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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 31-34

Patient-tailored analgesic practice for orthopedic patients


1 College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
2 Pal College of Nursing and Medical Sciences (Medical Surgical Nursing), Haldwani, Uttarakhand, India
3 College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
4 Department of Orthopedic, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
5 Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission26-Mar-2022
Date of Decision24-Apr-2022
Date of Acceptance27-Apr-2022
Date of Web Publication07-Jul-2022

Correspondence Address:
C Vasantha Kalyani
College of Nursing, All India Institute of Medical Sciences, Deodhar, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jssrp.jssrp_5_22

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  Abstract 


Background: Pain is a highly deleterious experience for human being during disease condition.Post operative pain of patient is an important concern for health care professional. Aim: The aim of the study was to assess the level of pain and pattern of analgesic practices among patient undergoing orthopedic surgeries and to develop patient tailored analgesic practice. Objectives: The present study objective is to assess the level of pain and pattern of analgesic practices among patient undergoing orthopedic surgeries with a view to develop patient tailored analgesic practice. Materials and Methods: Quantitative research approach with a prospective Observational Design was used for the present study to assess the level of pain and pattern of analgesic practices among patient under going orthopedic surgeries with a view to develop patient tailored analgesic practice in selected orthopedic inpatient department at All India Institute of Medical Sciences, Rishikesh, India.This study consisted of 100 patient undergone orthopedic surgery among them majority (49%) of patient were suffering from lower extremity injury. Results: The result of study revealed that majority (85%) ofpatient were suffering from severe pain and pattern of analgesic were tramadol, paracetamol used by them intravenous route. Conclusion: Pain management in Postoperative period after orthopedic surgery should be given a high priority. While, appropriate pain management strategy should be implemented to decrease postoperative pain.

Keywords: Orthopedic surgery, pain, pattern of analgesic


How to cite this article:
Kalyani C V, Parashar AK, Verma P, Khandwal P, Payal Y S, Rohilla KK. Patient-tailored analgesic practice for orthopedic patients. J Surg Spec Rural Pract 2022;3:31-4

How to cite this URL:
Kalyani C V, Parashar AK, Verma P, Khandwal P, Payal Y S, Rohilla KK. Patient-tailored analgesic practice for orthopedic patients. J Surg Spec Rural Pract [serial online] 2022 [cited 2022 Sep 27];3:31-4. Available from: http://www.jssrp.org/text.asp?2022/3/2/31/350166




  Introduction Top


Pain is predestined part of the postoperative period. It also plays a significant role in patient recovery and lessens the risk of complications. Postsurgical pain is usually occurring due to the tissue response to the trauma which stimulates the reactivity of CNS.[1]

The Taxonomy Committee of the International Association for the Study of Pain defines pain as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.[1] It is experienced by several people due to disease conditions, diagnostic tests, and treatment. Pain is also referred as the fifth vital sign which may lead to several physiologic changes in the individual. Pain is considered as a subjective experience and is mainly based on duration, location, and speed of sensation.[2]

Effective postoperative pain assessment is an essential component of nursing care for surgical patients.[1] Person undergoing orthopedic surgeries usually have improper functioning of musculoskeletal systems such as unstable fracture, bone deformities, degenerative or joint disorder, bone infection, and trauma or tumor. The most common surgical procedure in orthopedic is open reduction internal fixation, arthroplasty, joint replacement, amputation, and others. Systematic logical assessments and the use of specific scales to measure pain can provide accurate subjective experiences of the patient regarding pain and also identify the pattern of analgesic practice during the postoperative period.[3]

Nurses are the primary health-care provider who spend more time with the patient in pain; nurses need to be sensitized the significance of pain assessment for postoperative patients. Assessment of pain and pattern of analgesic practice contribute to awareness about the magnitude of pain and adequacy of analgesic treatment for the need of every individual. In context to this, the present study aims to assess the intensity of pain and pattern of analgesic practices of postoperative orthopedic surgical patient.

Research statement

A prospective observational study is to assess the level of pain and pattern of analgesic practices among patients undergoing orthopedic surgeries with a view to develop patient-tailored analgesic practice in selected orthopedic inpatient department at All India Institute of Medical Sciences, Rishikesh, India.

