Assigment .Apa seven . All instructions attached.

9

Pain Management in Older Orthopedic Surgical Patients

Yurienis Viltres

Grand Canyon University

Nursing Research and Evidence Based Practice

Faculty Name: Jesy Franke

May 19, 2024

Pain Management in Older Orthopedic Surgical Patients

Pain management in older orthopedic surgical patients is an important part of post-operatively quality care. The demographic trends for an aging population increase the demand for surgical interventions in older persons. Older patients are also at increasing risk for postoperative delirium, functional decline, and age-related consequences on top of already poor outcomes related to routine surgery, like death and morbidity (Shellito et al., 2021). Since aging physiologically affects every organ system, demographics, and organ aging should be considered equally in geriatric perioperative treatment. Traditionally, opioid analgesics have been considered to be at the center of treatment for acute post-operative pain. However, the use of opioids solely as monotherapy for pain management leads to a lot of complications, especially in the elderly. Opioids cause respiratory depression, delirium, and constipation and have a high potential for developing dependence. Such complications interfere with recovery, prolong hospitalization, and increase treatment costs.

Multimodal pain management (MPM) has now emerged as a promising way out of this problem. MPM utilizes analgesic techniques that are a combination of NSAIDs, acetaminophen, regional anesthesia, and non-pharmacologic interventions, including physical therapy and cognitive-behavioral strategies. Diverse pain pathways are targeted in the aim for pain control to be more effective while using the least number of opioids possible. MPM may be of particular assistance to an elderly population that is already quite vulnerable to the adverse effects of opioids because of physiological changes associated with aging. Initial perspectives state that MPM may improve the control of pain, reduce opioid consumption, and hasten functional recovery. Evaluating whether MPM is effective versus opioid-alone management in the first 72 post-operation hours allows for designing evidence-based protocols that improve patient outcomes, safety, and quality of care in geriatric orthopedic surgery. This article compares multimodal pain management to opioid-only in older orthopedic surgery patients to improve pain control and functional recovery with evidence-based nursing practice guidelines.

PICOT Question

In older patients who have undergone orthopedic surgery (P), how does the use of multimodal pain management techniques (I) compared to current opioid-only pain management practices (C) affect measurable pain scores and range of motion (ROM) (O) within the first 72 hours’ post-operation (T)?

Method of Studies

Jildeh et al. (2022) is a randomized controlled trial of multimodal non-opioid treatment of pain versus common opioid therapies. The study was conducted among 120 patients older than 65 who had undergone arthroscopic rotator cuff surgery. Patients were randomized to multimodal non-opioid treatment or opioid-sole management. The pain intensity was measured by a standard pain scale at different intervals and analyzed statistically to compare the outcome in both these groups.

Nallani et al. (2021) conducted a qualitative inquiry investigating how nurse anesthetists managing elderly patients in the perioperative ambulatory surgery setting were satisfied with and experienced pain management. Semistructured interviews were conducted to derive data on nurses' perceptions of pain management strategies, including effectiveness and preference for multimodal pain treatment. Using thematic analysis, results were established from the interview transcriptions regarding the role of nurses in education about pain management and their perceived benefits from multimodal techniques.

Gao et al. (2022) used a quantitative, randomized, double-blind controlled trial to find out how continuous intravenous DEX further added to the combination of local infiltration analgesia and FNB resulted in more postoperative pain control and functional recovery in patients undergoing TKA. It recruited 95 patients aged 60-80, randomly divided into intervention and control groups. The intervention group received LIA, FNB, and DEX, while the control group received LIA, FNB, and normal saline. Analyses using statistical data were done measuring pain levels, opioid intake, and functional outcome measures of recovery.

Hulsbæk et al. (2023) qualitatively investigated older patients' perspectives on participating in a multimodal rehabilitation program following hip fracture surgery. The authors conducted a semistructured telephone interview with 19 participants regarding experiences and perceptions related to the rehabilitation process. Using qualitative content analysis, data retrieved from interviews were analyzed such that information about the views of the patients sustaining the effectiveness and acceptability of the multimodal approach could be generated.

