Importance of Postoperative Pain Management

Importance of Postoperative Pain Management CHAPTER-II Review of literature is a key step in research process. The literature review is to discover what has previously been done about the problem to be studied what remains to be done, what methods have been employed in other research and how the result of other research in the area can be combined to develop knowledge. It is essential step; it can be done before and after selecting the problem. It can help to determine what is already known about the topic (A.P.Jai, 2005). This chapter attempts to present a review of studies done methodology adopted and conclusion attained by earlier investigators which helps in this study. The sources are internet search, textbook, published journal, editorials published and unpublished thesis. In this chapter, the researcher presents the review of the literature under the following headings, Section-I: Studies related to importance of postoperative pain management. Section-II: Studies related to Using Numeric Rating Scale for pain Assessment. Section-III: Studies related to effectiveness of music therapy among General Surgical Patients. Section-IV: Studies related to Effectiveness of Music Therapy among Post Caesarean Mothers. Section-V: Studies related to Gate Control Theory of Pain (Melzack and Wall (1965). Section-VI: Conceptual Framework Based on Gate Control Theory of Pain (Melzack and Wall (1965). SECTION-I: STUDIES RELATED TO IMPORTANCE OF POSTOPERATIVE PAIN MANAGEMENT. Kolawole and Fawole, (2003) conducted a study on Postoperative pain management following caesarean section in University of llorin Teaching Hospital (UITH).llorin, Nigeria. Prospective descriptive design was used to assess the effectiveness of various common methods of analgesia used in hospital following caesarean section. This study was conducted over a period of 18 months. Pain assessment was carried out by 4-point Verbal Rating Scale of None, Mild, Moderate, and severe. The first 24hrs postoperatively was particularly painful for the patient with 79.6% and 54.6% reporting moderate to severe pain in the recovery room and day 1 respectively. They concluded that the pain remains a significant problem following surgical operation in our environment. (PMID.15008293) Seers and Carroll, (1998) conducted a study on Relaxation techniques for acute pain management. They were used a systematic review of randomized controlled trials and seven studies involving 362 patients were included. Three of the seven studies demonstrated significantly less pain sensation or pain distress in those who had relaxation, four studies did not detect any difference. It was concluded that the well designed and executed randomized controlled trials are needed before the clinical use of relaxation in acute pain management can be firmly underpinned by good quality research evidence. So we can recommend that the relaxation in acute pain settings is carefully evaluated and not used as the main treatment for the pain management. SECTION-II: STUDIES RELATED TO USING NUMERIC RATING SCALE FOR PAIN ASSESSMENT. Yaakov Beilin, Jabera Hossain, and Carol, (2009) conducted a study on Numeric Rating Scale and Labor Epidural Analgesia, in this study a Numeric Rating Scale(NRS) used to evaluate pain in research studies, they define desire for additional analgesic medication as a clinically relevant outcome in research studies about pain and compare it with the results of the NRS. A post hoc analysis of three studies that conducted previously in concerning labor epidural analgesia was performed. In all three studies, score was obtained before and 15 min after analgesia. They found that the very few patients (2%) with a score of 0-1 wanted more medication. When the score was 2 or 3, 51% of the patients wanted more medication, and score was >3, almost all patients (93%) wanted more medication. Grouping the final NRS scores into 3 categories (0 or 1, 2 or 3, and >3) is more useful to the clinician than using individual NRS scores. Cinzia Brunelli, (2009) did a study on Comparison of Numerical and Verbal Rating Scales to measure pain exacerbations in patients with chronic Cancer pain. Crosses sectional multicentre study conducted on a sample of 240 advanced cancer patients with pain, background pain and BP were measured by 6-point VRS and 11 point NRS. In order to evaluate the reproducibility of the two scales, a subsample of 60 patients was randomly selected and the questionnaire was administered for a second time three to four hours later. The proportion of inconsistent evaluations was calculated to compare the two scales capability in discriminating between background and peak pain intensity and Cohens K was calculated to compare their reproducibility. It concludes that NRS revealed higher discriminatory capability than VRS in distinguishing between background and peak pain intensity