Aim of the study

The aim of the study was to assess the level of pain and pattern of analgesic practices among patient undergoing orthopedic surgeries and to develop patient-tailored analgesic practice.


  Materials and Methods Top


Study design and participants

Quantitative research approach with a prospective observational design was used for the present study to assess the level of pain and pattern of analgesic practices among patients undergoing orthopedic surgeries with a view to develop patient-tailored analgesic practice in selected orthopedic inpatient department at All India Institute of Medical Sciences, Rishikesh, India.

The sample consisted of 100 adult patients who have undergone orthopedic surgery and were selected for the present study using the total enumerative sampling method. The samples were selected according to inclusion criteria such as patients aged should be 18 years and above who have undergone orthopedic surgeries and willing to participate, also receiving analgesics for postoperative pain management through IV route. The exclusion criteria included patients with serious or life-threatening illness and able to understand Hindi or English. Data were collected for 6-month time period from January 4, 2021 to June 4, 2021, and no reward or incentives were given for participants.

Samples were aware of their right to withdraw at any point of time, and the anonymity of the information was taken care of by the researcher. The present study was delimited to patients undergoing orthopedic surgeries at selected hospital in Rishikesh, India. Ethical approval for the study was given by Ethical Committee of AIIMS, Rishikesh.

Study instruments

Data collection questionnaire consisted of two main components that were biodemographic details which include gender and type of surgery, assessment of pain level by Numeric Rating Scale, and clinical profile variables included UHID, diagnosis of patient, name of drug, and pain score which used to assess the pattern of analgesia used in patient undergone orthopedic surgery.

Statistical analysis

Data analysis was done using descriptive and inferential statistics. Calculations will be carried out using Microsoft Excel and the Statistical Package for the Social Sciences (SPSS). IBM SPSS statistics version 23.0 (IBM Corp., Armonk, NY) is used for statistical analysis where both descriptive and inferential statistics were used. Frequency and percentage were calculated for sociodemographic variable, assessment of pain, and pattern of analgesia use for pain management.


  Results Top


In the present study total sample were included 100 patient undergone orthopedic surgery, As per the data given in [Table 1], majority (49%) of patient were suffering from lower extremity injury and had severe pain (85%). Whereas, 32% patient were suffering from infectious injury followed by 12 patients were having upper extremities injury, only 7 patient had cancer and had moderate pain. Moreover, out of 100 patient 85% had severe pain and only 15% were suffering moderate pain.
Table 1: Bio-demographic Characteristics of patients (n=100)

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According to [Table 2], In upper extremity injury, out of 12 patients only 1% patient used paracetamol dose of 3000 mg/day and tramadol dose of 200 mg/day analgesia medication for control moderate level of pain. Whereas, for management of severe pain most of the patients 11% used paracetamol dose of 1000-3000 mg/day followed by 9% patient used tramadol dose of 50-2000 mg/day and only 4% patient were used diclofenac dose of 75-150 mg/day. Thus, for management of pain in upper extremity surgery commonly analgesia used by patient were paracetamol and tramadol for management of sever and moderate level of pain after orthopedic surgery.
Table 2: Pain management drugs used for upper extremity injury according to different level of pain

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As per data given in [Table 3], Patient with lower extremity injury, out of 49 patient 8 patient were used paracetamol dose of 3000 mg/day followed by 8patient were used tramadol dose of 200-300 mg/day. Whereas, only one patient was used ketorolac dose of 60 mg/day for managing moderate level of pain. Moreover, for managing severe pain 39 patients were controlling pain by using paracetamol dose of 750-4000 mg/day and tramadol dose of 100-300 mg/day. Whereas, 9 patients were used diclofenac dose of 30-150 mg/day and only one patient used ketorolac dose of 60 mg/day.
Table 3: Pain management drugs used for lower extremity injury according to different level of pain

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As per data given in [Table 4], Patient with lower extremity cancers, moderate level pain was managed by using paracetamol dose of 3000 mg/day, tramadol dose of 100-300 mg/day and diclofenac dose of 75-150 mg/day. Whereas, severe cancer pain was managed by paracetamol dose of 1600-4000 mg/day, tramadol dose of 100-225 mg/day and diclofenac dose of 150 mg/day.
Table 4: Pain management drugs used for extremity cancers according to different level of pain