Make sure to include information on the setting, sampling, data gathering, and data analysis methods for this qualitative study.  Make sure to also include details on the specific statistical method for quantitative studies, and specific thematic analysis method used for qualitative studies. These are important elements to include as well.

Results of Studies

Jildeh et al. (2022) showed that multimodal non-opioid pain treatment has been more effective in the management of post-operative pain as compared to opioid analgesia. The treated multimodal patients reported lower scores in the results, with less pain and fewer complications related to opioid analgesia. The findings suggest that multimodal is an effective technique for improved outcomes in pain management for elderly populations undergoing orthopedic surgery. Nallani et al. (2021) demonstrated that perioperative nurses are responsible for teaching patients the different options for managing their pain. Nurses recommend multimodal pain management since it is non-toxic and has fewer adverse effects than opioid monotherapy, which most physicians prefer. The study suggests nurses must develop multimodal pain management skills to increase patient safety.

Gao et al. (2022) demonstrated that the effectiveness of the multimodal pain control technique via LIA-FNB-DEX significantly improved postoperative pain and functional recovery in TKA patients. The results revealed that the interventional group had lower pain scores, less opioid consumption, and improved knee ROM than the control group. These results support multimodal techniques for improving improvement and recovery, along with reductions in opioid-related side effects. Hulsbæk et al. (2023) reported multimodal rehabilitation to make many of the respondents feel good and benefit from extra care, structured physiotherapy, as well as anabolic steroids. The study showed improvements in the functional recovery of patients treated with a multimodal approach and increased satisfaction with the general rehabilitation process. The results support the use of multimodal rehabilitation strategies in enhancing outcomes during the recovery of elderly patients following hip fracture surgery.

Please include specific numerical results (p-value, and interpretation for example), or measures of central tendency (mean, median, mode) for quantitative research articles. Include a discussion on whether findings are statistically significant,and why.

Include clear and specified enumeration of themes and sub-themes for qualitative research results.

Outcomes Comparison Part 1: Anticipated Outcome

The anticipated outcomes following the PICOT question are improvements in pain control and functional recovery within the initial 72 hours after surgery for elderly patients undergoing routine orthopedic surgical interventions with the application of multimodal techniques over opioid-only pain control. Multimodal strategies are anticipated to lower pain ratings, opioid consumption, and opioid-related adverse effects while speeding up functional recovery.

Outcomes Comparison Part 2: Four Articles

Jildeh et al. (2022) support the results expected by pointing out that multimodal approaches to pain control are equally if not more effective than opioid-alone strategies on patients who underwent surgery. Patients experienced better pain control and fewer opioid-related complications, aligning with the expected benefits of multimodal strategies. The qualitative results of Nallani et al. (2021) show that most perioperative nurses now view multimodal pain management positively. The nurses' statements show that it is an effective multimodal approach to managing pain and reducing opioid side effects, which will support the expected benefits of better pain control and functional recovery.

Gao et al. (2022) findings align with the anticipated outcomes by showing that combining LIA, FNB, and DEX significantly improves postoperative pain control and functional recovery. The patients in the treatment arm were recorded to have less pain scores, reduced use of opioids, and superior functional outcomes that support the benefits of multimodal pain management strategies. The findings from Hulsbæk et al. (2023) confirm more evident results through the signs that the patients are cooperative and receptive to the multimodal rehabilitation programs. Patients report better functional recovery and overall satisfaction which is what was anticipated from multimodal pain management methods to contribute to better recovery outcomes.

Proposed Evidence-Based Practice Changes Part 1: Link Between PICOT Question

The PICOT question and research articles address the nursing problem of managing pain in senior orthopedic surgery patients. The articles focus on evidence that a multimodal approach improves postoperative pain control and functional recovery in older persons. The research articles support the findings of the use of multimodal regimens instead of opioid-only-based pain management, as it will be safer and more effective and correlate with the expected outcomes of the PICOT question.

