Spinal anaesthesia for a transurethral resection of the prostate (TURP) the gold standard choice of anaesthesia for this type of surgery

Literature Review on spinal anaesthesia for a transurethral resection of the prostate (TURP) the gold standard choice of anaesthesia for this type of surgery.

Instructions

Your assessment requires you to complete a literature review which requires you to review and evaluate the current evidence base (literature) surrounding your chosen topic. e.g spinal anaesthesia for a TURP – is there good evidence to support its use, is it the gold standard for care etc…

When discussing your chosen literature articles to support your discussion, you also need to evaluate the literature itself; did they have a small sample size, was it a randomised controlled trial etc, is the literature surrounding your topic conflicting, or does it support a unified approach to patient care etc.

Below are some further tips for your discussion.

  • Compare and contrast different authors’ views on an issue
  • Group authors who draw similar conclusions,
  • Criticise aspects of methodology,
  • Note areas in which authors are in disagreement,
  • Highlight exemplary studies,
  • Identify patterns or trends in the literature
  • Highlight gaps in and omissions in previous research or questions left unanswered
  • Conclude by summarising what the literature says.

Below is a brief example of how you may choose to phrase your literature review discussion (Different topic – spinal for TKR)

“….Conversely, there is limited evidence in the current literature indicating the use of systemic analgesia alone, such as morphine and ketamine, when the use of regional techniques may fail or are not appropriate for particular patients (Maxwell & Nicoara, 2014).  The purpose of this literature review was to determine the efficacyof intravenous (IV) ketamine on acute postoperative pain following thoracotomy as an adjunct to IV morphine patient controlled analgesia (PCA).  Studies that compared the effecacy of ketamine in conjunction, or comparison, to  regional analgesia were excluded from the literature obtained due to the difficulty in ascertaining the actual effect of ketamine, as regional analgesia may have resulted in adequate pain relief on its own (Yazigi et. al., 2012; Joseph et. al., 2012).

Michelet et al. (2007) was one of the few studies found in the review of the literature investigating the influence of ketamine on acute postoperative thoracotomy pain.  The study was prospective, randomised and double blind, with ethics approval and informed consent obtained from patients undergoing lobectomy via posterolateral thoracotomy incision.  The primary goal of this study was to investigate if adding IV ketamine to IV morphine PCA would reduce opioid consumption and/or produce an opioid sparing effect following thoracotomy and improve respiratory related complications (Michelet et. al., 2007).  Visual Analogue Scale (VAS) was used for participant self assessed pain rating (0 no pain to 100mm severe pain) and morphine was titrated in PACU until VAS was under 30mm.  PCA was then connected to ‘Group M’ who received 1mg/ml of morphine and ‘Group MK’ 1mg ketamine/ 1mg morphine, with 0.015mg/kg bolus every ten minutes (Michelet et. al., 2007). ……..”

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