Understanding of the Post-Surgery Pain Management Essay (Book Review)

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Integration/Synthesis of Evidence

Notable Themes in the Study

The notable themes in this review include sample size characteristics, randomized techniques, and pain reduction. These themes appeared in most of the papers. The following sections of this paper discuss them in detail

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  • Small Sample Sizes: The use of small samples was a notable theme in most of the studies sampled. The average sample size was about 30 respondents. For example, Chander, Liddle, Kaur, and Varghese (2011) sampled 30 respondents for each study group and Baig et al. (2006) sampled 70 patients only. Cardero and Rodriquez-Merchan (2010) sampled 25 respondents in two groups, while Shalan, Badawy, Yousef, and Nazar (2002) sampled 60 respondents. Based on the phenomenon under investigation, these sample sizes were small and unreliable in developing reliable findings.
  • Randomization: Randomization was another theme that emerged from the review. It refers to the process where researchers allocate respondents randomly across different studies (Cardero & Rodriquez-Merchan, 2010). Different authors used this method in their methodological framework. For example, Baig et al. (2006) used the randomized control trial to divide a group of 70 respondents into two groups of 35 people. CicconeII, Busey, Weinstein, Walden, and Elias (2008) also used randomized control trials to divide 128 participants into four distinct groups. Randomization was a common theme in the other studies because it appeared in five more articles (Leach & Bonfe, 2009; Singelyn & Gouvernuer, 1999; Cardero & Rodriquez-Merchan, 2010; Chander et al., 2011; Seet, Leong, Yeo, & Fook-Chong, 2006).
  • Pain Reduction: Pain reduction was a common theme in most of the articles sampled because it was a common consequence of the adoption of peripheral nerve block and the use of a continuous infusion pump to manage pain in the post-surgery process (Cardero & Rodriquez-Merchan, 2010; Chander, Liddle, Kaur, & Varghese, 2011). Pain reduction also emerged as a key hypothesis in most of the articles sampled because many of the authors predicted that pain reduction would occur from the use of peripheral nerve blocks in pain management. For example, Baig et al. (2006), Leach & Bonfe (2009), Singelyn & Gouvernuer (1999), Cardero & Rodriquez-Merchan (2010), and Chander et al. (2011) affirmed this fact when their studies proved that pain reduction occurred from the use of peripheral nerve blocks. In terms of pain management, most of the studies found that pain management is successful through peripheral nerve blocking. Most of the studies also affirmed their hypothesis, which supported the potential success of the continuous peripheral nerve block in pain management. For example, Cardero and Rodriquez-Merchan (2010) and Chung et al. (2013) affirmed this fact. However, the studies used different patient classification metrics to come up with these findings. For example, some of them used demographic differences to analyze the efficacy of different pain management methods, while others used operational stages to classify study participants.

Critique of the Evidence

Melynk introduced a critical appraisal instrument known as the “rapid critical appraisal tool” to evaluate the quality of research. It asks three fundamental questions that focus on understanding how well researchers conducted a study, what the study means, and if the results apply to different groups of patients. The evidence provided in the ten articles sampled was relevant to the study question. They sought to find out if the placement of a continuous peripheral nerve block and/or with the use of a continuous infusion pump lessened the amount of oral or intravenous narcotic medication needed in post-surgical patients, compared to not having a continuous peripheral nerve block and/or continuous infusion pump placed. Most of the studies showed either a reduction in pain or an increase in pain (Leach & Bonfe, 2009; Singelyn & Gouvernuer, 1999; Cardero & Rodriquez-Merchan, 2010). From this review, we see that they focused on the research question. In terms of understanding how well the researchers conducted their research, it is pertinent to mention that most of the studies were simple and easy to follow (Leach & Bonfe, 2009; Singelyn & Gouvernuer, 1999; Cardero & Rodriquez-Merchan, 2010; Chander et al., 2011; Seet et al., 2006). Using different measurement criteria, the readers could also follow how the researchers arrived at their conclusions. Furthermore, the adherence to ethical guidelines in most of the studies shows that their findings are credible.

Based on the above insights, my overall impression of the quality of the studies was positive because the researchers did a good job simplifying the research processes for easy comprehension. Similarly, the researchers used reliable and credible instruments of data collection and analysis. For example, the use of randomized control trials across most of the studies improved the quality of the findings obtained because Shalan et al. (2002) say good randomization would eliminate population bias and improve the data analysis process. Similarly, through the randomization process, it is easy to identify populations of participating individuals, thereby improving the possibility of study replication (Shalan et al., 2002).

What the Study Means

Based on the evidence provided in the sampled articles, we find that their findings have a strong impact on understanding the most effective types of pain management methods. The results have a strong bearing on patient welfare because patient satisfaction is at the heart of nursing and the wider medical practice (pain management affects patient satisfaction). Depending on the results provided by each author, the varying levels of pain measured during the post-surgery process shows that peripheral nerve blocks and intravenous narcotic medication have a significant impact on pain management.

Gaps in the Evidence

Most of the articles in this review used a small sample size (usually between 20 – 60 participants). Such sample sizes are inadequate in developing reliable and credible findings of pain management. There needs to be further research to ascertain whether the current findings would remain the same if the researchers used a large sample size. In an unrelated analytical metric, most of the researchers used one pain measurement method – VAS. Therefore, their studies relied on only one pain measurement method to come up with their research findings. There needs to be further research to determine whether using a different pain measurement instrument would affect the findings. By doing so, we would have a more reliable and credible understanding of the post-surgery pain management process. Another research gap that emerges from the review is the missing body of information about chronic conditions that could influence post-surgery pain management. They include chronic conditions, addictions, and other factors. Although Baig et al. (2006) used chronic conditions as an exclusion criterion in their study; they did not explain the influence of these factors on pain management. Therefore, it is difficult to know the extent of these factors on their findings and pain management in general. Future studies need to explain the extent of their influence on post-surgery pain management.