Proposed Evidence-Based Practice Change Part 2: EBP Proposal

The research indicates that implementing a standardized multimodal pain management protocol has better outcomes than older orthopedic surgical patients who do not have the plan. The strategies include providing educational training programs to the nursing staff on a comprehensive base regarding techniques for managing pain, like NSAIDs, acetaminophen, regional anesthesia, and non-pharmaceutical approaches mainly represented by physiotherapy and cognitive-behavioral strategies. The standardized protocol should outline specific guidelines regarding the administration of medication, regional anesthesia techniques, and non-pharmacologic interventions. Patients should be educated about the value of multimodal pain management for making a comprehensive decision. There has to be a set monitoring system regarding patient outcomes related to pain control and functional recovery. There should likewise be interdisciplinary collaboration from surgeons, anesthesiologists, nurses, and physical therapists to ensure a coordinated manner of pain management. These evidence-based practice changes can optimize pain control, decrease opioid-related problems, and improve functional recovery for older orthopedic surgical patients to ultimately achieve better patient outcomes and quality of care.

Conclusion

Multimodal strategies for pain management in older orthopedic surgical patients are a significant improvement over the opioid-only approach. Evidence from the studies provided has proved multimodal techniques to have better pain control with reduced opioid consumption and, through this, promote accelerated recovery of the functional status post-operation. These benefits would be valuable for an aging population more vulnerable to the adverse effects of opioids. The proposed changes in evidence-based practice encourage standardizing protocols, promoting nursing education and awareness of the patients, and enabling interdisciplinary collaboration to effectively optimize pain management. The protocol needs to be established to enhance patient outcomes, reduce issues of opioid-related complications, and increase the quality of care given to patients. Multimodal pain management will enhance the ability to attain the goals of the PICOT question for a more efficacious and safer practice of postoperative pain control in elderly orthopedic surgery patients.

This conclusion is too long. Please provide a short wrap up (four sentences tops) just to remind your reader about what you discussed in the body of the paper. For example:

 “This paper discussed the value of addressing the issue of problem x. Articles were reviewed to provide support for the proposed intervention y. This author is therefore proposing practice change z.”

References

Gao, C., Huang, T., Wu, K., Zhang, W., Wang, S., Chai, X., Xie, Y., & Tang, C. (2022). Multimodal analgesia for accelerated rehabilitation after total knee arthroplasty: A randomized, double-blind, controlled trial on the effect of the co-application of local infiltration analgesia and femoral nerve block combined with Dexmedetomidine. Brain Sciences, 12(12), 1652. https://doi.org/10.3390/brainsci12121652

Hulsbæk, S., Laursen, L. B., Kristensen, M. T., & Midtgaard, J. (2023). Older patients’ perspectives on participating in multimodal rehabilitation including anabolic steroids following hip fracture: a qualitative study embedded within a pilot RCT. Disability & Rehabilitation, 45(1), 81–89. https://doi.org/10.1080/09638288.2022.2025929

Jildeh, T. R., Abbas, M. J., Hasan, L., Moutzouros, V., & Okoroha, K. R. (2022). Multimodal nonopioid pain protocol provides better or equivalent pain control compared to opioid analgesia following arthroscopic rotator cuff surgery: a prospective randomized controlled trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 38(4), 1077-1085.

Nallani, R., Fox, C. C., Sykes, K. J., Surprise, J. K., Fox, C. E., Reschke, A. D., ... & Villwock, J. A. (2021). Pain management and education for ambulatory surgery: a qualitative study of perioperative nurses. Journal of Surgical Research, 260, 419-427.

Shellito, A. D., Dworsky, J. Q., Kirkland, P. J., Rosenthal, R. A., Sarkisian, C. A., Ko, C. Y., & Russell, M. M. (2021). Perioperative pain management issues unique to older adults undergoing surgery: a narrative review. Annals of Surgery Open, 2(3), e072. https://doi.org/10.1097/AS9.0000000000000072

NRS-445: Research Critiques and Evidence-Based Practice Change Proposal Guidelines

Use this document to synthesize the information from your "Literature Evaluation Table" from Topic 1 into a literature review. Successful completion of this assignment requires that you use your conclusions from your literature review to propose an evidence-based practice change.

Introduction

· Introduce your nursing practice problem and discuss the purpose of your paper.

· State your updated PICOT question incorporating any feedback that you received from your instructor.

Method of Studies

· State the methods of the four articles you are comparing and describe how each method helps answer the associated research question.

Results of Studies/Key Findings

· Summarize the key findings of the four studies.

