Paper #2: Research Utilization Paper (Research/Global Health)

Postoperative Pain

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Abstract

Postoperative pain is common for most of patients who have undergone reconstructive surgery after a burn. The American Society of Pain (ASP) has devised methods of dealing with this problem since most patients report the incident and only half of them were reported to have recovered from post-operative pain. The problem is a real challenge for the medical professionals and the medical society’s device ways of dealing with the issue on every occasion. The use of local anesthetic-based peripheral regional analgesic technique is one way of dealing with the pain and the multi-modal approach for pain management is another technique that has been used for patients after a forty eight hour period post operation. The techniques are also different in the USA and other countries. The American society of regional anesthesia (ASRA) has approved these methods and through research has come up with the organizational plans that assist outpatients with postoperative pain management. Measures such as preoperative education, preoperative pain management and pharmacological and non-pharmacological modalities have been recommended. Evidence shows that multi-modal methods of dealing with postoperative pain have been used for most of the cases. This paper will explore the evidence of postoperative pain management after burn reconstruction surgery and include the comparison between the uses of local anesthetic to the use of multi-modal methods in dealing with postoperative pain. In adition, the paper will look at the use of these postoperative methods both in the USA and other countries and how these methods impact patient outcome.

Keywords: Evidence-Based, Research, Nursing Research, Postoperative, Patient Response.

Significance and background

Burn reconstruction is a common experience for patients both in the USA and other countries in the world. Postoperative pain is expected after a burn reconstruction hence the incorporation of methods such as the use of local anesthesia and multi-modal techniques in dealing with pain is recommended. The interrogant is whether the use of local anesthetic is more effective than the multi-modal method in dealing with postoperative pain in adult patients recovering from reconstructive surgery within a forthy eight hour time frame.

A research done on the same was composed of members of the American Society of Pain (ASP) with the help from the American Society of Anesthesiologists (ASA). They assembled in a meeting where the members with expertise in anesthesia or pain medicine were put in a research panel (Fuzaylov & Kelly, 2015). The panel’s objective was to review the evidence presented to them and recommend on ways of managing postoperative pain. The target audience of the study were clinicians who managed chronic pain, acute surgical pain, dental pain, and even traumatic pain (Fuzaylov & Kelly, 2015). Over 858 studies were included in the research making it a very effective research. Therefore, post operative pain mangement has been reviewed by the nursing department over time making it easier to compare the different postoperative pain techniques and delivering a good report on the same.

Purpose

Postoperative pain can be a problem for burn victims especially the ones who have already been on the surgical table. Over the years, burns were observed as a deformation of the skin but today with technology advancement, it has become easier to reconstruct and reverse the burn process. The pain experienced after the surgical procedure can be managed in different ways. One way is through the subcutaneous infusion of local anesthetics. The infusion is done using a sacker that penetrates the skin to the lower layer and the drug is given at that juncture. Skin burns are accompanied by a burning sensation that can be very irritating to the victim. This method of anesthetic admission reduces that unpleasant burning feeling.

Local anasthetics have been used in other countries to treat the burn reconstructed patient and it usually works differently depending on the age of the patient. For adolescents, the anaesthetic is administered in different dosage for those of 13-18 years, adults 19-44 years and adults between 45-64 years to both male and female (Poulsen, 2019). The anesthetic is administered in small amounts over the course of the healing and no use of multi-modal techniques is required.

Most countries especially the developing ones do not have adequate clinical equipment to perform multi-modal methods of dealing with postoperative pain. In some countries, skin reconstruction procedures are not available to burn victims, thus, most people are forced to remain with healing scars. The lack of resources has been the down side of many countries without the necessary equipment (Poulsen, 2019). Victims are left with no choice but to receive local anesthesia and wait for the pruritic burns to resolve in time.

In the United States, the methods for treating postoperative pain are different since the American Society of pain (ASP) establishes guidelines concerning this issue. Continuous use of the infusion of local anesthetics is done in order to provide analgesia following a skin harvest from the thigh which is used in the burn reconstruction process. The administration of local anesthesia is introduced depending on the patients consent. A multi-modal approach of dealing with postoperative pain is widely practiced in the USA since most clinicians are assigned to the task of reducing pain after surgery (Poulsen, 2019). Therapeutic exercise and constant skin stretches are recommended by the ASP in the postoperative period for pain control. Therefore, there is an obvious difference between the practices in the USA and other countries on how they handle burn victims.

Study #1: Nursing research Study in the USA

Research is the key to many issues affecting the nursing field and postoperative pain for burn victims is one area that can be used for research. The American Pain Society (APS) and the American Society of Anesthesiologists (ASA) have joined hands and handle the research being done in the USA (Poulsen, 2019). Preoperative education and preoperative pain management planning has been one key recommendation of these societies. Clinicians are advised to brief the family and the patient on the surgical procedure to be performed and how the postoperative pain experience will be managed. Medication is administered to provide pain relief and to make sure it is reduced as much as possible.

The method of checking is based on tracking patient’s response to postoperative pain treatment and change the treatment plan if the need arises (Poulsen, 2019). General principles regarding the use of multi-modal therapies is recommended and the clinicians are advised to use non- pharmacological interventions for the treatment of postoperative pain. Cognitive behavioral modalities are recommended by the societies in order to access the patient’s response to surgery and ascertain whether they are still in their right set of mind. The panel neither recommends nor stops the use of other therapeutic method to control pain such as acupuncture and massage therapy (Poulsen, 2019). The choice is left entirely to the clinician assigned the task of managing the patient’s postoperative pain.

