This paper presents a critique of the research article “Nurse Practitioner-Administered Chloroprocaine in Children with Postoperative Pain. ” Its central objective is to evaluate the contents within every section of the article. The critique is guided by research guidelines in providing information presented in the study . According to the study, the administration of chloroprocaine is effective in the evaluation of the functions of postoperative epidural and peripheral nerve catheters (Sweet, Shusterman, Nedeljkovic, & Solodiuk, 2018). While the study methodology and results are effective in supporting the discussion and conclusions, there are limitations with the sampling procedure and sample size, which may affect the applicability of results to clinical practice.
The objective of the study was to determine how chloroprocaine, a local anesthetic, affects catheter functions by evaluating the change in patients’ responses to pain. The effect on catheter function could also be determined by observing and evaluating the changes in patients’ emotional and behavioral changes. The introduction of the study highlights the importance of understanding and distinguishing the changes in pain and emotional responses in postoperative patients. It also explains the significance of epidural and peripheral nerve catheters (PNCs) in the management of postoperative pain. This introduction and explanation of these concepts make it easy to understand the rationale and objectives of the study. By describing how the core concepts relate with each other, introduction creates a comprehensive picture of the research background and rationale. The background of the study presents the main issues discussed in the research.
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The literature review section of the study provides a background of the use of chloroprocaine in research and clinical practice. The section presents the findings of some previous studies on the advantages and use of chloroprocaine by nurse practitioners. Some of the advantages addressed include lowering the toxicity profile as well as a shorter time of action. It also allows for, observations of emotional, evaluation of behavioral reactions and pain scores alterations in critical signs to verify catheter purpose. More literature on peripheral and epidural nerve catheters is provided to indicate their use in managing moderate to severe postoperative pains. This section provides clarity on the scope of studies related to this study and brings into perspective the use of chloroprocaine in clinical practice.
The study presents research from the past decades, which claim that Chloroprocaine is important in neonates since it is quickly metabolized in the plasma. Neonates contain a decreased a1-acid glycoprotein and plasma concentration of albumin as the main protein for binding amide local anesthetics. Normally the reduced level of a1-acid glycoprotein found in neonates continues until 3 to 6 months old. It is safer to increase the possibility of toxic effects of the local anesthetics in neonates through the use of dosing per kilogram, especially for older children. If children with PNC or epidurals self-report or exhibit pain behaviors, assessments of catheters functions are essential. The bedside nurses assessed pain through the use of developmentally suitable pain scales in the study’s pediatric institution. The nurses also assessed the faces, Legs, Activities, Cries, Consolability scales, Wong-Baker FACES scales, numeric rating scales, and individualized numeric rating scales.
The study was a cross-sectional research design. Data was obtained from the electronic medical records (EMR) of the health facility, focusing on patients who had received chloramphenicol injections between January 1, 2014, and December 31, 2015. Inclusion was based on age and intervention, i.e., all patients less than 26 years and had received chloroprocaine injection into a catheter for pain management. Patients older than 26 years or those who had been administered with the anesthesia only for the initiation of the catheter were excluded. The methodology of the study was clear, precise, and can be replicated in other studies. Retrieving patient information from the EMR also reduces limitations such as bias and loss of data associated with other research designs such as randomized control trials. However, the sampling procedure does not specify the gender of the patients. Exclusion of gender may affect the findings and discussion of results, given that gender is one of the factors that affect drug pharmacokinetics and pharmacodynamics.
Results from the study indicate that 128 patients of 141 satisfied the inclusion above criteria and received 137 provisions of chloroprocaine to analyze the efficiency of the catheter. The mean age of the participants was 14 ranging from 2 to 25 years. There were no also considerable adverse measures. The injection was used in guiding the intervention by finding out the purpose of local analgesia in the greater part (98.5%) of participants. The sample size is quite small, making it difficult to determine whether the results can be extrapolated to the larger population.
The authors also present some suggestions for Nursing Education, Research, and Practice. Since chloroprocaine is a local analgesic that is short-acting, nurse practitioners can safely administer them through injections using peripheral and epidurals nerve catheters. Bedside nurses can then monitor them on general surgical units. Chloroprocaine injections result in dense and rapid numbness, motor blocks in the expected nerves and analgesia. The injections also guide the management in the overwhelming effects of chloroprocaine among the majority of patients. During the examinations analysis shows that chloroprocaine injection was useful, and patients with positive response were subsequently managed the continuation of peripheral and epidural nerve infusions. Participants who exhibited negative responses had their pain managed using systematic analgesics, after the catheters were removed.
The study indicates that it is safer to administer chloroprocaine through epidurals and catheters if the protocols are in place. The findings further indicate that were no predictable signs of local toxicity, besides the expected meteor and sensory loss after the injection of chloroprocaine. In many instances, the injection of chloroprocaine was vital in funneling interventions. Therefore, the utilization of chloroprocaine was effectual among the participants in determining the efficiency of the catheter. It also guided the management of pain among many patients. The study presents adequate information on the roles of chloroprocaine, but further research on the topic is needed to enhance more knowledge on how chloroprocaine can be effective.
In conclusion, the study has effectively addressed the pertinent issues related to the administration of chloroprocaine in catheterized postoperative patients. The study background and literature review explicate the research and clinical basis of the study. The cross-sectional research design and data collection procedures are precise and can be replicated in other studies. However, the sampling procedure and sample size are not well addressed, affecting the discussion of the results and extrapolation of the study findings to the general population.
Reference
Sweet, E., Shusterman, C. S., Nedeljkovic, M. S., & Solodiuk, J. C. (2018). Nurse practitioner-administered chloroprocaine in children with postoperative pain. Pain Management Nursing , 19 (4), 424-429.
