Postoperative Pain Management Options

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PostoperativePain Management Options

Comprehensivepost-operative pain management is indispensable in surgical patients’care. Ineffective pain management is inhumane, as well as it can leadto death or morbidity. Since the invention of surgery as an essentialmedical problems solution, postoperative pain management has oftenbeen a major problem. Fortunately, advanced research in pharmacologicsciences has assisted in the discovery of assorted therapeuticanalgesics that are presently used in the medical field. Severalstudies have concluded that ineffective pain management can causesignificant delay in a patient’s recovery through inducing painrelated complications. However, most of the drugs are attributed withsevere side effects on the patient. The objective of this study isinvestigating whether epidural fentanyl-bupivacainepatient-controlled analgesia (PCA) is more effective and has feweradverse effects (nausea and vomiting) than epidural or intravenousmorphine.

Recommendedpain management solution

Theepidural fentanyl-bupivacaine patient-controlled analgesia (PCA) isone of the major regional anesthesias for surgical medications. Inaddition, the drug is also occasionally used in post-operation painmanagement. Several studies indicate that it provides an adequateamount of pain suppression that can accelerate the rate of apatient’s recovery (Weinbroum, 2001). However, the drug isassociated with a variety of adverse effects that can affect thehealth of a patient negatively. In a study that aimed at evaluatingthe probability of patients taking epidural fentanyl-bupivacainepatient-controlled analgesia suffering from nausea and vomiting, theresults indicated that the drug does not cause any of these sideeffects. As long as the patient can follow a physician orpharmacist’s instructions clearly, they can avoid experiencingthese side effects (Kaplow, 2013).

Onthe other hand, the study concluded that epidural or intravenousmorphine patient-controlled analgesia had high risk of inducingnausea and vomiting effects among children. The intravenous morphinecontains has opioid as one of its primary compositions. According toSmith (2011), nausea and vomiting is one of the major side effects ofopioid related medication. Similarly, intravenous morphine has nauseaand vomiting as some of the key adverse effects when used asanalgesics. In another study, Garrett et al. (2003) reported that thedrug mainly induces severe vomiting and nausea conditions on patientsfor the first 7-14 days after administration of the drugs. Thecondition keeps improving from then onwards. The intravenous morphinepatient-controlled analgesia is mainly suitable for short-termpost-operative pain management as it may also lead to secondarycomplications such as addition (Badner et al., 1996). Nausea andvomiting may in turn result as a secondary illness from withdrawalsymptoms. The combination of these side effects makes s intravenousmorphine an unsuitable anesthesia when compared withfentanyl-bupivacaine patient-controlled analgesia (PCA).

Accordingto Smith (2011), fentanyl-bupivacaine patient-controlled analgesia(PCA) is the most preferred alternative anesthesia for patientssuffering from nausea and vomiting. Several post operation nursesoften recommend the drug as the most appropriate intervention forpatients suffering from vomiting and nausea caused by analgesics.Garett et al. (2003) concentrated on evaluating both preoperative andpostoperative causes of vomiting and nausea, as well as the bestsolution for treating such conditions. The study was based on PCA andPCEA anesthetic factors. The Weinbroum and Aviv (2005) study focusedon evaluating essential considerations that nurses should understandregarding patient care after administering them with anesthesia.Besides, the study sought to understand the strength differencebetween epidural and intravenous PCA. For the Weinbroum et al.(2001), the research aimed at developing a better understandingconcerning deliriums caused by intravenously administered sedatives.The main objective of the study was identifying the side effects thatoften result from PCA. Badner et al. (1996) the authors concentratedon evaluating the necessity for nurses tracking the progress of postoperation patients as a strategy for determining their probability ofregaining consciousness. In addition, the study also determinedsuitable strategies for reducing and assessing after-surgery adverseeffects that may develop such as discomfort and nausea. Lastly,Kaplow (2013) determined the most efficient analgesic in determiningefficient doses and precautions health care professionals couldobserve to make post-operative pain management effective.

Theepidural fentanyl-bupivacaine patient-controlled analgesia (PCA) ismainly administered to patients as an intravenous medication. On thesame note, patients taking the medication should refrain from takingother forms of drugs that may lead to cause contraindication (Garrettet al., 2003). Similarly, patients suffering from pre-existingcondition should inform their physicians or pharmacists in advance sothat the healthcare professional can recommend a solution that canprevent the patient from experiencing any adverse effect. Experiencednurses determine the health condition of patients, potentialcontraindication factors and the level of target pain to be mitigatedwhen administering the drug (Smith, 2011).

Lastly,the health care professionals should advise patients on variousprecautions they should maintain after adopting the new painsuppression drug in order to prevent developing adverse effects(Weinbroum &amp Aviv, 2005). For example, post-operative patientsusing fentanyl-bupivacaine as the primary analgesics should not beexpectant or planning to conceive within the duration that they willbe using the medication (Weinbroum et al., 2001). Patients sufferingfrom pre-existing conditions such as liver and renal diseases shouldalso inform the healthcare professionals since they may requirespecial treatment.


Inconclusion, epidural fentanyl-bupivacaine patient-controlledanalgesia (PCA) more effective and have fewer adverse effects (nauseaand vomiting) than epidural or intravenous morphine PCA. The drugsare preferred to intravenous morphine when in a situation whentreating persons suffering from nausea and vomiting, as they do notcause the condition.


Kaplow, R. (2013). ‘Safetyof patients’ transferred from the operating room to the intensivecare unit’,Atlanta: University Hospital press, vol. 33. No 1 68-70

Smith,A. (2011). ‘PostoperativeNausea and Vomiting in Adults: Implications for critical care’University of Blvd American Association of critical care Nurses

Weinbroum,AA &amp Aviv, T (2005). ‘Superiorityof post operative epidural over intravenous patient controlledanalgesia in orthopedic oncologic patients’.Israel Mosby Inc.

BadnerNH, Reid D, &amp Sullivan P. (1996). ‘Continuousepidural infusion of ropivacaine for the prevention of postoperativepain after major orthopedic surgery: a dose finding study’.Canada Journal of Anesthetic: 43:17-22. Internet resource

Garrett,et al. (2003),’ManagingNausea and Vomiting current strategies’Vol. 23 no. 1 31-50, Columbia Viejo Inc. Print.

WeinbroumAA, Marouani N, Lang E, Niv D, Rudick V. (2001). ‘Painmanagement following limb-sparing surgery’.The Netherlands: Kluwer Academic Publishers p. 567-580.