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According to [Table 5],Management of pain for extremity infections in patient after orthopedic surgery, majority of patient managed moderate level of pain by used paracetamol dose of 200-3000 mg/day, tramadol dose of 8-200 mg/day and diclofenac dose of 150 mg/day. Moreover, severe level of pain was treated by paracetamol dose of 750-4000 mg/day, tramadol dose of 100-300 mg/day, diclofenac dose of 150 mg/day and ketorolac dose of 60 mg/day.
Table 5: Pain management drugs used for various extremity infections according to different level of pain

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  Discussion Top


In the present research study, patients with upper extremities injury, diclofenac, paracetamol, and tramadol were commonly used to manage moderate levels of pain after orthopedic surgeries in postoperative, whereas paracetamol, tramadol, and diclofenac were used by patients to manage severe level of pain after orthopedic surgeries in postoperative period, whereas lower extremities injury, cancer, and infections patients with pain in postoperative period after orthopedic surgeries were managed by diclofenac, paracetamol, and tramadol by IV route. Paracetamol and tramadol were commonly used among patients, whereas ketorolac is less used by patient to manage pain in orthopedic surgeries. Furthermore, parental route was used to the administration of these drugs. Farhat et al. findings of the study by study findings revealed that for the management of postoperative pain in orthopedic surgeries, diclofenac drug was preferred which is partially support to the findings of our study.[4]

The present study finding was partially consistent with a study conducted by Barbosa MH;[5] the result of the study interpreted that a total of 109 (81.3%) patients underwent surgical procedures of lower limbs with increased mild pain reported in post operative period. In our study, 61 patients who underwent surgical procedures in the lower limbs reported moderate and severe pain.


  Conclusion Top


Pain management in the postoperative period after orthopedic surgery should be given a high priority, while appropriate pain management strategy should be implemented to decrease postoperative pain. In the present study, samples were adult patients more age more than 18 years and the type of injury included upper extremities injury, lower extremities injury, cancer, and infections. Moreover, out of 100 patients, the majority (49%) were suffering from lower extremity injury and had severe pain, whereas the level of pain was categorized into three categories such as mild pain, moderate pain, and severe pain. Thus, all of the patients were suffering moderate-to-severe pain, and none of them were having mild pain. Moreover, medication used by patients to manage pain after orthopedic surgeries was, namely paracetamol, tramadol, diclofenac, and ketorolac.

Financial Support and Sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.



 
  References Top

1.
Joshi S, Shetty Y, Panchal R, Patankar P, Salgaonkar S, Rawat R, et al. An observational study to evaluate the prescription pattern of analgesics used in the perioperative period in a tertiary care hospital. Perspect Clin Res 2021;12:165-70.  Back to cited text no. 1
  [Full text]  
2.
Gupta A, Kaur K, Sharma S, Goyal S, Arora S, Murthy RS. Clinical aspects of acute post-operative pain management & its assessment. J Adv Pharm Technol Res 2010;1:97-108.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Smeltzer C, Hinkle LJ, Bare GB. Medical Surgical Nursing. 12th ed. Philadelphia: Lippincott Williams & Wilkins; 2010. Available from: https://www.google.co.in/books/edition/Brunner_Suddarth_s_Textbook_of_Medical_s/SmtjSD1x688C?hl=en&gbpv=1&dq=medical +surgical+nursing&printsec=frontcover. [Last accessed on 2020 Oct 16].  Back to cited text no. 3
    
4.
Dashputra AV, Badwaik RT. Utilization of analgesics in preoperative cases of teaching hospital. Int J Med Pharm Sci 2013;3:14-9.  Back to cited text no. 4
    
5.
Barbosa MH, Araújo NF, Silva JA, Corrêa TB, Moreira TM, Andrade ÉV. Pain assessment intensity and pain relief in patients post-operative orthopedic surgery. Escola Anna Nery 2014;18:143-7.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Materials and Me...
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