with a lower proportion of patients giving inconsistent evaluations (14% vs. 25%) (Cohens K of 0.86 for NRS vs 0.53 for VRS) while the reproducibility of the two scales in evaluating background pain was similar (Cohens K of 0.80 vs. 0.77). Nathalie Dieudonne, Alexandra Gomola, Philippe Bonnichon, and Yves M.Ozier, (2008) conducted a study on Prevention of postoperative pain after thyroid surgery. In this study double-blinded, randomized, placebo-controlled trial used to evaluate the analgesic efficacy of bilateral superficial cervical plexus blocks performed at the end of surgery. Ninety patients were randomized to receive 20 mL isotonic sodium chloride or 20 mL bupivacaine 0.25% with 1:200,000 epinephrines. Postoperative pain was assessed every 4 h using an 11-point numeric rating scale (NRS-11). All patients received acetaminophen every 6 h. In addition, morphine was administered following a standardized protocol if the NRS-11 score was à ¢Ã¢â‚¬ °Ã‚ ¥4. The main outcome variables were pain scores (NRS-11), the proportion of patients given morphine at any time during the 24-h period, and the amount of morphine administered. The Bupivacaine group had a smaller proportion of patients given morphine (66.0% vs 90.0%; P = 0.016), and lower initial median pain scores (P = 0.002). SECTION-III: STUDIES RELATED TO EFFECTIVENESS OF MUSIC THERAPY AMONG GENERAL SURGICAL PATIENTS. Sigma Theta Tau International, (2009) conducted a study to assess and compare the effect of music therapy on postoperative pain of patient undergone elective abdominal surgery. A quasi-experimental design was used and convenient samples of 30 (15 in each expcontrol group). Pain was measured by Verbal Rating Scale. Music therapy was given as per patients wish to experimental group and intensity of pain was monitored before and immediately after recovery from anesthesia, during the 1st and 2nd postoperative day for both the groups. Results revealed that those patients who listened to self selected music tapes had significant differences (p Tse MM.Chan Me. Benzie, (2005) conducted a study to find the effectiveness of music therapy on postoperative pain and analgesic use following nasal surgery. Sample size was 57 patients (24females33 males) who were matched for age and sex and then non-selectively assigned to either an experimental or a control group. Music was played intermittently to members of the experimental group during the first 24hrs postoperative period and pain intensity was measured by Verbal Rating Scales. It shows the significant decrease in pain intensity over time were found in the experimental group compared to the control group (p Nilsson, Unosson and Rawal, (2005) conducted a study on Stress reduction and analgesia in patients exposed to calming music postoperatively. The randomized controlled trial was designed to evaluate the effectiveness of music therapy. Seventy-five patients undergoing hernia repair in day care surgery were allocated to three groups: intraoperative music, postoperative music and silence (control group). Patients postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were studied. The postoperative music group had less anxiety and pain and required less morphine after 1hr compared with the control group. The result concluded that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption. SECTION- IV: STUDIES RELATED TO EFFECTIVENESS OF MUSIC THERAPY AMONG POST CAESAREAN MOTHERS. Arastirma TAF pre Med Bull, (2009) conducted a study to evaluate the effectiveness of music therapy on postoperative pain after Caesarean section. The sample size was 100 and randomly allocated into two groups (50 in each group).Group 1, patients listened to music through a headphone for 1hour immediately before surgery where as in group-2, not listen to any music during the same period. In the postanaesthesia care unit patients were connected to I.V. PCA device when they were able to respond to commands. The patients level of satisfaction with perioperative care was assessed by a 10cm Visual Analogue Scale and the severity of postoperative pain was assessed by VAS. The results shows that the postoperative tramadol consumption, total amount of tramadol consumption, additional analgesic use and all VAS values were lower in group-1(p Amin Ebneshahidi, and Masood Mohseni, (2008) conducted a study to evaluate the effect of patient selected music on early postoperative pain, anxiety and Hemodynamic profile in Caesarean section. The sample size was 80 who were undergoing elective C.S.surgery enrolled randomly to listen 30 minutes of music or silence by head phones postoperatively. Pain and Anxiety were measured with visual Analogue Scale. Results says that the pain score and postoperative cumulative opioid consumption were significantly lower among patients in the music group (p SECTION-V: STUDIES RELATED TO GATE CONTROL THEORY OF PAIN Marial, (2007) did a study to assess the effectiveness of back massage on pain during first stage of labour among mothers in selected maternity centre at tirupur. 