How nerve blocks contribute to pain control
Abstract
As surgeries become more efficient, one underrated element is postoperative pain management. There is need to explore the best practice when it comes to pain management. While some proponent have suggested the use of nerve block technique, others have suggested the use of combination therapy in achieving pain management protocol. Pain management after a surgical operation is critical in the recovery proves that a patient endures. The paper examines pain management in the context of adults and draws critical information from existing literature in a quest to establish a standard practice in pain management
How nerve Blocks contribute to pain control
Osteoarthritis is thought to be leading cause of disability in adults who are more than 65 years (Neogi, 2013). This is the most common form of arthritis, something that drive the patients to seek medical attention due to the pain associated with the disease. Pain associated with lower extremity osteoarthritis has over time made it the most frequent cause of loss pf mobility in old adults (“Prevalence of Disabilities and Associated Health Conditions among Adults — United States, 1999”, 2001). Dwindling quality of life. Don't use plagiarised sources.Get your custom essay just from $11/page
Proper techniques of pain management are pivotal concern of patients undergoing surgery as well as medical professionals. The most common of the management protocols is the post-operative pain management. . It is common practice for the patients to enquire the amount of pain during and after a surgical procedure life a knee surgery (Vadivelu et al, 2010). Postoperative pain has been known to affect the quality of life of a patient and also the healing process. Many advance have made in the field of pain management but the desired result is not always in achieved in every case of postoperative pain management.
Though it being an undervalued facet of postoperative care, pain management remains one of the most critical parts. The postoperative acre pain management has been a subject of discussion in the past couple of recedes with surgical and surgical related pain taking Centre stage. Medical complicating such as alladynia and hypegesnia have been found to result from poor management of postoperative pain (Stubhaug et al, 1997). . The studied then offered guidance in the sense that the general perception of pain should be studied in close association to the transmission pathway through which the pain signals are transported to the CNS.
There has been a rapid studies and subsequently discovery of target blocking that is credited with development of a number of techniques that vary with approved pharmaceutical products administered in varying ways and having varying modes of action (White & Kehlet, 2010).
Vadivelu et al (2010) conceptualized that the choice of the management technique need to be aligned with the need s of the patients including exposure to anesthesia, comorbidities, psychological status and also the surgical procedure to be conducted. The relevant choice of the pain management protocol has over the years proven to be critical in settling on the multimodal pain care approach.
Pain management is broadly divided based on route of administration, the type of them, pharmaceutical product, and also the mode of action. The administration route include rectal, epidural, intramuscular, oral, intravenous, subcutaneous, transdermal, and intrathecal. Peripheral nerve blocking and neuraxial blocking have been noted as the other category bases on neurons. Advances in such class of administrative route techniques include extended duration analgesia that allow for home administration and epidural analgesia that allows for administration through the use of catheter with an aim of blocking the nerve endings. The mechanisms of action classification is broadly under anti-inflammatory agents and analgesics. Analgesics include acetaminophens and opioids while the anti-inflammatory drugs are considered nonsteroidal anti-inflammatory drugs.
The basic mechanism, of pain managements is based on recognition of the molecular target whether central or peripheral blocking the signal of the pain , making pharmaceutical product that affect the target receptors, determining the administrative route, determining administration and developing novel anesthetic techniques (Vadivelu et al., 2010). The management of pain is broadly classified as either non-pharmacological or pharmacological protocols, as the names suggest, non-pharmacological depends on the various routes of administration pharmacological techniques involve use of opioids and non-opioid pharmaceutical products. Nerve blocking techniques block the perception of pain and it is sometimes used in combination with anesthesia. In this paper we examine the effect of the use of Anastacia and blocking against the use of block only and the effect it exerts on the postoperative pain management and relief especially the first three days after the surgery.
Problem description
Application of multimodal analgesia is an important aspect of enhanced recovery after operative surgery. Any patient who undergoes surgery and specifically knee surgery becomes a critical study subject in the case of this study. Pain has been found to have devastating impact that includes lengthy stays in the health facilities and increased recovery time. Cullen et al (2006) indicated that America has witnesses a threefold increase in ambulance surgical procedures but the surgical center visits have remain unchanged. Prolonged hospital stay and delayered recovery has been though too associated with pain management with parenteral opioid analgesics. As the clinicians seek to reduce the time the time the patients stay in the medical facilities, recovery continues to be a critical part of the concentration involving postoperative pain managements.
Knowledge gotten form from the study of pain management techniques has made it possible to decrease the discharge time. The enhanced recovery protocols have been found to show significant variations among institutions but they bare a lot of similar elements. The ERAS measures have been found to decrease the cost of medical care, increase customer satisfaction and it does so without increasing mortality and morbidity.
Postoperative pain has been punctuated by poor pain managements over the years with surveys in the US and Europe not showing any critical signs of things getting better. After most surgical procedures including knee operations, postoperative pain is common. Opioids have been verified as being addictive in nature but they are still being applied widely in pain management’s cases. Other significant drawbacks have been established to be associated with opioids. Over the past few decades, multimodal analgesic techniques have been applied widely in pain management. Current studies are disturbing by the fact that they seem to discard the historical practices suggesting that the like of epidural analgesia as no longer reliable in the management of pain and for that reason it cannot be considered to be a standard treatment techniques. Though underutilized, perineal methods seem to be the most promising frontier when it comes to major orthopedic surgical operations. Infiltrative techniques which some use catheters have been found to be useful in any surgical procedures despite the surgery being carried out. Simple delivery techniques of anesthesia can be pivotal point of improving the postoperative care. Transverses abdominal plane block as well as infiltration analgesics has changed the postoperative pain management.
