Literature review and evaluation of the evidence - Essay Example

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A well designed before-after study with a concurrent control group performed by Rose (1997) revealed that anesthesiologists’ practice of pain management can be improved through education and feedback. The study was carried out in tertiary-care teaching institutions affiliated with the University of Toronto…
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Literature review and evaluation of the evidence
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Download file to see previous pages With the patient as the “unit of analysis,” comparing the feedback-2 period with baseline, the proportion of patients who received any promoted strategy increased from 0.7% to 45.6% (P < 0.01) at the study hospital and from 8.5% to 31.3% at the control hospital (P < 0.01). This absolute increase at the study hospital was greater than at the control hospital (44.9% vs 22.8%, P < 0.0001). However, the study had several limitations. Rigid patient protocols, practice guidelines, and economic incentives were avoided in the study and allowed the anesthesiologists to choose the promoted strategies based only on the educational and feedback interventions. The avoidance of these additional approaches may have limited the ability to affect changes in practice and outcome.
Pouzeratte et al (2001) reported that thoracic epidural analgesia was more effective with bupivacaine than with ropivacaine when these two local anesthetics are used in a mixture with sufentanil after major abdominal surgery and ropivacaine alone was less effective than ropivacaine in combination with sufentanil. Intensity of post-operative pain was assessed with a reliable and valid Visual Analogue Scale. The study was planned well with a prospective double blind design.
In order to assess the tolerability and efficacy of a single dose of paracetamol solution infused intravenously (1g) compared with those of a single dose of Propacetamol (2g) in patients with moderate to severe pain after minor gynecologic surgery, a randomized, double blind, active controlled, 2-parallel group study was performed by Marty et al (2005). The study concluded that a single dose of IV-Paracetamol infusion was associated with better local tolerability, simlar analgesic efficacy, and greater patient satisfaction compared with a single bioequivalent dose of Propacetamol in patients with moderate to severe pain after minor gynecologic surgery.
Charghi et al (2003) examined the hypothesis that pain treatment with patient controlled analgesia (PCA) using iv morphine is a suitable and safe alternative to epidural analgesia in morbidly obese patients undergoing gastric bypass surgery. They concluded that PCA with iv morphine is an acceptable strategy for pain management in obese patients undergoing gastric bypass surgery.
Mujadi (2006) in a prospective, randomized, double-blind clinical trial reported that preoperative gabapentin decreased pain scores and postoperative morphine consumption in patients following thyroid surgery.
Reuben (2000) evaluated the analgesic efficacy of administering a single preoperative dose of celecoxib or rofecoxib for spinal fusion surgery. The study found that rofecoxib demonstrated an extended analgesic effect that lasted throughout the 24-h study. The morphine dose required was significantly less in five of the six time intervals in the rofecoxib group compared with the celecoxib group.
Rockeymann (1997)compared the costs, quality of analgesia, and side effects of postoperative patient-controlled epidural analgesia (PCEA) with bupivacaine/ sufentanil versus an epidural bolus (BOLUS) of clonidine/morphine in 68 patients with pancreatic surgery. An epidural clonidine/ morphine bolus technique resulted in inferior analgesia, more side effects, and comparable costs compared with a bupivacaine / sufentanil patient controlled ...Download file to see next pagesRead More
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