The use of systematic pharmacological therapies have also been recommended by the societies. The use of oral methods over the intravenous administration of opioids for patients after surgery are highly recommended to those who can receive the drugs orally. The intramuscular route should be avoided at all costs since patients are not very stable after surgery and the injection can become lethal to them, especially within burn victims. The use of gabapentin and pregabalin is recommended among multi-modal analgesia.

For adults, intravenous ketamine should be used as a form of multi-modal analgesia but it is not a strict recommendation since research evidence was based on moderate quality evidence (Poulsen, 2019). Therefore, in the USA, nursing research has been spearheaded by medical societies that have made it easier to be able to apply both the local anesthetic methods and the multi-modal technics in an effective manner. Medical societies have shaped down the nursing sector and all clinicians are subjected to a study session where they learn how to manage postoperative pain. In addition, specific clinicians in health centers are given the task of evaluating the outcomes.

Study #2: Nursing Research Study Non-USA

The nursing research modality in foreign countries is totally different from that of the USA. The differences are brought about by different government policies that are used to control the medical space. The policies in different countries enable the study to be carried out in a very fast and effective manner. While some other counties lack the necessary resources in order to make the research a success (Cooney, 2016). Time has shown that research needs to be taken seriously with the result being studied on a daily basis and ensuring that patients are the sole beneficiaries of the programs.

For example, in a study of burned victims conducted in Ukraine, the results obtained were different since clinic resources were limited and patients were numerous. Therefore, clinicians had to administer small dosages of medicication to a total of 109 patients present and then observe the results. A group of 64 patients received the standard postoperative drug of metamizole 1g or ketorolac 3%-30mg by the nursing staff (Chou & Gordon, 2016). The other 45 patients received a different type of dosage and then the researchers had to wait and observe the patients.

From the presented case, it is clear that the hospital in which the study was being performed had inadequate resources; Thus, researchers were forced to maintain spare supplies for future use to avoid depletion. Hence, there is a clear cut difference between researchers in international communities in countries that have underfunded medical budgets, or in countries where there is scarcely any tools for research. Burn patients in such countries face many difficulties in utilizing what is available to them. Nevertheless, some countries do have the resources, for instance England, wich is part of the European nations, competing with the USA in terms of delivering research including nursing professionals. Life has never been easy for such counties since they have societies that keep pushing the delivery of better health care to its people.

Organizational structure, policies and procedures have been laid down by societies on the placement of surgery platforms for safe and effective delivery of postoperative pain control (Chou & Gordon, 2016). For example, surgical rooms should be full of clinicians that have specialized in pain management. Facilities in which neuraxial analgesia and continuous peripheral blocks are conducted have procedures for safe delivery and trained individuals to manage those procedures.

In England, clinicians consider the surgical local anesthetic based on topical pharmacological therapies due to their location and constant weather change in the region. Therefore, pain reduction after an operation also considers the weather at the time and prevent any medication that can endanger the patient. Therefore, the difference is there for cases in and out of the USA. Though the approach and goals are the same, the execution of duties change depending on the region. Countries that are able to compete with the USA have been reviewing their nursing profession and making sure their research is as good as any other. Hence, research in the nursing sector is beneficial to many postoperative cases and the morale for research should be encouraged.

Conclusion

Neither the local anesthetic analgesic techniques nor the multi-modal techniques can be dismissed. Both techniques target the same issue from different approaches to relieve postoperative pain. Over the years, patients have required innovative methods of controlling pain. Pain manifests differently from person to person, and recovery is based on the person’s overall health, age, and comorbidities. For instance, a person who smokes chronicly, or has a long standing use of ilicit drugs may have more difficulty recovering after surgery as opposed to a person who has maintained a healthy life style and has no significant comorbidities.

The comparison between the local anesthetic-based peripheral regional analgesic techniques, with the use of a multi-modal approach for pain management alone differs in countries depending on the resources available. For multi-modal approaches a country needs to provide the necessary resources in order for them to be applied. For local aesthetics to be used the process needs to be funded. The USA has shown to be better equipped with societies such as the APS managing the nursing sector and making sure that the required research is conducted properly.

Changes that relate to these question of comparison include the research process. The research is sometime equipped with moderately researched evidence. At least, the conserved parties should try and have very strong recommended research as the only option when it comes with dealing with postoperative pain. Therefore, the research should be define and there should not be any second guessing on the final recommendations of the research.

Another factor, would be to provide the guidelines of the practice to nurses or other clinicians and make sure they follow those steps for the safety of the patient. In addition, there should be a clear understanding of which multi-modal therapies to use and the medical societies should not be skeptical with use of therapies such as acupuncture.

Postoperative pain has been reported to persist for years in some patients. The nursing research team and any governmental policy that is aimed at helping research through funding, should prioritize this matter and establish evidence based guidelines, and create innovative methods to help patients who are experiencing postoperative surgical pain. A relief to the suffering of this patients should be provided, and the most accurate results come from research. Based on the presented review of studies, the use of local anesthetic-based peripheral regional analgesic techniques, and the use of multi-modal approaches should both be considered to provide fast and effective pain relief in recovering surgical patients.

References

Chou, R., Gordon, D. B. (2016). Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. The Journal of Pain.

Cooney, M. F. (2016). Postoperative pain management: clinical practice guidelines. Journal of Perianesthesia Nursing.

Fuzaylov, G., Kelly, T. L. (2015). Post-operative pain control for burn reconstructive surgery in a resource-restricted country with subcutaneous infusion of local anesthetics through a soaker catheter to the surgical site: Preliminary results. Burns.

Poulsen, M. J. (2019). Music as a Postoperative Pain Management Intervention. Journal of PeriAnesthesia Nursing.