New Approach to Minimize Postoperative Pain in Bariatric Surgery Paper Example

Introduction

Management of pain following surgery is an essential practice in a clinical setup. During bariatric surgery, postoperative pain is also managed to help the patient recover from the surgery. The objective of this study is to provide a review of the new approach to minimize the postoperative pain in bariatric surgery. The hypothesis for this study is that the use of bilateral ESP catheters inserted at the T8 level might provide effective postoperative analgesia for bariatric surgery.

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The pain management strategies are diverse and extensive. They include physical modalities to the intravenous infusion if new sedoanalgesic agents and therapeutic alternative that are at hand. The primary aim of reaching good clinical practices on pain control is mainly individualized the patient, procedures, and populations (Kozlowski, Kozakiewicz, Dadan, & Mysliwiec 2016). This is a widely accepted perception of pain management, therefore, the need to have a guide on its management with the objective scales and active agents (Garimella & Cellini 2013). Importantly, bariatric surgery has a difficult population because of its high prevalence that is associated with Obstructive Sleep Apnea (OSA) and cardiovascular risk factors. Opioid has been found to show impair ventilatory functions through affecting both central and peripheral carbon chemo reflex loos, therefore, having a particular contradiction in patients who are at high risk of preoperative hypoxia such as OSA.

Additionally, another essential aspect to take into account is the use of opioid that is associated with bowel dysfunction (Garimella & Cellini 2013). It is a necessary cause if postoperative mobility and it causes increased hospital stay. Primarily, it presents as constipation, and it can also be counted for the reduced gastric emptying, delayed gastrointestinal transit, bloating, and adnominal pain.

The paper represents new ways to minimize pain in bariatric surgery based on literature review and clinical study. The goal of the postoperative pain management is to reduce the pain while at the same time keeping the side effects at the minimum possible. This is mainly achieved through a multimodal approach.

Literature Review

The American Society if Anesthesiologist defines postoperative pain like the pain that is present after a surgical procedure. Poorly, managed postoperative pain can result in prolonged rehabilitation and complications. On the other hand, postoperative pain is mainly associated with the development of chronic pain and with a reduction in the quality of life. According to Garimella & Cellini (2013), appropriate results in shortened hospital stays increased patient satisfaction and reduced hospital costs. Resultantly, the management of postoperative pain is monitored quality measure. Moreover, the failure to provide excellent postoperative analgesia is multifactorial. Kozlowski et al., (2016), states that inadequate education, reduced staffing, and fear of complications associated with analgesic drugs.

Moncada et al., (2016), argues that early mobilization in the postoperative bariatric patient mainly helps reduce the number of avoidable complications which include deep vein thromboses and pneumonia, and this can be facilitated by good pain control. According to Moncada et al., (2016), administering effective pain control strategies to a patient with postoperative bariatric can be challenging and comes with additional risks. This is because obtaining intravenous access is difficult especially on patients who have a high body mass index. According to Garimella & Cellini (2013), junior staff members and administration of medication in the surgical ward has been associated with errors that occur both in the administration and preparation of the patient. Similarly, the drug administration through the intramuscular route is unachievable due to the excess subcutaneous tissue. According to Kozlowski et al., (2016), another additional risk is the use of some classes of analgesics can be contraindicated.

After surgery, the patient undergoes pain. There is the need to manage the pain, and this management requires slow recovery. According to Lima (2017), during the time that the patient recovers, serious complications can arise if the patient is not managed. This makes pain management following a surgery an effective and appropriate intervention. Mitra, Carlyle, Kodumudi, Kodumudi & Vadivelu, (2018), states that the major challenge is that even with the significant advances in modern medicine, postoperative pain poses a substantial threat to both the patient and outpatient following a surgery. The greatest challenge with postoperative pain following bariatric surgery is that it is difficult to manage.

On the other hand, postoperative pain depends on the type of surgery that has been conducted on the patient as well as the prevailing and the preexisting conditions. Additionally, patients in such health condition are linked to the development of obstructive sleep apnea as well as the risk of developing respiratory depression with opioid analgesia. However, several promising advances and approaches have been put across to manage the postoperative pain.

Material and Methods

In this essay, data will be collected through a systematic review of existing literature from various journal databases (DClinPsy & Williams, 2017). The search criteria will be based on the set inclusion and exclusion criteria. Inclusion criteria involved research studies conducted within 15 years since sine their date of publication and those relating to the topic of study. Any article order than 15 years since publication was excluded from the study.

