Patient Education And Epidural Pain Management Essay Example for Free

Patient Education And Epidural Pain Management Essay The term pain pertains to a sensation that is communicated by the sensory neurons that are located around the human body to the brain. This sensation is described as an unpleasant feeling that is generally related to a form of damage to a particular tissue in the body. Pain thus activates a specific physical and psychological reaction that tends to find a mechanism to terminate the unpleasant feeling. The ability to sense pain serves as the body’s warning system that informs us of any form of injury to our bodies. Pain is generally described in terms of its intensity and its duration. Intensity can be expressed through a range of descriptors from slight to agonizing, while the duration of pain may be depicted as constant or intermittent. Other characteristics that are commonly employed to describe pain include sharp, dull, throbbing and nauseating. The threshold of pain varies among individuals hence a numeric rating scale, with rating from 1 as the least painful situation to 10 as the most painful condition, has been employed for a more specific quantification of pain in patients. The numeric rating scale identifies level 4 as the cut-off score for pain that impedes an individual from performing his normal functions (Krebs et al. , 2007). In order to relieve an individual from pain, pain management is often provided at hospitals and clinics. In cases wherein the patient only suffers from acute pain, temporary medications are commonly administered to correct the medical problem. However, if the patient is experiencing chronic pain that is related to a condition that is currently being treated or is still undiagnosed, pain conduits are often put up to alleviate the sensation of pain in the patient. These conditions generally include cancer and neuropathy, wherein the pain is distinguished from the major medical condition of the patient. Pain management usually employs that administration of pharmacologic drugs such as analgesics and pain modifiers. In addition, other non-pharmacologic treatments may also be provided, which as normally interventional methods such as physical therapy, heat or cold compression and psychological therapy. One of the major interventional methods for pain management involves the administration of epidural analgesia, which is provided through the introduction of a catheter into the epidural space which is the space between the spinal cord and spinal canal. The effect of the injection of pain medications is to essentially remove the pain that the patient is experiencing by inhibiting further conduction of pain signals along the nerves or the spinal cord. Epidural analgesia is considered as a common technique for pain management because aside from reducing the pain felt by the patient, it also promotes vasodilation of blood vessels. Such result is actually a side-effect of epidural analgesia, yet it still benefits a patient if he has been diagnosed with a peripheral vascular medical condition. In addition, the utilization of epidural analgesia extends the effect of the pain medications for several days, instead of just a few days. In specific conditions that have associated pain such as childbirth, epidural analgesia is the favored pain management regimen because it does not cause any changes in muscle movement or power and it still retains its main role in pain conditions that may or may not require surgery. Epidural analgesia is also commonly used as an accessory to general anesthesia to decrease the patient’s need for opioid analgesics. Its use as an adjunct pain management scheme has been applied in a broad range of surgical procedures including hysterectomy, hip replacement, laparoscopy and open aortic aneurysm repair. Epidural analgesia is commonly used as the primary method for surgical anesthesia especially is Caesarean sections, which keeps the patient conscious during the entire surgical obstetric procedure (Halpern et al. , 2004). However, in such situations, the amount of anesthesia administered is generally much higher that what is usually employed for analgesia. Post-operative pain management may also involve epidural analgesia for the first few days after the procedure, which involves the introduction or retention of a catheter. There are certain situations when the patient is allowed to regulate the amount of pain medications that will be passed through the catheter. Such patient-controlled analgesia makes use of an infusion pump which the patient himself controls. Epidural analgesia is also used as remedy for back pain, as well as for palliative care. It has been established that epidural analgesia is most effective for the treatment of pain in specific regions such as the abdomen, pelvic and legs. This pain management technique is less effective in treating pain in chest, neck or arms, and is not effective for pain treatment in the head. It has been proven that epidural analgesia is more effective in relieving pain than intravenous narcotics and has been identified as the second most frequently used pain medication (Leighton and Halpern, 2002). Majority of women who give birth in hospitals are usually given only two options with regards to pain management, namely epidural analgesia or intravenous narcotics. It should be noted that alternative pharmacologic treatments for pain are also available, such as nitrous oxide and paracervical blocks. In addition, there are also doulas and continuous labor support, which typically requires less medical treatment and results in better outcomes with regards to the health of the mother and child. Also, these women are generally more satisfied with the results they observed after such alternative treatments. However, these alternative options are generally much more expensive (Simkin and OHara, 2002). It is interesting to note that