Introduction
The hip is one of the essential joints in the human body. The linkage has soft tissues that cover the joint and aid in the movement of the joint. The normal flexion and extension of the legs are dependent on the hip joint. A defect in the hip joint results in numbness, a change in walking method, and groin pain. Normalcy is attained through surgical procedures since it is practically difficult to heal on its own. A hip defect may result from wearing out of the cartilages. Hip replacement, therefore, is the most successful surgery conducted in the modern day.
The Germans were the pioneers of this operation in the 20th century. Improvements have further been made in the field of pain relief through the discovery of pain relief medication. Surgeons, through extensive study and research (Fan & Chen, 2020), use the direct anterior approach. This method is preferred nowadays since it is less economical, has complex anatomy familiarity, and has a well-understood body habitus. According to Moisset et al. (2020), hip replacement involves a surgical procedure where a defective joint is replaced with an artificial hip. There are several indications for hip replacement which include a fracture in the hip, osteoarthritis, and rheumatoid arthritis. The main goal of this surgery is not only to relieve pain in the groin but also to replace damaged hip parts.
The PICOT question is: In adults with total hip replacement (P), what is the effect of pharmacology therapy (I) compared to non-pharmacology therapy (C) in controlling post-operative pain (O) during the perioperative and recovery time (T)? This research paper aims at creating awareness on the implication of hip replacement in adults and the effects of both pharmacological and non-pharmacological approaches in the management of pain.
Surgical Procedure
Hip replacement is offered to patients who complain of swelling and pain in the groin, experience difficulty in performing their daily activities, and patients feeling depressed due to pain felt in the hip region. The process occurs in theaters where aseptic techniques are employed. There are three types of hip replacement, partial, resurfacing, and total (Fan & Chen, 2020). Total hip replacement is the most commonly conducted. The surgeon may choose to use a general anesthetic or spinal anesthetic. In spinal anesthetic, the patient is injected anesthetic near the lower spinal cord. An incision is made in the hip; this is succeeded by the removal of the hip and implanting a new artificial hip, and the procedure takes approximately 1 to 2 hours.
However, the surgical procedure has few complications, which include infection, blood clots, and stiffness. Infection may arise from the prosthesis and can last for weeks; hence the patient is observed and issued with antibiotics (Fan & Chen, 2020). Blood clots may occur during the operation; for instance, the lumps occur in the veins and travel to the lungs, which is fatal since breathing would be complicated. The operation involves an incision into the hip region. Blood flow is evident in this region; hence pricking of the blood vessels may result in bleeding, which if not controlled can lead to fatality.
Pharmacological Therapy
Before the operation, the doctor should know the medications an individual used to prevent complications that might arise. The most anticipated and obvious expectation after surgery is pain. Post-operative pain is pharmacologically managed by the issue of pain relievers. Pain medication issued include nonsteroidal anti-inflammatory drugs, opioids, and acetaminophen (Meinyk & Fineout-Overholt, 2018). Pain is initiated by the release of prostaglandins and inflammatory mediators such as bradykinin. NSAIDs function by inhibiting of synthesis of prostaglandins and inhibiting cyclo-oxygenase enzymes.
Opioids can be administered by mouth or injection. Examples of opioids used include codeine, tramadol, oxycodone, and morphine. Opioids relieve pain by initiating the closure of calcium channels, specifically the N-type channels. They promote the opening of calcium-dependent inwardly-rectifying potassium pathways (Meinyk & Fineout-Overholt, 2018). The effect is hyperpolarization which reduces the net neuronal excitability. Opioids promote inhibition of neurotransmitter release; the effect of their use is in relieving pain. However, these drugs are narcotics; hence their use can be addictive. When the pain stops, the patient should be advised to stop the medication. Moreover, the use of opioids may also cause constipation since they inhibit the colonic secretion and the transition of food in the intestines.
Post-operative pain management may include the use of acetaminophen, which is the first-line drug used. The recommended dosage for adults is 500 mg every eight hours (Fan & Chen, 2020). It is used for mild pain relief. The drug works by inhibiting prostaglandin synthesis. Although pain relief may be achieved, acetaminophen may have adverse effects on the patient. This may include hypersensitivity reactions, kidney damage, gastric ulcers, stomach upset, and skin reactions.
