosis’ (Parker, 2011). Fetherston and Ward (2007) stress the need for pain management for patients who have undergone a total knee arthroplasty (TKA) in order to promote the rehabilitation process. An appropriate pain management begins with an assessment of the pain through consultation with the patient. In essence, pain management will involve skilled assessment of the pain, inclusion of the patient in the assessment, and the application of multimodal approach (Parker, 2011). A timely intervention of this nature often aims at increased mobility, reduced postoperative organ dysfunction, and shorter hospital stay for the patients (Oakes, 2011, p.278).
Proper assessment and management of pain requires effective communication between the patient and the clinical nurse (Hartog et al, 2009). A self-report from the patient will provide a reliable indication of the nature of this pain (Parker, 2011). The professionals should identify and adjust to the factors that may bar proper communication with the patient such as deafness or language barrier to ensure that the patient describes the nature of pain experienced (Mackintosh, 2007). The professionals may be forced to probe since some patients are reluctant to report pain and often wait until it becomes unbearable. In certain instances, the pains experienced by a patient may stem from multiple causes other than the surgical operation procedures. The professional has to identify these factors and manage them separately if possible. McCaffery and Pasero (1999, cited in Mackintosh, 2007) provides eight factors that a professional need to check while assessing pain in the patient. These include the location of pain, its intensity, the duration it has taken, quality of the pain, the patient’s description, the patient’s preferred method for relieving the pain, the effects of pain on the patient, and the factors that decrease or increase it (Mackintosh, 2007, p.51). Nonetheless, a multidimensional approach that considers all these factors in postoperative pain management is often complex and may not be appropriate.
Pharmacological and non-pharmacological interventions
Fetherston and Ward (2007) observe that a number of measures exist for postoperative pain management for the TKA patients. Management of postoperative pain mainly involves the use of pharmacological interventions or comfort measures and it is often appropriate to use the approaches together in clinical practice (Mackintosh, 2007). The pharmacological measures include intravenous (IV) patient controlled analgesia, intrathecal and epidural analgesia, periarticular injection, continuous femoral nerve blockade, or oral and intramuscular narcotic and non-narcotic analgesics (Fetherston & Ward, 2011). The two researchers conducted a study to compare the effectiveness of different measures in postoperative pain management. Even though the use of narcotic PCA has proved to be effective, the duo observes that it has certain side effects that may interfere with early postoperative mobility. Their research indicated that femoral nerve catheters gain fame in the postoperative pain management for TKA patients due to mild side effects (Fetherston & Ward, 2011, p.5).
Pharmacological approach to postoperative pain management involves the use of analgesic ladder developed by the World Health Organization. In its original form, the ladder was developed to manage pain in palliative care and the treatment began at the bottom with weak analgesic drugs as the ladder climbs to stronger drugs (Mackintosh, 2007). For management of acute postoperative pain, the ladder is used from top down. The severe pain that follows total knee arthroplasty requires the clinical nurses to begin pain management with preemptive analgesia, which is sometimes used even before the surgical incision (Parker, 2011). The pain management begins with strong opioids-based analgesic drugs such as morphine and it climbs down to mild forms such as aspirin and paracetamol (Mackintosh, 2007). Morphine does not have extraordinary side effects. It is used with the technology-based interventions like PCA and at times, it is applied through intramuscular route. The application of multimodal approach to pain management involves the use of two or more drug categories, which relieve pain through different mechanisms (Parker, 2011). The pain management should be performed continuousl...
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