Examination of current literature using the 5 articles presented here:
1. Bilir, Y., Hanc? V., Okyay R., Erdo?an K., Ayo?lu H., Özkoçak T. (2016). Effects of Peroperative Intravenous Paracetamol and Lornoxicam for Lumbar Disc Surgery on Postoperative Pain and Opioid Consumption: A randomized, prospective, placebo-controlled study. A?r?-The Journal of The Turkish Society of Algology, 2016 April;28(2):98-105. doi: 10.5505/agri.2015.45220.
In this study Bilir, Y., Hanc? V., Okyay R., Erdo?an K., Ayo?lu H., and Özkoçak T., perform a study to compare the effects either Lornosicam (NSAID) , IV acetaminophen or placebo, prior to surgery will decrease post-op pain, and analgesic control.
I find this research very interesting because even though there was no direct answer to my PICOT question the above information does place me in a position to incorporate my thoughts because this study utilizes Demerol PCA for breakthrough pain.
In this study there was no significant change in the demand dosing of the PCA when paired with either drug. This however is not including the placebo where there was an obvious increase there. This means that pain is decreased with oral medication and there is a decreased need in patient controlled analgesia and adverse events related to it.
Garcia, R., Cassinelli, E., Messerschmitt, P., Furey, C., Bohlman, H., (2013). A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.
Journal of Spinal Disorders and Techniques. 2013 Aug;26(6):291-7. DOI: 10.1097/BSD.0b013e318246b0a6
This study was to determine if multimodal medication management would decrease the consumption of morphine use post lumbar laminectomy.
Evaluation of patient pain was using the visual analog scale and were recorded every four hours up until the thirty-six hour mark.
This study concluded that there too was a reduction in PCA usage and goals were met for earlier mobility.
Kim, S., Ha, K., Oh, I., (2016). Preemptive Multimodal Analgesia for Postoperative Pain Management After Lumbar Fusion Surgery: a randomized controlled trial.
European Spine Journal. 2016 May;25(5):1614-9. doi: 10.1007/s00586-015-4216-3
In this study there are 80 participants that were divided into two groups. Both groups were thoroughly investigated to be sure that they met the inclusion criteria. Both groups had surgery for symptomatic lumbar stenosis of L4-5. They were then placed in subgroups where group 1 had multimodal pain medication including schedules celecoxib, extended release oxycontin, and pregabalin. Group 2 only had IV morphine. Both groups had morphine PCAs.
In this study they used scheduled pain medication for these patients. The results concluded that treating the patients pain preemptively was successful when compared to patient controlled analgesia for lumbar surgery.
Kumar, K., Kulkarni, D., Gurajala,I., and Gopinath, R., (2013). Pregabalin Versus Tramadol for Postoperative Pain Management in Patients Undergoing Lumbar Laminectomy: a randomized, double-blinded, placebo-controlled study, Journal of Pain Research 6: 471478. doi: 10.2147/JPR.S43613
In this study there was a group of 75 patients. Each group of 25 had been given one of 2 pain medications and then the placebo. Drug one Tramadol caused the patient to use less rescue pain medication than group 2 the pregabalin group, and of course the placebo group required the most rescue doses of medication.
This is significant because finding the best combination of drugs will decrease the need for PCA and opiate use.
Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B., Woolacott,N., (2011). Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. British Journal of Anaesthesia 2011; 106 (3): 292-297. doi: 10.1093/bja/aeq406
Maund, E., McDaid, C., Rice, S.,Wright, K., Jenkins, B., Woolacott,N., (2011), performed a study to compare the effectiveness of NSAIDS, acetaminophen, and COX-2 inhibitors to control post operative pain. This study showed that the three non-opioids were effective in decreasing the use of the morphine PCA in the first 24 hours post surgery. Also in the study it showed that NSAIDS also decreased morphine related adverse effects. However none of the three drugs were proven to be better than the other.
This study gives me the impression that with these medications that there can be complete control of pain without PCA or opiates for relief.
Ultimately with these surgeries there is consistency of PCA use with that being said, non-opioids are paramount and NSAIDS have a bonus for their anti-inflammatory effects although they carry an increase risk for bleeding so the risks and benefits must be weighted.
Answer the following question usinf the resources provided.
Intervention or therapy- To determine which treatment leads to the best outcome
In adult patients post lumbar laminectomy (P)
how effective is PCA pain medication management (I)
compared to scheduled oral pain medication (C)
in controlling post op pain (O) during the recovery phase.
Identify the implications to nursing practice and patient outcomes –
Include with the poster a section describing the implications to nursing practice and patient outcomes.
Evidence Based Research Poster Rubric 45 points
Mastery (A = 45)
Developing (B = 36)
Limited (C = 33.75)
Poster shows evidence of application of skills of analysis, synthesis, and evaluation. Logic is nearly flawless.
Poster shows inconsistent application of skills of analysis, synthesis, and evaluation. Logic may be flawed.
Poster shows minimal application of skills of analysis, synthesis, and evaluation. Logic may be flawed.
Poster remains focused with every reference appropriate to topic of paper
Poster remains focused with most references appropriate to topic of paper
Poster without clear focus with some references appropriate to topic of paper.
Quality of support
Well-chosen textual support adequately examined and relevant.
Acceptably chosen support with inconsistent relevance.
Questionable support with few valid points, lacking relevance.
Information is very organized with clear titles.
Information is organized but the titles are missing or do not help the reader understand.
Information is without organization.
Mechanics and Style
Poster is well written in scholarly style and follows all APA formatting
Poster is acceptably written in scholarly style and follows most APA formatting
Poster is poorly written with little scholarly style and/or is inconsistent in following of APA formatting.
Peer Evaluation Template