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Epidural Analgesia Research Paper

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Benefit-risk of epidural analgesia - post-operative period Epidural analgesia is also widely used during the post-operative period and has been shown to be superior to systemic opioid analgesia for the control of postoperative pain (23). Other beneficial or harmful side effects of TEA during the postoperative period were investigated in a systematic review and meta-analysis including 125 trials, with a total of 9044 patients, analyzing various outcomes (24). In the group receiving TEA vs. systemic opioids the major outcome was a reduced mortality rate (2-3.1% in the epidural group vs. 3.2-4.9% in the control group (OR >0.60)). The main adverse effects of TEA to be mentioned are pruritus, urinary retention, motor blockade and hypotension. Hypotension, a complication observed in approximately 9% of the patients, is mainly due to local anesthetics and can be reduced by combining local anesthetics with opioids (25). Technical failure of TEA was reported in 6.1% of patients but without severe neurologic complications, infections, hematoma or trauma for the totality of patients included. TEA also significantly decreased the odds of various morbidity endpoints: atrial fibrillation, supraventricular tachycardia, respiratory depression, atelectasis, pneumonia, ileus, nausea and vomiting (24). …show more content…

A correct analgesia may also allow the patient to be mobilized faster and begin earlier respiratory physiotherapy

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Justin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.

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Mr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.

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1831 Words | 8 Pages

Anaesthetic Phase According to the HPC Code of Conduct (2015), all registrants and students must respect service user’s right of confidentiality. Therefore, the author will fictionally refer the patient as Sibert. Before Sibert came to theatre for surgery, a pre-assessment is conducted in the pre-assessment clinic. During this assessment, medical history, general health and family history are checked and assessed.

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360 Words | 2 Pages

There are also other associated risks such as hemorrhage anesthesia reactions (if

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720 Words | 3 Pages

The purpose of my paper is to discuss the history of Congenital Analgesia and its presence in the human body. Congenital Analgesia, also referred to as Congenital Insensitivity to Pain or CIP, is a rare neurological disorder of the nervous system that prevents a person from being able to feel pain. Congenital Analgesia results from the “lack of ion channels that transport sodium across sensory nerves. Without these channels, nerve cells are unable to communicate pain” (Hamzelou, 2015, p. 1). While the body does not respond to extreme changes in temperature or bodily harm and damage, those with Congenital Analgesia can still process normal sensations such as body-to-body contact or joint movement.

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492 Words | 2 Pages

(2013, p.12) emphasised the importance of nursing care for patients after hemicolectomy to promote rapid recovery and quicker discharge from the hospital. They reported that the greatest postoperative complication for hemicolectomy patients is pain management; postoperative patients therefore require scheduled pain management to control severe pain and pain intensity. This may involve both pharmacological and non-pharmacological interventions, as non-pharmacological have been reported to increase the efficacy of pharmacological pain management interventions. Isaacson et al. (2013, p.12) recommended massage, repositioning, ensuring a calm environment and allowing the patient to listen to music.

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1301 Words | 6 Pages

This helps provide more patient centered care. Guidelines to follow after opioid administration will vary by hospital but it is still necessary to use sedation scales with acceptable measures of reliability and validity for pain management. The use of sedation scales should be used with consistent monitoring of respirations. Pasero (2009) emphasizes that a comprehensive evaluation of respiratory status that includes depth, regularity, rate, and noisiness of respiration in addition to sedation assessment is essential to decision making during opioid administration for pain management. Respirations should be counted for a full minute while the patient is at rest in a quiet and relaxed environment.

