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Critical Appraisal Research

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Critical Appraisal Research

The paper that follows will describe the differences in the effectiveness and safety of extended-release epidural morphine (EREM) and perineural infusion (PNI) for the control of pain in a post-surgical total knee arthroplasty (Schmidt et al., 2009). Pain control is critical in the post-surgical patient, staff, and the facility providing care. The use of research and the increase in patient satisfaction is an important way for the medical team and patient community to increase trust and quality of care in the hospital setting. The research that is accomplished by nurses is seen as important in the health care field. The importance of nurses deciding to research pain management indicates the understanding of providing quality care, decreasing facility costs and determining ways to improve nursing workloads, thus providing holistic care.


The significance of pain control for patients is imperative, thus governing bodies that evaluate pain control for patients are in place to ensure superiority in health care. Orthopedic patients commonly suffer from pain for years prior to surgery, so the ability to control pain post-operatively is difficult. Researching different pain medications and administration is crucial in the ability to increase the value of patient care. Society expects to have excellent pain control, and research involving providing these cares is necessary. If the community does not see there is an increase in methods of pain control, the community will find other means of health care causing the hospital to suffer a financial loss.

The literature review dealing with extended-release epidural morphine versus continuous peripheral nerve block for management of postoperative pain after orthopedic knee surgery lacks research comparing the efficacy of EREM to PNI for post knee arthroplasty pain management. Results of the retrospective study create the need for additional studies. The review focuses on the orthopedic patient and narcotic use only in postoperative patients. Reviews need to include pain management prior to surgery and during the procedure. The review should also look for ways to provide pain management with nonnarcotic medications and nonpharmacologic interventions. The framework consistent with this research is problem-based research framework (Ellis & Levy, 2008). The challenging aspect of this study is the data collection of pain in individual patients. Examination of pain is subjective, leading to difficulties in research studies. A numerical pain scale rating provides a numerical evaluation of pain, unfortunately how the question is posed to the client regarding existing pain, if not said uniformly may cause question if the numerical pain scale is equivalent causing indistinguishable results.

The objectives for this study are clear. The ability to control patients' pain after a total knee arthroplasty is the only objective discussed. The question is how to provide pain control for patients who have undergone a total knee arthroplasty (Schmidt et al., 2009). The quality of pain control is always a concern for patients and thus is top priority of the health care team.

The design is a case study. The researchers took information from the charts to evaluate pain control. The groups selected consist of 200 people who received total knee arthroplasty. The first 100 people received extended-release epidural morphine whereas the other 100 people received perineural infusion morphine.

In this study pain measurements are conducted on the zero to 10 pain scale, zero represents no pain and a 10 denotes the worst pain ever experienced. The measuring tool was simple, providing validity to the research study. A data collection variable for this research is examined using the Wilcoxon rank test (Schmidt et al., 2009). The Wilcoxon rank test provides rankings of the nonparametric approximation of the t test provided by the zero to 10 pain scale (Schmidt et al., 2009).


The research focuses on the problem of pain control for patients post total knee arthroplasty. The purpose of the study is to compare EREM or PNI control effectiveness, leading to client satisfaction with health care provisions. The retrospective study provided researchers with results that increased pain control for the client undergoing total knee arthroplasty (Schmidt et al., 2009). The evidence that was collected guides the nursing staff in providing evidence-based nursing. The orthopedic client experiences severe pain; this study is intended to provide information to assist in decreasing the pain post operatively, likewise increasing



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