Outcomes Comparison

· What are the anticipated outcomes for your PICOT question?

· How do the outcomes of the four articles you chose compare to your anticipated outcomes?

Proposed Evidence-Based Practice Change

· What is the link between the PICOT question, the research articles, and the nursing practice problem you identified?

· Based on this information, propose an evidence-based practice change to improve outcomes of patient care for your identified setting.

· Suggest one way to assess outcomes for the proposed practice change to determine whether or not it is effective.

Conclusion

· Your conclusion should summarize the main points in the essay, including a varied restatement of the thesis.

© 2023. Grand Canyon University. All Rights Reserved.

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9

Pain Management in Older Orthopedic Surgical Patients

Yurienis Viltres

Grand Canyon University

Nursing Research and Evidence Based Practice

Faculty Name: Jesy Franke

May 19, 2024

Pain Management in Older Orthopedic Surgical Patients

Pain management in older orthopedic surgical patients is an important part of post-operatively quality care. The demographic trends for an aging population increase the demand for surgical interventions in older persons. Older patients are also at increasing risk for postoperative delirium, functional decline, and age-related consequences on top of already poor outcomes related to routine surgery, like death and morbidity (Shellito et al., 2021). Since aging physiologically affects every organ system, demographics, and organ aging should be considered equally in geriatric perioperative treatment. Traditionally, opioid analgesics have been considered to be at the center of treatment for acute post-operative pain. However, the use of opioids solely as monotherapy for pain management leads to a lot of complications, especially in the elderly. Opioids cause respiratory depression, delirium, and constipation and have a high potential for developing dependence. Such complications interfere with recovery, prolong hospitalization, and increase treatment costs.

Multimodal pain management (MPM) has now emerged as a promising way out of this problem. MPM utilizes analgesic techniques that are a combination of NSAIDs, acetaminophen, regional anesthesia, and non-pharmacologic interventions, including physical therapy and cognitive-behavioral strategies. Diverse pain pathways are targeted in the aim for pain control to be more effective while using the least number of opioids possible. MPM may be of particular assistance to an elderly population that is already quite vulnerable to the adverse effects of opioids because of physiological changes associated with aging. Initial perspectives state that MPM may improve the control of pain, reduce opioid consumption, and hasten functional recovery. Evaluating whether MPM is effective versus opioid-alone management in the first 72 post-operation hours allows for designing evidence-based protocols that improve patient outcomes, safety, and quality of care in geriatric orthopedic surgery. This article compares multimodal pain management to opioid-only in older orthopedic surgery patients to improve pain control and functional recovery with evidence-based nursing practice guidelines.

PICOT Question

In older patients who have undergone orthopedic surgery (P), how does the use of multimodal pain management techniques (I) compared to current opioid-only pain management practices (C) affect measurable pain scores and range of motion (ROM) (O) within the first 72 hours’ post-operation (T)?

Method of Studies

Jildeh et al. (2022) is a randomized controlled trial of multimodal non-opioid treatment of pain versus common opioid therapies. The study was conducted among 120 patients older than 65 who had undergone arthroscopic rotator cuff surgery. Patients were randomized to multimodal non-opioid treatment or opioid-sole management. The pain intensity was measured by a standard pain scale at different intervals and analyzed statistically to compare the outcome in both these groups.

Nallani et al. (2021) conducted a qualitative inquiry investigating how nurse anesthetists managing elderly patients in the perioperative ambulatory surgery setting were satisfied with and experienced pain management. Semistructured interviews were conducted to derive data on nurses' perceptions of pain management strategies, including effectiveness and preference for multimodal pain treatment. Using thematic analysis, results were established from the interview transcriptions regarding the role of nurses in education about pain management and their perceived benefits from multimodal techniques.

Gao et al. (2022) used a quantitative, randomized, double-blind controlled trial to find out how continuous intravenous DEX further added to the combination of local infiltration analgesia and FNB resulted in more postoperative pain control and functional recovery in patients undergoing TKA. It recruited 95 patients aged 60-80, randomly divided into intervention and control groups. The intervention group received LIA, FNB, and DEX, while the control group received LIA, FNB, and normal saline. Analyses using statistical data were done measuring pain levels, opioid intake, and functional outcome measures of recovery.

