In adult patients undergoing total hip replacement (P), how effective is PCA pain medication (I) compared to “PRN” IM pain therapy (C) in controlling post-operative pain (O) days after the operation (T)?
The search terms were drawn from the research topic: The effectiveness of PCA pain medication in controlling post-operative pain in adult patients undergoing a total hip replacement. The keywords used for the search were: PCA pain medication, post-operative pain, control, patients, patients with total hip replacement.
The keywords were keyed in the search field of the target databases to generate possible sources of evidence to answer the PICOT question. They were manipulated to provide the required level of rigor and effectiveness. They were used in various ways using the Boolean Operators (AND, OR, and NOT). The databases used for the search were CINAHL & MEDLINE Combined Search, MEDLINE, Ebscohost, and Nursing Reference Center Plus.
The first search used the PCA pain medication generated more than 15,000 articles because it was too general. However, combining other keywords using the Boolean Operators narrowed down the search because it was more specific. The search conducted using PCA pain medication to control postoperative pain in patients with total hip replacement generated only 400 sources from Ebscohost, 143 from CINAHL & MEDLINE Combined Search, 153 from MEDLINE, and 131 from Nursing Reference Center Plus. It was easy to filter fewer sources to access only five sources that would generate evidence to answer the PICOT question. Evidently, the combination of the key words had implications on the nature of evidence used to answer the PICOT question. The following five articles were selected from the search to answer the research question:
- Hall, M. J., Dixon, S. M., Bracey, M., MacIntyre, P., Powell, R. J., & Toms, A. D. (2015). A randomized controlled trial of postoperative analgesia following total knee replacement: transdermal fentanyl patches versus patient controlled analgesia (PCA). European Journal of Orthopaedic Surgery & Traumatology, 25(6), 1073-1079.
- Harsten, A., Kehlet, H., Ljung, P., & Toksvig-Larsen, S. (2015). Total intravenous general anaesthesia vs. spinal anaesthesia for total hip arthroplasty: A randomised, controlled trial. Acta Anaesthesiologica Scandinavica, 59(3), 298-309.
- Katz, P., Takyar, S., Palmer, P., & Liedgens, H. (2017). Sublingual, transdermal and intravenous patient-controlled analgesia for acute post-operative pain: systematic literature review and mixed treatment comparison. Current Medical Research and Opinion, 33(5), 899-910.
- Marques, E. M., Jones, H. E., Elvers, K. T., Pyke, M., Blom, A. W., & Beswick, A. D. (2014). Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short-and long-term effectiveness. BMC Musculoskeletal Disorders, 15(1), 220.
- Schug, S. A., Palmer, G. M., Scott, D. A., Halliwell, R., & Trinca, J. (2016). Acute pain management: scientific evidence, 2015. Medical Journal of Australia, 204(8), 315-317.