Comparison to own Practice

The findings that have emerged from the literature review have a strong influence on my role as a nurse because pain management is one of my key responsibilities. Indeed, in my role as a surgical nurse/assistant, I have first-hand experience regarding the use of the peripheral nerve block and/or with the use of the infusion pump to manage pain. However, my knowledge is limited to the technical use of the methods. From this background, I have always wanted to know their efficacy. The findings from this review have contributed to my understanding of this issue. For example, in my practice, I have found that having a reliable metric to measure pain is a more accurate assessment of pain because pain is relative. Therefore, from the findings I have seen in this review, I find that pain measurement tools, such as VAS, which appear in Seet et al. (2006) and Schmidt et al. (2009) provide a reliable metric for pain assessment. Similarly, based on the positive response highlighted by researchers who have affirmed the efficacy of the peripheral nerve block and/or with the use of the infusion pump to manage pain, I believe that using these pain management techniques could improve patient satisfaction. The main point of contention I find with the analyzed studies is their apparent lack of explanation of the role of individual (patient-specific) factors in pain management. This concern stems from my experience, which has taught me that post-surgery pain management differs across patient groups. Furthermore, my experience has taught me that the type of surgical procedure a patient undergoes and the type of hospital giving the care, and even the surgeon who performs the procedure could have an impact on the pain management processes. The sampled studies have only mentioned these issues lightly. There is a need for a deeper examination of their effects on pain management processes.

Conclusion

This paper has reviewed ten articles that have focused on understanding post-surgery pain management. This focus centered on answering my PICO question, which strived to identify the most appropriate pain management technique for post-surgery patients. In line with this assessment, the sampled studies examined the effect of the peripheral nerve block as one method of pain management. They also analyzed the effects of continuous infusion pumps on pain management. Most of their reviews showed a positive outcome (reduction of pain management) after using the peripheral nerve block method and/or continuous infusion pump. However, the studies also showed varying levels of success. Although the small sample size used in most of the studies limited the findings, the use of randomized trials improved their validity and reliability by reducing bias and spurious causality. Most of the studies were also simple to understand, thereby making them easy to comprehend and follow. These tenets of the methodological framework affirm the studies’ high-quality findings. They influence pain management processes in the post-surgical process by identifying the most effective types of interventions. In this regard, they contribute to my understanding of the effectiveness of peripheral nerve blocks and/or with the use of the continuous infusion pump in pain management.

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References

Baig, M. K., Zmora, O., Derdemezi, J., Weiss, E. G., Nogueras, J. J., & Wexner, S. D. (2006). Use of the ON-Q Pain Management System Is Associated with Decreased Postoperative Analgesia Requirement: Double Blind Randomized Placebo Pilot Study. The Journal American College of Surgeons, 202(2), 297-305. Web.

Cardero, P. G., & Rodriquez-Merchan, E. C. (2010). Postoperative Analgesia in TKA: Ropivacaine Continuous Intra-articular Infusion. Clinical Orthopaedics and Related Research, 468, 1242-1247. Web.

Chander, R., Liddle, D., Kaur, B., & Varghese, M. (2011,). Anesthesia: Essays and Researches, 5(2), 142-146.

Chung, D., Lee, Y., Jo, M., Park, H., Lim, G., Cho, H.,… Kim, S. (2013). The ON-Q pain management system in elective gynecology oncological surgery: Management of postoperative surgical site pain compared to intravenous patient-trolled analgesia. Obstetrics & Gynecology Science, 56(2), 93-101. Web.

CicconeII, W. J., Busey, T. D., Weinstein, D. M., Walden, D. L., & Elias, J. J. (2008). Assessment of Pain Relief Provided by Interscalene Regional Block and Infusion Pump After Arthroscopic Surgery. Arthroscopy: The Journal of Arthroscopic and Related Surgery, 24(1), 14-19. Web.

Leach, D., & Bonfe, M. (2009). The Effectiveness of Femoral/Sciatic Nerve Blocks on Postoperative Pain Management in Total Knee Arthroplasty. Orthopaedic Nursing, 28(5), 257-262.

Schmidt, N. R., Donofrio, J. A., England, D. A., McDonald, L. B., Motyka, C. L., & Mileto, L. A. (2009). Extended-release epidural continuous peripheral nerve block for management of postoperative pain after orthopedic knee surgery: A retrospective study. Journal American Association of Nurse Anesthetists, 77(5), 349-354.

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Seet, E., Leong, W. L., Yeo, A. S., & Fook-Chong, S. (2006). Effectiveness of 3-in-1 Continuous Femoral Block of Differing Concentrations Compared to Patient Controlled Intravenous Morphine for Post Total Knee Arthroplasty Analgesia and Knee Rehabilitation. Anaesthesia and Intensive Care, 34(1), 25-30.

Shalan, H., Badawy, A., Yousef, H., & Nazar, M. (2002). Effect of intraperitoneal bupivacaine on postoperative pain following laparoscopic pelvic surgery. Gynaecological Endoscopy, 11, 371-375.

Singelyn, F. J., & Gouvernuer, J. A. (1999). Postoperative Analgesia After Total Hip Arthroplasty: IVPCA with Morphine, Patient-Controlled Epidural Analgesia, or Continuous “3-in-1” Block: A Prospective Evaluation by Our Acute Pain Service in More than 1,300 Patients. Journal of Clinical Anesthesia, 11, 550-554.

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