Hulsbæk et al. (2023) qualitatively investigated older patients' perspectives on participating in a multimodal rehabilitation program following hip fracture surgery. The authors conducted a semistructured telephone interview with 19 participants regarding experiences and perceptions related to the rehabilitation process. Using qualitative content analysis, data retrieved from interviews were analyzed such that information about the views of the patients sustaining the effectiveness and acceptability of the multimodal approach could be generated.

Make sure to include information on the setting, sampling, data gathering, and data analysis methods for this qualitative study.  Make sure to also include details on the specific statistical method for quantitative studies, and specific thematic analysis method used for qualitative studies. These are important elements to include as well.

Results of Studies

Jildeh et al. (2022) showed that multimodal non-opioid pain treatment has been more effective in the management of post-operative pain as compared to opioid analgesia. The treated multimodal patients reported lower scores in the results, with less pain and fewer complications related to opioid analgesia. The findings suggest that multimodal is an effective technique for improved outcomes in pain management for elderly populations undergoing orthopedic surgery. Nallani et al. (2021) demonstrated that perioperative nurses are responsible for teaching patients the different options for managing their pain. Nurses recommend multimodal pain management since it is non-toxic and has fewer adverse effects than opioid monotherapy, which most physicians prefer. The study suggests nurses must develop multimodal pain management skills to increase patient safety.

Gao et al. (2022) demonstrated that the effectiveness of the multimodal pain control technique via LIA-FNB-DEX significantly improved postoperative pain and functional recovery in TKA patients. The results revealed that the interventional group had lower pain scores, less opioid consumption, and improved knee ROM than the control group. These results support multimodal techniques for improving improvement and recovery, along with reductions in opioid-related side effects. Hulsbæk et al. (2023) reported multimodal rehabilitation to make many of the respondents feel good and benefit from extra care, structured physiotherapy, as well as anabolic steroids. The study showed improvements in the functional recovery of patients treated with a multimodal approach and increased satisfaction with the general rehabilitation process. The results support the use of multimodal rehabilitation strategies in enhancing outcomes during the recovery of elderly patients following hip fracture surgery.

Please include specific numerical results (p-value, and interpretation for example), or measures of central tendency (mean, median, mode) for quantitative research articles. Include a discussion on whether findings are statistically significant,and why.

Include clear and specified enumeration of themes and sub-themes for qualitative research results.

Outcomes Comparison Part 1: Anticipated Outcome

The anticipated outcomes following the PICOT question are improvements in pain control and functional recovery within the initial 72 hours after surgery for elderly patients undergoing routine orthopedic surgical interventions with the application of multimodal techniques over opioid-only pain control. Multimodal strategies are anticipated to lower pain ratings, opioid consumption, and opioid-related adverse effects while speeding up functional recovery.

Outcomes Comparison Part 2: Four Articles

Jildeh et al. (2022) support the results expected by pointing out that multimodal approaches to pain control are equally if not more effective than opioid-alone strategies on patients who underwent surgery. Patients experienced better pain control and fewer opioid-related complications, aligning with the expected benefits of multimodal strategies. The qualitative results of Nallani et al. (2021) show that most perioperative nurses now view multimodal pain management positively. The nurses' statements show that it is an effective multimodal approach to managing pain and reducing opioid side effects, which will support the expected benefits of better pain control and functional recovery.

Gao et al. (2022) findings align with the anticipated outcomes by showing that combining LIA, FNB, and DEX significantly improves postoperative pain control and functional recovery. The patients in the treatment arm were recorded to have less pain scores, reduced use of opioids, and superior functional outcomes that support the benefits of multimodal pain management strategies. The findings from Hulsbæk et al. (2023) confirm more evident results through the signs that the patients are cooperative and receptive to the multimodal rehabilitation programs. Patients report better functional recovery and overall satisfaction which is what was anticipated from multimodal pain management methods to contribute to better recovery outcomes.