Available Knowledge
Lewis et al (2015) in a study examining the ultrasound guidance for upper body and lower limb block as sort to find out whether ultrasound can be applied as a guide to nerve blocking. In their stud they established that the peripheral nerve blocks that were carried out with assistance of ultra sound only or with the help of PNS were thought to have an effective blockage of the sensory and motor blockage and in turn there was no need of the procedures being supplemented by other techniques or emergence of complications as a result of the blocking. Use of ultrasound in combination with PNS was thought to improve the performance time.
Kumar et al (2014) in a separate study compared ultrasonic blocking using multiple injections to peripheral nerve stimulation. The scholars found out that that using 0.5% bupivacaine in the multiple injection technique gave the same results in terms if effectiveness and complication when a comparison is made with the nerve stimulation technique. In the experiment, 20 ml of the bupivacaine effectively served in the nerve blocking function.
Kirsey et al, (2015) in another study performed a systematic review of the existing literature in an effort to analyze effectiveness of local anesthesia in peripheral blocking. The study found that clonidine, magnesium, buprenorphine, dexmedetomidine, and dexamethasone as agents that can be utilized for peripheral nerve blocking. The authors question the efficacy and safety, calling for further research around the same topic.
A study found that the regional Anastacia has an unclear impact when it comes to recovery especially after surgical procedures. The reach found that there was no sufficient value based outcome for the evidence. Regional Anastacia ate a common inclusion in the enhanced recovery protocols and that is because of their efficiency in improving recovery. The review found no sufficient evidence linking RA to decreased cost of healthcare and improving functionality of health outcome (McIsaac, Cole, &McCartney, 2015).
Garimella and Cellini, (2013) note that there is acritical level of uniqueness when handling individual patients allowing room for combination therapy in postoperative pain management. The scholars suggest inclusion of multimodal pain management when it is possible. The author recommend round the clock availability of acetaminophens or NSAIDS not unless the availability is counterproductive. In cases of ambulatory treatment, the scholars recommend the application of pre-emptive analgesia and regional block.
Methodology
The search and review was based on Levac and colleague’s proposal (Levac et al, 2010).
The initial stage is establishment of the research question and defining critical terms in the study. The study wanted to investigate in adult patients undergoing knee surgery, how the implementation of a nerve block along with anesthesia, as compared to not using a nerve block, affect the post-operative pain relief in the first 72 hours.
The second stage involved search strategy. In this case, the study was broadened to include pain management strategy related to the use of nerve blocking and anesthesia. The online scientific data bases provided an important source of information from which the journals and articles were retrieved. Academic sources were the only acceptable sources that were included in the search.
Selection of the study them followed. A robust inclusion and exclusion criteria was developed. The criteria was customized to maximize the sensitivity and accuracy. The study was more focused on adult patients with a special interest of postoperative pain managements.. Then followed data extraction where the critical information from the selected scholarly materials were included in the study. The extracted information from the study included the surgical techniques and the author details. The information form critical points of citation and reference of information. The last step in the process was summarization and reporting. The studies are bulky in nature. This element of the study ensures that the important communication in the study is included and summarized in a way that captures the essence of the research. Important calculations are performed at this stage and also the section sheds light on the outcomes of the study. The characteristics of the study are then focused on and brief description of the outcome is then presented.
Rationale
The use of combinational therapy is quite new but there are a number of proven drugs applied in the sector. As the minimal invasion surgery grow in popularity, adjuctive analgesics is the most preferred means despite the opioids are still common. With the public rage on the use of opioids and its addiction, there is need for intensive studies for alternative forms of postoperative pain management. Many drugs possess adverse effects. Adjunctive drugs are critical in limiting the effects. Combination therapy has gain popular in the recent past with suggesting that the combination can be critical in achieving enhanced recovery in patents.
Discussion
The healthcare services consumers expect that the best practice in the medical sector has scientific backing. Random controlled trials, as noted in most of the reviewed studies, have the most in terms of reliability and validity in the determination of clinical practice (Ohlsson, 1994). There is a need for medical practitioners and consumers to design and perform a robust systematic review of available literature to address clinical concerns. The basic definition of a systematic review point to the fact that the strategy applied is scientific, limiting biasness, contains critical appeals, and accumulates relevant studies specific to a particular topic. In this case, postoperative pain management. The meta-analysis sometimes referred to as quantitative overview, uses statistical techniques in combination and summarization of several trials. In a quantitative summary, the weight of the study is dependent on the variance inverse with studies with more activities being weightier. Grouping data and literature increase the power and credibility of the study, making it more effective. Systematic review offered the readers and the science community a less biased stud with pinpoint accuracy. In the recent past statistician, methodologies have been developed to summarize data from studies with diagnostic tests. Cumulative meta-analysis gives medical professionals and practitioners’ answers concerning the effectiveness of interventions at the soonest time possible (Ohlsson, 1994).
Conclusion
The research is set to build on existing studies and provide a critical guide for professional and scholars on the best techniques to apply in pain management. Whether use combinational therapy or single therapy, there is need to establish a scholarly backing to the application of the appropriate techniques.
References
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