Post-Operative Pain Management with People Who Have Had Total Knee Replacement Surgery - Essay Example

Running head: Post-operative Pain Management Post-Operative Pain Management with People Who Have Had Total Knee Replacement Surgery Insert Insert Grade Course Insert Tutor’s Name March 20, 2012 Post-Operative Pain Management with People Who Have Had Total Knee Replacement Surgery Introduction Total knee replacement surgery is done to increase mobility in individuals and it involves fitting artificial surfaces to the knee joints to hold the weight of an individual. This procedure is performed on individuals who are rendered immobile by knee complications caused by diseases. The operation can be major or minor and it requires careful post operation care to relieve pain and extensive physical therapy to increase mobility of the knee and facilitate complete recovery and mobility of the patients. Most patients decide to undergo total knee replacement therapy due to increasing pain and disability (Cremeans et al, 2009). This paper wills address the post operative management of pain for people who have undergone total knee replacement Surgery. The resultant physiotherapy and required exercises can result in patients experiencing substantial amounts of pain. Pain signifies trauma to the body and may be as result of tissue damage from injury, surgery, and diseases. Pain causes discomfort, immobility, and various biological responses that inhibit normal functioning of the body and its management becomes a necessary tool in nursing (Alfred, 2007). After total knee cap replacement surgery, effective pain relief measures are necessary for humane reasons and to facilitate an effective postoperative recovery, which necessitates intensive physiotherapy to reduce recovery time and facilitate mobility in most patients. Different people have different tolerances for pain and it is necessary to consider the individual patients before commencing on a post operation pain relief plan. Other important considerations that must be considered include clinical factors, patient related factors, and local factors. Post operative nursing care for patients who have undergone total knee replacement may include a combination of various procedures including education, assessment of pain, pharmacological, and non-pharmacological interventions.  Literature Review Pain management is deeply integrated and ingrained in medicine and is especially invaluable in patients who have undergone major and minor surgeries. Total knee replacement surgery is done to alleviate pain in the knees and is highly successful in restoring mobility. Though expensive, it is economically justifiable due to increased mobility that reduces reliance on other members of the society. The procedure results in post operative pain, which if not well managed can lead to chronic pains and disability (Eccleston, 2011). Post operative pain management practices are often hindered by costs, lack of appropriate technology and drugs, and information and when inefficient leads to prolonged stay in hospitals with corresponding increases in costs and complications. Due to the various hindrances, it is necessary for the medical fraternity to come up with uniform standards that can be effectively used to manage post operation pain in patients who have undergone total knee replacement surgery to facilitate their quicker reintegration into the society as normal human beings. The importance of efficient post operation pain management methods has seen the development of various methods, tools, and techniques to combat acute pain management in hospitals across different countries (Hartog et al, 2009; European Society of Regional Anesthesia and Pain Therapy, 2005). In managing pain in patients who have undergone total knee replacement therapy, the choice of the pain relieving technique to be used is determined by the availability of drugs and the expertise of the medical professionals available. The pain management plan is started prior to surgery and should be continued after surgery. The nurses should assess the degree of pain in the patients using various scales to check the effectiveness of the medication being used and should act appropriately if the sensations of pain are high. It is mandatory to pre medicate the patients at all times before physiotherapy and exercises and should always institute comfort measures as needed through re-positioning, relaxation, and reassurance. The patient’s pain tolerance is analyzed prior to the surgery to make an efficient management plan and after surgery to check whether the pain management plan is working. For efficient management of post operative pain, efficient assessment tools must be used preferably a 10 -point pain assessment scale where 1 indicates no pain and 10 is unbearable pain. The medical officer scores the degree of pain based on his or her observations. It is however necessary to ascertain the clinical effects of pain on the patient by objectively evaluating the ability to cough, move, and take deep breaths. This will indicate the success of the pain management plan in place and allow the use of additional therapeutic plans if necessary. A balance between giving the patient the necessary pain relief and the harsh side effects of analgesics should be a priority of the medical practitioner who should establish good communication channels with the patient to achieve the desired outcome. There are various strategies used to relief acute pains in patients after post operative surgery and they may include preemptive analgesics and responsive pain management, which can successfully mitigate the effects of pain if well administered. A timely and efficient post operative pain management intervention can succeed in increasing mobility, reducing post operation hospital stay, and reduces post operation organ failure that requires a second surgery (Oakes, 2011). Pain management is strategically approached by first using peripherally acting drugs and non steroidal anti-inflammatory drugs as the first line of pain relief. If they fail to adequately manage the pain weak opioids are used followed by strong opioids. The use of opioids is accompanied by many unwanted side effects that may include nausea, vomiting, respiratory depression, abnormal bowel functions among many other side effects. The side effects if not well managed may lead to death of the patient or addiction and hence many medical practitioners under treat post