Proposed Evidence-Based Practice Changes Part 1: Link Between PICOT Question

The PICOT question and research articles address the nursing problem of managing pain in senior orthopedic surgery patients. The articles focus on evidence that a multimodal approach improves postoperative pain control and functional recovery in older persons. The research articles support the findings of the use of multimodal regimens instead of opioid-only-based pain management, as it will be safer and more effective and correlate with the expected outcomes of the PICOT question.

Proposed Evidence-Based Practice Change Part 2: EBP Proposal

The research indicates that implementing a standardized multimodal pain management protocol has better outcomes than older orthopedic surgical patients who do not have the plan. The strategies include providing educational training programs to the nursing staff on a comprehensive base regarding techniques for managing pain, like NSAIDs, acetaminophen, regional anesthesia, and non-pharmaceutical approaches mainly represented by physiotherapy and cognitive-behavioral strategies. The standardized protocol should outline specific guidelines regarding the administration of medication, regional anesthesia techniques, and non-pharmacologic interventions. Patients should be educated about the value of multimodal pain management for making a comprehensive decision. There has to be a set monitoring system regarding patient outcomes related to pain control and functional recovery. There should likewise be interdisciplinary collaboration from surgeons, anesthesiologists, nurses, and physical therapists to ensure a coordinated manner of pain management. These evidence-based practice changes can optimize pain control, decrease opioid-related problems, and improve functional recovery for older orthopedic surgical patients to ultimately achieve better patient outcomes and quality of care.

Conclusion

Multimodal strategies for pain management in older orthopedic surgical patients are a significant improvement over the opioid-only approach. Evidence from the studies provided has proved multimodal techniques to have better pain control with reduced opioid consumption and, through this, promote accelerated recovery of the functional status post-operation. These benefits would be valuable for an aging population more vulnerable to the adverse effects of opioids. The proposed changes in evidence-based practice encourage standardizing protocols, promoting nursing education and awareness of the patients, and enabling interdisciplinary collaboration to effectively optimize pain management. The protocol needs to be established to enhance patient outcomes, reduce issues of opioid-related complications, and increase the quality of care given to patients. Multimodal pain management will enhance the ability to attain the goals of the PICOT question for a more efficacious and safer practice of postoperative pain control in elderly orthopedic surgery patients.

This conclusion is too long. Please provide a short wrap up (four sentences tops) just to remind your reader about what you discussed in the body of the paper. For example:

 “This paper discussed the value of addressing the issue of problem x. Articles were reviewed to provide support for the proposed intervention y. This author is therefore proposing practice change z.”

References

Gao, C., Huang, T., Wu, K., Zhang, W., Wang, S., Chai, X., Xie, Y., & Tang, C. (2022). Multimodal analgesia for accelerated rehabilitation after total knee arthroplasty: A randomized, double-blind, controlled trial on the effect of the co-application of local infiltration analgesia and femoral nerve block combined with Dexmedetomidine. Brain Sciences, 12(12), 1652. https://doi.org/10.3390/brainsci12121652

Hulsbæk, S., Laursen, L. B., Kristensen, M. T., & Midtgaard, J. (2023). Older patients’ perspectives on participating in multimodal rehabilitation including anabolic steroids following hip fracture: a qualitative study embedded within a pilot RCT. Disability & Rehabilitation, 45(1), 81–89. https://doi.org/10.1080/09638288.2022.2025929

Jildeh, T. R., Abbas, M. J., Hasan, L., Moutzouros, V., & Okoroha, K. R. (2022). Multimodal nonopioid pain protocol provides better or equivalent pain control compared to opioid analgesia following arthroscopic rotator cuff surgery: a prospective randomized controlled trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 38(4), 1077-1085.

Nallani, R., Fox, C. C., Sykes, K. J., Surprise, J. K., Fox, C. E., Reschke, A. D., ... & Villwock, J. A. (2021). Pain management and education for ambulatory surgery: a qualitative study of perioperative nurses. Journal of Surgical Research, 260, 419-427.

Shellito, A. D., Dworsky, J. Q., Kirkland, P. J., Rosenthal, R. A., Sarkisian, C. A., Ko, C. Y., & Russell, M. M. (2021). Perioperative pain management issues unique to older adults undergoing surgery: a narrative review. Annals of Surgery Open, 2(3), e072. https://doi.org/10.1097/AS9.0000000000000072