60 samples were selected by using convenient sampling method for the study (experimental group-30 and control group-30). Experimental group received massage were as the control group did not. She used Melzack pain gate control theory for conceptual frame work. Data was collected using behavioral intensity and visual analogue scale. The statistical calculation done was frequency mean, SD, chi-square andt test. The result of the study shows that massage is a cost effective nursing intervention that can decreases the pain perception during labour. Jacintha, (1995) did a study on the effect of back massage during the first stage of labour. She divided the samples in to two groups of 30 each. The experimental group received back massage for 10 minutes per hour. She used non participatory observation technique to observe the maternal behavioral every hour. She used Melzack pain gate control theory for conceptual frame work. The experimental group was interviewed regarding their experience and feelings of back massage before shifting them to the post natal ward. 100% of mothers remembered massage given to them during labour, with feeling of comfortable in 76.66% and relaxed in 43.33%. All the mothers were of the opinion that all mothers in labour should be given back massage. Locsin, (1981) did a study to assess the effectiveness of music on the pain of selected postoperative patients during first 48 hrs. The 24 female gynecology and/ obstetric patients were assign to two groups (control and experimental). The measurement of the experimental variable was done by an Overt Pain Reduction Rating Scale (OPRRS) which is devised by the writer. Significant differences were found between the groups of postoperative patients in their muscular-skeletal and verbal reactions during the first 58hr at the 0.05 level. The conceptual framework of the study was based on the concept of distraction following the Gate Control Theory of Pain by Melzack Wall (1965). The finding says that the music can be used as a nursing measure for postoperative patients. SECTION-VI: CONCEPTUAL FRAMEWORK BASED ON GATECONTROL THEORY OF PAIN (MELZACK AND WALL (1965) The conceptual frame work for the present study was derived from Gate Control Theory of Pain (Melzack and Wall, 1995) Application of Gate Control Theory of Pain Polit and Hungler, (1965) state that a conceptual framework is inter related concept on abstraction that is assembled together in some rational scheme by virtue of their relevance to a common scheme. It is a device that helps to stimulate research and the extension of knowledge by providing both direction and impetus. The present study was aimed at determining the effectiveness of music therapy on intensity of post operative pain among primipara mothers who had Caesarean Section. The conceptual frame work of this study was derived from gate control theory of pain. Gate Control Theory of Pain: Many theories of pain have been presented in the literature. These include specificity, pattern, affect and psychological/behavioral theory (Mander 1998). The most widely used and accepted theory is that of Melzack Wall (1965). These researchers have established that gentle stimulation actually inhibits the sensation of pain. Their gate control theory states that a neural or spinal gating mechanism occurs in the substantiate gelatinosa of the dorsal horns of the spinal cord. The nerve impulses received by nociceptors, the receptors for pain in the skin and tissue of the body, are affected by the gating mechanism. It is the position of the gate that determines whether or not the nerve impulses travel freely to the medulla and the thalamus, thereby transmitting the sensory impulse or message, to the sensory cortex. The pain impulses will be carried out by the small diameter slow conducting A-delta and C fibers. Impulses traveled through small diameter fibers will open the pain gate and the person feels pain. Pain gate is also receiving impulses produced by stimulation of thermo receptors or mechanoreceptors transmitted via large diameter; myellindated A-delta fibers inhibit superimpose the small diameter impulses. (Myles -2003) If the gate is closed, there is little or no conduction, for example distraction, counseling and massage techniques are ways to release endorphins, which close the gate. This prevents or reduces the clients perception of pain (Freeman and Lawlis, 2001) If the gate is open, the impulses and messages pass and are transmitted freely. Therefore, when the gate is open, pain and sensation is experienced. (Potter and Perry, 2009) Many non pharmacological procedures such as hydrotherapy, music therapy (distraction), application of heat or ice, massage, vibration, TENS and movement stimulate the nerve endings connected with large