even though epidural analgesia is reported to be significantly effective and common treatment for pain during child labor, there are a number of major side-effects that are associated with such use. It has been reported that epidural analgesia prolongs labor for an extended and considerable duration. In addition, its administration also influences the need for operative vaginal delivery and increases the chances for perineal laceration (Lieberman and ODonoghue, 2002). It has also been observed that the administration of epidural analgesia during obstetric procedures causes the mother to run a fever, which then results in the provision of antibiotics to the newborn child, as well as monitoring for symptoms and signs of sepsis in the infant. To date, great controversy envelopes the issue of whether epidural analgesia increases the risk of delivering a baby through Caesarean section as well as induces difficulty during labor. Research surveys show that most women have not been educated with regards to the possible side-effects of epidural analgesia (Declercq et al. , 2002). Hence the role and need for patient education has been an issue of close scrutiny in the past 5 years. Specific medical and non-medical groups have expressed their concern over the risks and benefits of epidural analgesia. More importantly, there has been concern that such type of patient education of pain management regimens should be given during pre-natal visits, and not during the actual labor stage of pregnancy. Hence, there is an urgent need to determine the amount of information that mothers know in relation to pain management and epidural analgesia because this option strongly influences the behavior of the newborn child, the breastfeeding conditions and the bonding between the mother and infant. In the United States, the dominant delivery method is composed of the induction of labor, administration of epidural analgesia, constant electronic fetal monitoring and Caesarean section. It has been analyzed that when the frequency of epidural analgesia is high, the alternative methods for childbirth are usually not available in the medical institution. These include sessions in childbirth education, doulas, non-pharmacologic pain management regimens, as well as the provision for nurses especially trained in assisting in medication-independent childbirth. Hence what is observed now in most of the hospitals are labor stages that are mainly supported by epidural analgesia and parenteral analgesics. In addition, medical healthcare professionals providing labor support are often overworked due to the huge number of delivery cases in a week. The issue of the shortage of nurses in the healthcare industry has also complicated the problem on the usage of epidural analgesia in hospitals. There are certain obstetricians who prefer to maintain a patient at labor that is supported by an intravenous line in order that they still find time to monitor their other patients in the hospital. It has been considered that the availability of healthcare professional during a patient’s labor and delivery is a luxury. More so, the inability to provide epidural analgesia to a patient during labor has often been a topic that has frequently been investigated in court malpractice cases. The importance of patient education with regards to epidural analgesia as the pain management scheme is thus very important in order to provide the patient with more than the regular two pain management choices that could be administered during her delivery. Patient education should also include the provision of information on the Caesarean delivery, wherein the patient must be able to carry enough knowledge to know that it is her right to request for a Caesarean delivery even when it is normally not recommended if there are no maternal or fetal complications for childbirth. There has been controversy with regards to the competence of smaller hospitals to could not universally provide epidural analgesia. It is unfortunate to know that not a single medical organization supports the concept of establishing a wide range of support methods during labor and pain management schemes, which is strongly associated with patient education and choice. In other countries, Caesarian delivery is the preferred delivery method by women because they are aware the other forms of labor and delivery schemes are not associated with sufficient medical care and attention (Behague et al. 2002). At the same time in the United States, women perceive that epidural analgesia is the sole and effective method for pain management. Actually, family physicians are not the main healthcare professionals that are responsible for the unbelievably high rates in the use of epidural analgesia during labor and childbirth. This medical professional observes when the patient is experiencing pain during labor and he relays this condition to the attending nurses, who in turn, will communicate the information to the anesthesiologist. Such relay of message from the patient to eventually the anesthesiologist is generally comprised by a simple nod from the family physician, which then triggers a battery of messages that eventually end with the administration of epidural analgesia to the patient. Such translation of patient pain to epidural analgesia administration is actually inappropriate and this is where patient education related to epidural analgesia comes into the picture. It is actually the family physician responsibility to educate his patient with regards to the choices in pain management. Instead of having a family physician that advocates epidural analgesia because it provides him freedom to look at his other patients while a particular patient is in labor, the family physician should be an advocate for the patient herself. Patient education entails spending time to teach and coach his patient which pain management schemes are currently