Date of Award

12-1992

Degree Type

Master's Essay - Restricted

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

First Advisor

Christine Shaw

Abstract

Pain Management has emerged as a significant concern for nursing practice (Mccaffery & Beebe, 1989). Nursing is concerned with the treatment of patient responses to illness or injury and plays a key role in the relief of pain (Morgan, 1988). Postoperative pain is usually acute in nature and in many cases requires some form of pain management (Acute Pain Management Guideline Panel, 1992). Research has shown that the traditional practice of ordering intramuscular injections of opioids "as needed" leaves approximately half of adults in pain after surgery (Donovan, Dillon, & McGuire, 1987; Marks & Sachar, 1973; Oden, 1989).

Epidural analgesia, the direct application of opioids or local anesthetics into the epidural space, is an alternative option for pain control which has been gaining popularity for the management of acute postoperative pain. The drugs most commonly used for epidural analgesia include morphine, fentanyl, sufentanil, meperidine, hydranorphone, and bupivacaine (Cohen, 1989b). Epidural opioids act by binding to opiate receptors in the spinal cord thereby blocking pain transmission. LOcal anesthetics, such as bupivacaine, block i ii conduction of pain impulses by binding to nerve roots as they exit and enter the spinal cord (Litwack & Lubenow, 1988).

Epidural analgesia has been associated with several annoying and a few potentially severe side effects. The most common side effects include respiratory depression, pruritis, urinary retention, and nausea and vomiting (Benedetti, 1987; Cousins & Mather, 1984). Respiratory depression occurs less frequently but causes great concern because its onset can be insidious and potentially lethal. Nurses caring for patients receiving epidural analgesia need to be knowledgeable of epidural anatomy, pain physiology, pharmacology, potential side effects and the management of side effects in order to provide safe and effective pain management.

Comments

An Essay Submitted to the Faculty of the Graduate School, Marquette university, in Partial Fulfillment of the Requirements for the Degree of Master of Science in Nursing Milwaukee, Wisconsin

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