diameter fibres which can produce a reduction of pain by closing the pain gate. Based on the principle of gate control theory, the following conceptual framework was developed. Method used to reduce intensity of postoperative pain is instrumental music which is composed by violin among Primipara mothers who had Caesarean Section. Stimulation of Pain Receptors: Surgical trauma of the uterus due to Caesarean Section stimulates pain receptors in lower abdomen and lumbar area of the back. In the control group there was more stimulation of pain receptors in these areas due to the close contact between the contracting uterus and abdominal and lower back structures. In case of experimental group(Music therapy), there was less stimulation of free nerve ending in the lower abdomen and lumbar area of back compared to the control group due to the distraction caused by music therapy. Travelling of Pain Impulses: Normally pain impulses are traveling through small short conducting A-delta and C fibres. Impulses from stimulation will be distracted by instrumental music and decrease in pain perception produce a reduction of pain by closing the pain gate in experimental group. Gating Mechanism: Pain impulses after the Caesarean Section are transmitted through the spinal nerve segment of T11-12 and accessory lower thoracic and upper lower sympathetic nerves, which are traveled through (A-delta and C) small diameter and slow conducting amyelinated fibres and reach the pain gate and open the gate thus the mother perceives pain in the lower abdomen and lower back. Impulses reduced by music due to decreased in pain perception to travel through fast conducting myelinated A-delta fibres which impose small fibres and close the pain gate. SUMMARY This chapter dealt with the studies related to importance of postoperative pain management, application of music therapy and conceptual frame work based on gate control theory of pain.

Disease Trends and Healthcare Delivery Essay

Statistics make the world go round, literally. A certain population or ethnicity and their disease trends can really have an effect on what can happen in the future for our healthcare systems. Demographics and Disease trends can go hand in hand with one another because disease trends are so constant and unnoticeable that it continues daily, therefore having a particular group being affected by the same disease. Some people do not believe it, but all you have to do is look at the statistics and you will then see how greatly they affect one another. To break things down, demographics are groups of people with a common link, such as; age, gender, race, education level, income level, even marital level, and etc. When in an environment where links are similar or the same, the same trends start to get picked up as well, linking you within the range of your demographics. Environment plays a big role in demographics as well. If you live in the same neighborhood or community as someone, you a re linked to that person no matter how small of importance it is. With everyone doing the same trends which come to them like habits, they may never go away until they know that it is a problem. Environment happens to play a role as well when it comes to demographics. Environment happens to play one of the main roles. Habits become hard to break because of the type of environment you around. Who, what, and the things that you are surrounded by happen to make up part of your environment, and it becomes hard to control when you get used to it and things become normal to you. An example would be; you stop by McDonald’s every day to get a Sunday just as a snack for the day. If that McDonalds was not so close to you, you would probably not have picked up the habit to buy an ice-cream. When you have so much or an environment surrounded by you that comes natural or that you see as being natural, it does not seem like anything to you because you do it in your everyday life. These things can affect your health and can affect the future of healthcare if gone unnoticed for so long. Even people play a big role in your environment. An example would be say you had a significant other. He liked to eat out all the times, but you liked home cooked meals bec ause that is what you were used to, but one day you said you did not feel like cooking and you at out. The one day changed everything and now you eat out just as much as your significant other and have begun to gain weight. It has become a habit for you to eat  out every day even though it seems so easy to stop. Well, that takes us to our next topic, obesity rates have gone up significantly throughout the United States. Of all countries, the United States has the highest rate of obesity. United States obesity rates have gone up from 13 percent in 1962 and estimates have increased to 19.4 percent in 1997, 24.5 percent in 2004, 26.6 percent in 2007 and 33.8 percent for adults and 17 percent for children in 2008. 