available, as well as describing to the patient the effectiveness, side-effects and complications of each pain management scheme. The patient should also be educated of the limitations of each of the available pain management options. It is also ideal that the patient knows that she has the right to choose which pain management scheme she wants to receive, but this can only be done if the patient has sufficient understanding of pain management. It is also ideal that family physicians learn more of the details of the other alternative methods in managing pain. It has been observed that such patient education regarding pain management choices are important so that the patient has knowledge of what to expect during the actual medical procedure (Marmor and Krol, 2002). Patient education also involves the explanation of patient-controlled epidural analgesia (PCEA), which is a labor and delivery pain management option that uses bupivacaine with or without opioids. The theory behind PCEA is that the patient can personally adjust the amount of epidural anesthesia that is needed to remove the pain he is experiencing. Such option for pain management often results in a high degree of patient satisfaction because it allows the patients to be free of the uncomfortable sensation of pain, as well as provide a way for the patient to feel a sense of control over the entire hospital procedure (Standl et al. 2003). It is thus important the patient education be provided to a patient, in order for him to understand the entire scenario of the procedure as well as to help him draw an image of the expected events that could unfold during his stay at the hospital. PCEA is currently in high demand because the patients often want a quick solution to the pain they are experiencing. In addition, these patients are not patient enough to wait for the next round of administration of pain killers when they are experiencing constant pain. It is also essential that patient education in relation to epidural analgesia must explain that PCEA is inefficient during the first stages of labor and thus a higher concentration of epidural analgesia is needed to relieve the patient from pain. Patient education also diminishes the expectations of patients that PCEA always results in the complete removal of the feeling of pain when they choose PCEA. Knowledge and understanding of epidural analgesia will thus result in patient satisfaction in terms of pain management. Patient education as related to epidural analgesia also includes a description of the possibility that an extensive spinal block in the positioning of the catheter may happen (Bernard et al. , 2000). This event often results in the decrease in the motor abilities of the legs and that once the patient observes this, he must inform a healthcare professional immediately for medical attention. In addition, patient education should also alert the patient that the catheter employed in epidural analgesia has a chance to migrate within the blood vessels, which is also known as intravascular migration. Such event is associated with a slower rate of infusion of analgesia which in turn generates systemic effects. The patient should also be educated with regards to the toxicity of epidural analgesia. Providing patient education in relation to epidural analgesia often results in patient satisfaction because the patient has a better understanding of the mechanisms and principles behind the pain management scheme, as well as its similarity and difference to other pain management options, such as continuous epidural infusion (CEI). Patient education also involves explanation on the receptors that are involved in controlling pain. These include the N-methyl-d-aspartate (NMDA) which acts in the central sensitization of the patient. Simple explanations regarding antagonists that decrease the sensitization for pain without reducing hemodynamic or respiration activity should also be included, and the other options that results in negative physiological effects such as opioids should also be described. The provisions for instruction is especially important to patients that suffer from pain due to general musculoskeletal tumor resections and those that have other medical conditions that are related to wakefulness and full orientation. There are also options in combining a N-methyl-d-aspartate receptor antagonist such as dextromethorphan with PCEA, which often circumvents the issue of sedation in PCEA (Weinbroum et al. , 2004). Reports have described that such combination generally results in better feelings of well-being in the patient. Dextromethorphan is relatively safe for orthopedic oncological patients who are commonly administered massive dosages of analgesics. There has also been reported the patients could not distinguish the feeling of PCEA and dextromethorphan, although there is a significant difference in a lack of inhibition of motor abilities using this combination. CONCLUSION This report suggests that patient education in relation to epidural analgesia results in patient satisfaction. Patient education generates a better understanding of the principles and mechanisms behind pain management schemes. In addition, the patient is given the right to reject or accept epidural analgesia based on his own comprehension that was earlier provided by the healthcare professional. Patient education also supports a PCEA setting that improves analgesia, as well as patient satisfaction during labor. This supports a better setting for the patient himself and decreases the need for rescue analgesia. Also, the increase in analgesia consumption can also be controlled through patient education, thus minimizing the side effects that are generated by particular pain killers. More importantly, patient education removes the discontent and disappointment that the patient may experience from insufficient knowledge and understanding of epidural analgesia.