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515 Words | 3 Pages

Informed consent is the process by which the treating health care provider discloses appropriate information to a competent patient so that the patient may make a voluntary choice to accept or refuse treatment. (Appelbaum, 2007)1 It originates from the legal and ethical right the patient has to direct what happens to her body and from the ethical duty of the physician to involve the patient in her health care. In order for the consent to be valid, the patient must be competent to take the particular decision; have received sufficient information to make a decision; and not be acting under stress.2,3 This may be an issue if consent is obtained upon the day of surgery. Most patients will have firmly decided to proceed for surgery. However,

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434 Words | 2 Pages

We all know that pain is usually one of the major complaint of patients with chronic problems or those recovering post operatively thereby making pain evaluation a fundamental requisite in the outcome assessment during hospital visits. Interpreting the data from a pain assessment scale is not as straightforward as it may seem since the provider must consider the intensity, related disability, duration, and affect to define the pain and its effects on the patient (Williamson & Hoggart, 2005). Pain rating scales are used in the clinical settings to measure pain and these include Visual Analogue Scale (VAS), Verbal Rating Scale (VRS), Numerical/numeric Rating Scale (NRS) (Haefeli & Elfering, 2006). Each scale is unique on its own in terms of sensitivity and simplicity that generates data that can be statistically analyzed for audit purposes. The EHR in our hospital utilizes the three rating scales mentioned as part of the pain assessment tool to measure pain that sets the tone for the direction of the type of pain management will .be given to the

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634 Words | 3 Pages

Ketamine. Palliative care patients often need a combination of 2-3 opioids to obtain effective analgesia with tolerable side effects (Moryl et al., 2008). Ketamine is considered a front-line treatment for neuropathic pain including cancer pain, central pain, and postherpatic neuralgia phantom pain (Ben-Ari, Lewis, & Davidson, 2007; Fitzgibbon & Viola, 2005). Low-dose ketamine is an effective co-analgesic medication (Fine, 2003; Moryl et al, 2008) and intrathecal ketamine has successfully been used in palliative care (Ben-Ari et al., 2007). A benefit of ketamine is that is does not affect respirations and can be administered via many routes including: IV, subcutaneous, intranasal, intrathecal, epidural, rectal, and transdermal (Prommer, 2012).

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246 Words | 1 Pages

Analgesics can be used to treat a wide range of pain. A three- step plan for prescribing pain relievers was developed by The World Health Organization which lists what medications to use depending on the intensity of pain experienced. Step one states that for mild pain, nonopioid and nonsteroidal anti-inflammatory drugs should be used. Pain relievers such as acetaminophen (e.g. Tylenol, Tempra) are non-narcotics. In addition, ibuprofen or aspirin (e.g. Motrin, Advil) are nonsteroidal medicines that can be taken to relieve mild pain.

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574 Words | 3 Pages

Although it may seem easier to the family to push the analgesia for the patient, they must be reminded that the patient is the only one who can truly determine the type and feeling of pain they are experiencing and then have the authority to decide if they need additional medication or

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334 Words | 2 Pages

Cape May County has a serious problem with heroin. Different law enforcement strategies and educational programs can help stop this problem. Heroin is an opioid drug that is synthesized from morphine, which is a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky matter known as “black tar heroin”. Heroin can be smoked, inhaled or injected, all deliver the drug extremely rapidly.

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913 Words | 4 Pages

Assessment is a fundamental component of any nurse’s role. However, from what I observed today it seems particularly vital to the PACU nurse. While they do provide interventions, the majority of PACU nurses’ time is spent assessing their patients and documenting their findings. Patients in the PACU have undergone the significant stressor of surgery under general anesthesia and they have the potential for very serious complications. It is up to the PACU nurse to observe if the patient is declining and act quickly and appropriately.

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717 Words | 3 Pages

The anaesthetist removed the ETT and proceeded to place a tight fitted mask on patients face. (REF)She then alerted the team that there was a problem with the patient airway (REF). The mask did not mist up – indicating of no air movement return, there was no carbon dioxide trace on the capnography and the patient oxygen saturation dropped steadily from 100% to 90%. He instigated vigorous jaw thrust to improve oxygenation, and using continuous positive airway pressure(CPAP) to deliver 100% oxygen flow through the breathing bag attached to the anaesthetic machine but all this effort was not having any effect on the ventilation. He then asked my mentor the Operating Department Practitioner (ODP) to administer 50mg/5ml of intravenous Propofol.

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