2010 reports from CDC were said that numbers were still increasing counting 35.7 percent of the total American population for adults were obese and 17 percent of American children. Factors affecting obesity would be none other than environment. The fact that the United States has so many fast food services; people cannot help but to get dragged into being obese. Food is always in their faces or else they see someone else eating and crave it as well. Obesity has accounted for 100,000 to 400,000 deaths in the United States per year. It has increased healthcare use and expenditures. Obesity rates has cost society about 117 billion dollars in direct and indirect costs. It has exceeded the health care cost and will continue if obesity rates continue to go up. Obesity rates happen to be ore that that of the smoking and drinking rate and accounts for 6 percent to 12 percent of national health care expenditures in the United States. To reduce obesity rates, people can try switching up their everyday environments by going to a gym, going to a track, or even by just going to the grocery store and buying more healthy foods to cook and it. If people were to exercise as much as they eat, obesity rates could be lowered. The fact that children see things and grow up eating things they shouldn’t grows with them. Obesity rates could change in the future if children were taught to eat more healthy foods and not just foods that just taste good. There are so many things that people can do to reduce their own obesity rate. They can exercise three times a week and also eat healthier. Overall living a healthier lifestyle would help greatly. Changing the people around you as well can help. Choose to be around people that care about their health a lot or care about their health just as much as you do. You could always have a workout buddy, someone that will encourage you to lose weight. Even the fact of knowing that you could possibly be obese leading to more and more diseases can trigger something in someone to make them want to become a bit healthier. In the future of health care in the United States, there is really no way of  telling whether obesity rates will go down, but they could possibly go down drastically if the government, communities, societies, schools and cities come together annually and create awareness and activities that encourage people to lose weight, stay fit, and become healthy. Age can affect the U.S health care systems just as much obesity can. There are more modern medicines to help with diseases that were in the past. Let’s face it; now that we have more modernized medicines and machinery, people are living longer than they were 200 and 300 years ago. Today 40 million people in the United States are ages 65 and older. The number is to more than double to 89 million by 2050. The United States has a smaller share of older person than many developed countries, and its populations are graying at a slower pace. Environment definitely plays a role. People are aging slower within the United States because of more and more technology being implemented within the health care system. At this rate everyone will live until they are 100. It is not a bad thing to live a long life, but it does get harder when you get older and it often puts a burden on health care systems as well. The reason being is because elderly are more likely to be in high demand of healthcare and, getting help is expensive. The aging trend is likely to increase due to environmental factors. The more and more people that get older, the more and more nursing homes, and assisted living facilities begin to be built in order to help support the elderly. Retirement homes, assisted living facilities, nursing homes, happen to play a huge role in the United States. These homes often need a lot of co-workers as well which is really needed and in demand. Things that could be done to reduce health complications related to aging would be; living a healthy lifestyle no matter how old you are, and possibly make health care a little less expensive. Avoiding disease is the number one way to avoid getting complications in life when aging. Possibly choose a health plan that implements preventive health care and always get monthly and yearly screenings that could be recommended by your doctors. Health care delivery will most likely adapt to the United States environment in the future to provide care for age- related health issues by implementing more preventative care, making sure that everyone has health care coverage or are able to get it. Doctors and nurses need to be good at their jobs as well in order to catch even the hardest complications. There needs to be more  hospitals willing to accept a broad range of health issues and of course the number one thing would be price reduction. Health care will become a bit better than what it is now especially with the