Additionally, articles that contained keywords such as postoperative pain and bariatric surgery were included. Any report without the keywords was excluded from the study. Another inclusion criterion will be the publications done in the English language, and research studies that are evidence-based and reliable. Highly cited papers produced within ten years were searched from Semantic Scholar, ResearchGate, NCBI, Wiley Online Library, and EBSCO databases. Articles older than ten years were rejected and those who has less than 20 participants were also done away with. These were searched, and the reports found screened by a specialized librarian with assistance from a qualified clinical nurse practitioner. The scrutiny was done by assessing the abstract, title, the keywords, and the key subheadings. The main reason was to make sure they provide adequate information about the topic. The research title on the database was "approach to minimize postoperative pain in bariatric surgery" "postoperative pain in bariatric surgery management" and "postoperative pain control." This was necessary as it narrowed down the research topic to the desired articles.

Results

List of clinical studies used for the study

Reference Sample size TAP Block procedure Effects of the Analgesic Requirements Surgical procedure Effects on Pain Effects on sedation

Conaghan et al. 11 74 40 mL of 0.25% levobupivicaine (20 mL on each side) (Ultrasound) Decrease in IV opiate use (TAP Group) Laproscopic colorectal Not studied Not studied

Ra et al. 34 54 15 mL of 0.25% and 0.5% of levobupivacaine on both sides (Bilateral ultrasound) Decrease in total postoperativeanalgesics (TAP Group) Laparoscopic Cholecystectomy Decrease in pain up to 24 hours (TAP Group) Not studied

Previous reviews of literature review had analyzed various TAP studies for insight into the efficacy of both ultrasounds guided and standard TAP procedures. For instance, the study Conaghan et al. 11 identified 74 randomized clinical trials. Moreover, the paper uses another study that used 54 participants.

Ultrasound Identification of the Transversus Abdominis Plane

From various research studies, the use of bilateral ESP catheters inserted at the T8 level is an effective perioperative analgesia for Bariatric surgery. Its use presents a plethora of advantages over other interventions and approaches that have been adopted. Success in their use has been ascertained and this has made it an evidence-based practice.

Discussion and Conclusion

Several research studies have been done on the various approaches that have been used to minimize postoperative pain in the bariatric surge. Many of the studies show that postoperative pain can be reduced to allow both the outpatient and inpatient recover effectively after the surgery. In general, the postoperative techniques as pointed out by Elrazek, Elbanna & Bilasy (2014) are intravenous fluid management, ambulation, pain management, and pulmonary hygiene. The pain management techniques are effective after bariatric surgery. According to Quidley, Bland, Bookstaver & Kuper, (2014), opioid management has been used previously as the mainstay. However, there is no reliable data to support its use in the management of pain after bariatric surgery. Another suitable and recent anesthetic technique used to manage the pain is the ultrasound-guided transversus abdominis plane block. According to Dey et al. (2018), ultrasound-guided transversus abdominis plane block is a current technique that uses the analgesia regimen to reduce the postoperative pain following surgery. After conducting a randomized control study in which they studied the effectiveness of ultrasound-guided transversus abdominis plane block versus the systemic analgesia, Dey et al. (2018) found that the ultrasound-guided transversus abdominis plane block is a possible technique compared to systemic analgesia in the treatment of the postoperative pain following surgery. This shows that ultrasound-guided associated methods are suitable in the treatment of the postoperative pain following surgery.

A more effective and fast technique is the ultrasound-guided erector spinae plane (ESP) block. Ultrasound-guided erector spinae plane (ESP) block provides thoracic analgesia when it is performed at the level of the T5 transverse process. After completing their study, Orozco, Serrano & Rueda-Rojas (2018) established that ultrasound-guided erector spinae plane block does not require an additional opioid and does not lead to further adverse effects or complications whatsoever. Additionally, the technique is fast as well as safe making it suitable for use as an appropriate adjunct that can ensure the postoperative analgesia. It is also advantageous in that does not require excessive use of opioid when treating the patients and it offers good pain management (Orozco, Serrano & Rueda-Rojas, 2018). The technique has also been found ultrasound-guided erector spinae plane block to be effective, safe, simple and a large sensory block by Forero, Adhikary, Lopez, Tsui & Chin (2016).

The transversus abdominis plane (TAP) involves the injection of local anesthetic solution between the transversus abdominis muscle and the internal oblique muscle. According to Tsai et al. (2017), ultrasound-guided TAP block has become an analgesic method that is done after surgery that involves the abdominal wall. Blanco, Ansari, & Girgis, (2015) states that the main reason is that the TAP blockade is limited to the bodily anesthesia of the abdominal wall meaning t is highly dependent on several new techniques that have been proposed in order to enhance analgesia and single modality. Blanco, Ansari, Riad, & Shetty (2016) states that the variants of the quadratus lumborum blocks (QLBs) have been proposed as the once that are more consistent. According to Parras & Blanco (2016), although the analgesic effect only covers somatic pain that has a short duration on the other had a single-shot TAP block plays a crucial role in the multimodal analgesia. Despite...