Perioperative time refers to treatment issued before an operation, and hip replacement is usually associated with perioperative pain. The degree of pain affects recovery time; hence many complications may arise. However, good perioperative management increases recovery time. A multimodal approach is preferred to opioids since they are addictive. Multimodal pain management involves the use of peripheral nerve blocks and oral medications. According to Moisset et al. (2020), glucosamine chondroitin usage shows pain reduction when issued to patients. Glucosamine’s function is to protect chondrocytes. The chondrocytes are essential in the maintenance of tissue homeostasis and maintain normal cartilage structure. The effect of the presence of chondrocytes is the slowing of deterioration of the cartilage in the joints hence relieving pain. However, the effect of glucosamine is that pain reduction is minimal. The tables below display the search results for PICOT question variables from four databases.
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Non-pharmacological Management
Drugs relieve pain, but most of them have side effects such as nausea. Some medicines are irritant to the patient’s gut and skin; hence may cause skin rashes. Due to these reasons, non-pharmacological pain management is advisable though it is not effective in the faster elimination of pain (Fan & Chen, 2020). The non-pharmacological methods used include the use of cold packs, relaxation therapy, and complementary therapy such as listening to music.
Non-pharmacological methods can be categorized into four categories. Passive application of cold packs, massage, and heats packs. Cold packs are most commonly used since they are effective in reducing pain (Fan & Chen, 2020). They numb the hip, therefore, reducing pain and are more effective compared to the use of pressure bandages. The other category is physical exercise; physical activities such as light sports and walking aid in pain elimination. Nevertheless, excessive exercise may increase pain felt in the extremities.
An individual’s psychology is essential in defining how he or she perceives issues. Relaxation, meditation, and visualization have proved fruitful in the management of pain. The final category is a distraction, where an individual’s attention is captured. The patient may choose to talk to other people as a means of forgetting the presence of pain. Emotional support relieves pain since the patient receives help in conducting his daily activities. According to Moisset et al. (2020), the environment is essential in coping with pain. According to research conducted in the United States, out of 100 sampled patients, 92 had faster pain relief due to environmental exposure.
The other pain management relevant to hip replacement is positioning. The position a patient assumes determines the degree of pain felt and relieved. Sleeping position is also essential in the management of pain where the patient is advised to sleep with a pillow between the knees (Meinyk & Fineout-Overholt, 2018). This is essential in avoidance of crossing of legs which elevates the pain. A relaxed position reduces the ache, hence making it comfortable for one to sleep.
Conclusion
Total hip replacement in adults is essential in the resumption of the normal functioning of an individual. Hip replacement is conducted in hospitals where an implant replaces a fractured part. The substitution can be painful on most occasions, and the pain felt should be managed effectively to prevent further complications. Pain can be managed by both pharmacological and non-pharmacological methods. The pharmacological methods used include the use of pain relievers such as NSAIDs and acetaminophen. This necessitates the use of non-pharmacologic methods, which include the use of cold packs, physical exercises, positioning, massage, and psychological methods. Emotional support and assistance in performing activities help in relieving pain. Nurses should educate the patient on postures they can use during sleeping and carrying out activities. Pharmacological therapy is the most effective compared to non-pharmacological therapy. However, a combination of both therapies promotes pain relief.
References
Fan, M., & Chen, Z. (2020). A systematic review of nonpharmacological interventions used for pain relief after orthopedic surgical procedures. Experimental and Therapeutic Medicine, 20(5), 1-1.
Meinyk, B., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing and health care. A Guide to Best Practice.
Moisset, X., Bouhassira, D., Couturier, J. A., Alchaar, H., Conradi, S., Delmotte, M. H., Lanteri-Minet, M., Lefaucheur, J. P., Mick, G., Piano, V., Pickering, G., Piquet, E., Regis, C., Salvat, E., & Attal, N. (2020). Pharmacological and non-pharmacological treatments for neuropathic pain: systematic review and French recommendations. Revue Neurologique, 176(5), 325-352.
Appendix
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