HITECH act in which is trying to put good use of information technology within hospitals, and physicians’ offices. As long as technology is always improving, the healthcare system improves as well. Health care delivery for obesity adaptation may get worse before it gets any better in such that people will not realize their issues until it is too late. In doing so this will trigger a movement within the United States that would make people want to change and teach their children as well. Health classes will begin to be implemented into elementary schools very early to teach children what are good foods and what aren’t. Instead of having soda machines and vending machines, machines are just going to be light snack machines and juice. In conclusion, healthcare delivery will change no matter what the case is. People play a big role in the future of health care and vice versa. With that being said, the only way for better adaptations would most probably be people actually wanting to change and more research within the world. With research, there comes, new inventions, with new inventions, there comes better technology to have in order to play roles within our lives. In order for change to occur within the future of health care, there has to be a change within people. When people decide to get up and take preventative measures within their own lives, and then their children life will then be when they decide to help the future of health care. Reference Jacobsen, L. (2009). America’s Aging Population. Retrieved from http://www.prb.org/Publications/PopulationBulletins/2011/americas-aging-population.aspx (2013). Obesity in the United States. Retrieved from http://en.wikipedia.org/wiki/Obesity_in_the_United_States â€Å"Statistics Related to Overweight and Obesity†. CDC. 2006. Retrieved 2009-01-23 F as in Fat: How Obesity Policies are Failing in America, 2008, Trust For America’s Health, pp. 10–11. Note: Defines â€Å"overweight† as BMI ≠¥25, â€Å"obese† as

Diva Momma Gives A Fierce Performance

Beyondg's vocal ability and potential, she proved them wrong to do so, when she performed at the Super bowl half- time show with approximately about 12 minutes of booty-shaking, body grinding, hair-tossing and GIRL POWER! They were definitely wrong to say so, as not a single yawn was let out. No one peeped out a word during it as everyone was completely entranced by Honey Bee's cabinetmaking performance. Everyone at the edge of their seats wondering what song she will sing next.And every single time, she didn't disappoint her fans, not one bit. In fact, she got them even more excited, got them screaming and shouting her lyrics back at her throughout the whole performance. The Stage setting and special effects intertwined in elegance and awe. It was very well organized and clearly was thought through for weeks, even months! The lighting was so effective, while adding flavor to Beyondg's performance and still managed to keep the focus on her!My favorite special effect though was when a guitarist (who rocked everyone's socks off by the way) came out of nowhere and had sparks coming out of it, while Beyond was right beside it wowing off the vast variety of pitches she can belt out. Was captivated. Her outfit was very bold and out of this universe. She wore a cropped black leather motorcycle jacket and a leather bodysuit made with strips of python and iguana, with some lace. It was like a woman's modern warrior outfit.It's already fierce enough as it is, but to put Bye in it? The fierce-meter is about to explode! Honey Bee looked rather smashing and wore it as if to remind everyone in the audience that she is one sexy, sexy woman, because, we didn't know that already. Her song choices were very clever as they were all well-known which allowed the audience to sing/scream along. It included ‘Crazy in Love' ‘End of Time' and 3 songs which she sang with her ex-group members Kelly Rowland and Michelle Williams.They literally came shooting up out of the underg round, and blew everyone away when they performed ‘Single Ladies'. Best surprise in Super-Bowl Half-Time Show history. The choreography was flawless and they showed that ‘Diva' is really a ‘female version of a hustler' if you know what I mean! Although Kelly and Michelle ere on stage with Beyond, Beyond was still everyone's focus. No one can ever steal her spotlight!Singing Halo as her last song was an epic conclusion. She managed to belt the notes effortlessly, proving herself once again, to be the Queen of RAN. The show was the sexiest Super Bowl Half Time show since 2004 when Janet Jackson had a ‘Wardrobe malfunction†. Yikes! From beginning to end, the singer didn't let motherhood get in the way of delivering an energetic performance that killed! And most importantly, she had now silenced her doubters.

Abuse Of The Ages Child Abuse And Neglect - 1311 Words

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