Evidence Based Practice and Post Operative Pain

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Evidence Based Practice and Post Operative Pain
Evidence-based practice refers to a practice based on evidence or evidence-based practice. The concept of evidence-based practice is the painstaking and well thought-out to use of existing best evidence from clinical research in modified care for each patient. According to White-Williams (2011), Evidence-based medicine has increased the biological component of medical activity. A dogmatic emphasis on testing, the results of clinical trials, would overlook the emotional, psychological and social condition in question. The abandonment refers to the preferences of patients, the impact of educational level and social class effect, among many other important issues for the patient and for general practitioners or family who believe that other possible medical activity. Scientific medical activities centered on the patient, to solve problems without creating others, able to assess their importance in risk factors (including genetic) and avoid the medicalization of everyday life (White-Williams, 2011).
Strengthening the evidence of acute pain medicine has greatly increased over the last two decades. Knowledge of the physiology and psychology of acute pain have made great progress, methods to measure acute pain improved, new drugs and new techniques for management of acute pain appeared and the relief of acute pain has evolved through many clinical situations, including post-operative pain, trauma, pain having to origin of burns, lesions of the spine, back pain and acute diseases. In addition, the need a management of acute pain is now recognized in various clinical settings, especially aftercare for surgery, intensive care units, emergency departments and pre-hospital care (Atallah, Kumar, Hilali, & Hickey, 2000). Thanks to this development, needs of specific patient populations (pediatric and elderly patients, pregnant patients, patients cognitively compromised, patients with kidney or liver disease patients and upload tolerant) drew attention. Not only the amount of evidence has increased, but the quality of the evidence has improved and extent of evidence available has widened. The practice of pain medicine acute now extends well beyond taking charge of post-operative pain. In addition, the focus has shifted to results beyond a relief adequate pain, such as reductions in postoperative morbidity and reductions in the risk of developing Chronic pain after surgery, injury or acute illness (White-Williams, 2011)..
A set of published evidence cannot be used to guide clinical practice unless it is organized, synthesized and updated. Given the rapidly growing volume of studies now available on acute pain, extract knowledge from the evidence presents a formidable challenge. Fortunately, there are many tools to facilitate this business, including systematic reviews, evidence summaries, guidelines and clinical practice tables of the “league” analgesic (Levin, Amit & Ashkenazi, 2006).
Complete summaries of evidence provides an update and a general analysis of “best evidence available “for the management of acute pain many different etiologies, particularly causes post-surgical and post-trauma including spinal cord injury and burns, as well as acute pain associated with various conditions such as migraine, herpes zoster, hematological disorders or cancer. Summaries of evidence also analyze and summarize the evidence on a specific drug, analgesic technique or a painful condition (Cheetham & Phillips, 2001). They also facilitate extrapolation is good evidence of a frame to another when specific evidence of high quality are fault. Among the examples is the extrapolation of evidence from animals to humans, the framework laboratory to the clinical setting or context of acute pain to chronic pain settings (Levin, Amit & Ashkenazi, 2006).
Medicine by the evidence is the careful, clear and well thought-out use of current best evidence for makes decisions concerning the management of a patient (Atallah, Kumar, et al., 2000). Good doctors use equally soul clinical expertise and the best outside evidence accessible and one without the other is insufficient. While the best available evidence can and should guide the management of acute pain, the evidence current has a quality, enforcement capacity and limited generalization (Curatolo & Sveticic, 2002). Clinical trials targeting medium samples of patients, but clinicians in practice treat one patient at a time. Few patients come approximately in the middle of a sample and the individual variation is important. Clinicians should take into account factors that are unique to each case and the published evidence in support of acute pain (Hutchison, 2007).
In the search for quality and accessibility of health care, we must constantly strive to realize in nursing practice evidence-based approaches. Today the challenge for health systems around the world is injustice in the distribution of the quality and quantity of care, and reduced financial resources. Lack of reliable information for decision-making becomes a major obstacle for assistance was the most optimal way and among other consequences of a less efficient, less productive and inequitable access to health services. Thus, the use of scientific data as a basis for our action is crucial and achievable way to improve health care delivery system (Hardcastle, 2010).
However, the increasing availability of information, in addition to facilitating the search for scientific data, can create a sense of insurmountable problems. Today more than ever it is important that nurses have learned not only to carry out scientific research, but also to implement this knowledge in daily practice (Eid & Bucknall, 2008). Not all scientific data are rigorous or reliable. Nurses should learn to determine which are the best scientific data, taking into account the needs and preferences of consumers of health services, to apply its own experience, skills, critical thinking to determine the applicability of certain scientific data in the context of the institution.
References
Atallah, N., Kumar, M., Hilali, A., & Hickey, S. (2000). Post-operative pain in tonsillectomy: bipolar electrodissection technique vs dissection ligation technique. A double-blind randomized prospective trial. The Journal of laryngology and otology (Vol. 114, pp. 667 – 670).
Cheetham, M. J., & Phillips, R. K. (2001). Evidence-based practice in haemorrhoidectomy. The Journal Of The Association Of Physicians Of India, 3(2), 8 – 11. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1463-1318.2001.00189.x/full
Curatolo, M., & Sveticic, G. (2002). Drug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination. Best practice research Clinical anaesthesiology, 16(4), 507 – 519. Retrieved from http://linkinghub.elsevier.com/retrieve/pii/S1521689602902545
Eid, T., & Bucknall, T. (2008). Documenting and implementing evidence-based post-operative pain management in older patients with hip fractures. Journal of Orthopaedic Nursing, 12(2), 90 – 98. doi:10.1016/j.joon.2008.07.003
Hardcastle, T. (2010). Sucrose has been shown to have analgesic properties when administered to neonates and infants: is there the potential for its use in post-operative pain management? Journal Of Perioperative Practice, 20(1), 19 – 22.
Hutchison, R. W. (2007). Challenges in acute post-operative pain management. American journal of healthsystem pharmacy AJHP official journal of the American Society of HealthSystem Pharmacists, 64(6 Suppl 4), S2 – S5.
Levin, L., Amit, A., & Ashkenazi, M. (2006). Post-operative pain and use of analgesic agents following various dental procedures. American Journal of Dentistry, 19(4), 245 – 247.
White-Williams, C. (2011). Evidence-based practice and research: the challenge for transplant nursing. Nursing, 21(4), 299 – 304 quiz 305. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22548991

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