operative pain because of the risks involved from their side effects. They should be trained adequately and have adequate practice in the different therapeutic methods of pain relief to gain confidence through understanding the strength of the analgesics and the length of time they act in the body facilitating the comfort of the patient. Under treatment of post operative pain can be illustrated by a research in Italy, which concluded that post operative analgesic treatment in Italy was still below the optimal levels required for effective pain relief (Tofano et al, 2012). Pain relieving drugs may be administered through many different routes but many analgesic especially opioids are administered intramuscularly, which requires efficient pain assessment strategies and should be administered by qualified personnel to give good results. Patient controlled analgesic (PCA) is a patient regulated method of post operative pain management through opiods administration using intravenous drips. The patient administers the drug depending on the pain experienced and it is useful as different patients require different levels of opioids to relieve pain. Epidural and spinal analgesics can also be used successfully. Femoral nerve catheters have reduced side effects when used in total knee replacement surgery patients and are highly recommended (Fetherston & Ward, 2011). Other routes of administration may be used depending on the physician and the desired effects. The risks associated with use of narcotics and the various ways of administering the drugs should be carefully assessed before their use as their success depends on individual patient’s age, weight, and past medical history. Other methods of treating post operative pain include acupuncture techniques, which can be successful if applied before anesthesia administration and can be used without the risk of side effects (Vadivelu, Urman and Hines, 2011). It is important to educate the patients and their caregivers on the post operative pain management plans and their effects and risks as this will promote better cooperation and reduce anxiety with better results. They should be carefully instructed on the dos and don’ts so as to reduce the psychological trauma associated with pain of physical trauma that can result from unintentional mishandling of the TKA patients As Mackintosh (2007) observes, the degree of pain felt can be affected by the psychological factors. Fear and anticipation of pain heightens the pain felt and this varies from person to person. This may be compounded by language barriers and hence post operational pain management requires the use of a multidimensional approach depending on the situation. Patient doctor relationship is necessary and will facilitate the use of psychological and physical methods to increase the comfort of the patients Conclusion The decision to undergo total knee replacement surgery is dependent on the individual and may be because of increased disability and pain and the promise of a future with increased mobility and no pain, which promises independence. The post operative pain and the risks associated with the surgery though minimal is a major concern to most patients seeking this treatment. It is inhumane and medically unsound to allow patients who have undergone total knee replacement to suffer pain due to lack of post operative pain management or under treatment of the same. Unmitigated pain may lead to increased immobility and sometimes death due to biological responses of the body to pain and reduced immunity. This is contrary to the objectives and goals on medicine and hence a combined effort of all stakeholders should be used to combat pain through all available means. It is necessary for all medical practitioners, patients, the general public, and all stakeholders to be sensitized on the dangers of unmanaged postoperative pain and the available means to manage it. Though some procedures require expensive investments on the part of the hospital, the overall gains are greater at the long term and cost should not be used as a hindrance to pain management. There is need for medical researchers to come up with better procedures and close fitting devices used in knee surgery to reduce the pain and discomfort experienced by TKA patients. More research is necessary on new analgesic therapies that could make pain management easier. More training and practice should be availed to nurses and doctors so that they can gain confidence in pain relieving therapies, which can help increase patient comfort at all levels. Reference List Alfred, K. (2007). The impact of music on postoperative pain and anxiety. ProQuest, Ann Arbor. Cremeans-Smith, J. K., Boarts, J. M., Greene, K., & Delahanty, D. L. (2009). Patients’ Reasons For Electing To Undergo Total Knee Arthroplasty Impact Post-Operative Pain Severity And Range Of Motion. Journal of Behavioral Medicine, 32(3), 223-233. doi:10.1007/s10865-008-9191-2 Eccleston, C. (2011). Post-operative pain management. Retrieved from http://www.thecochranelibrary.com/details/editorial/1336605/Post-operative-pain-management.html European Society of Regional Anesthesia and Pain Therapy (2005). General recommendations and principles for successful pain management. Retrieved from http://www.esraeurope.org/PostoperativePainManagement.pdf Fetherston & Ward (2011). ‘Relationships Between Postoperative Pain Management And Short-Term Functional Mobility In Total Knee Arthroplasty Patients With A Femoral Nerve Catheter: A Preliminary Study,’ Journal of Orthopedic Surgery and Research, Vol.6 No.7. Ebschost Hartog, C., Rothaug, J., Goettermann, A., Zimmer, A. & Meissner, W. (2010). Room for improvement: nurses’ and physicians’ views of a post-operative pain management program, Acta Anaesthesiologica Scandinavica 54: 277–283 Mackintosh, C. (2007). Assessment and Management of Patients with Post-Operative Pain, Nursing Standard, Vol.22 No.5; 49-55, Ebscohost. Oakes, L. (2011). Compact Clinical Guide to Infant and Child Pain Management: An Evidence-Based Approach for Nurses, New York: Springer Publishing Company. Tofano, R et al. (2012). ‘Post-Operative Pain; Research on Post-Operative Pain’, Obesity, Fitness & Wellness Week, Atlanta, Retrieved from http://proquest.umi.com/pqdweb?index=2&did=2603811701&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1332149181&clientId=29440 Vadivelu, N., Urman, R. & Hines, R. (2011). Essentials of Pain Management. New York: Springer Read More