Download 6. BRIEF RESUME OF THE INTENDED WORK. INTRODUCTION: “It

6. BRIEF RESUME OF THE INTENDED WORK.
INTRODUCTION:
“It is the health that is real wealth and not pieces of gold and silver”
-Mahatma Gandhi.
As the trends in life style have been changing like dressing, food patterns, job, social status and so on,
individuals are experiencing a drastic change in health pattern. People are prone to get many diseases and some
conditions are so severe, it may lead the individual to undergo certain minor and major surgeries. Surgery is a
medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a
pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for
some other reason. There are numerous surgeries undertaken every day around the globe and it is a painful
activity. To overcome this pain, anaesthesia is provided.
Anaesthesia has traditionally meant for the condition of having sensation (including the feeling of pain)
blocked or temporarily taken away. This allows patients to undergo surgery and other invasive procedures
without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes,
in 1846. There are different types of anaesthesia like general anaesthesia, regional anaesthesia, moderate
sedation, monitored anaesthesia and local anaesthesia. The regional anaesthesia has elicited more popularity, in
which an anaesthetic agent is injected around nerves so that the area supplied by these nerves is anesthetized.
Among the types of regional anaesthesia, most commonly used and the important one is spinal anaesthesia. (1)
The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments and all
are capable of producing pain. Spinal anaesthesia is a form of regional anaesthesia that involves injection of the
anaesthetic agent adjacent to the spinal cord or just outside it using a long needle. This renders the portion of the
body beyond or below the point of injection to become numb and anaesthetized, while the rest of the body
remains unanaesthetised. The injection is usually administered in the lumbar spine. The first spinal analgesia was
administered in 1885 by Leonard Corning (1855-1923), a neurologist in New York. He was experimenting with
cocaine on the spinal nerves of a dog when he accidentally pierced the dura mater. The first planned spinal
anaesthesia for surgery in man was administered by August Bier (1861-1949) on 16 August 1898, in Kiel, when
he injected 3 ml of 0.5% cocaine solution into a 34 year old labourer.
There is no procedure completely free of risk, hence spinal anesthesia also has its own complications
which include, severe headache, back ache, drop in blood pressure, nerve damage, infection and allergic reaction
to the anesthetic agents.(2)Low back ache is among the most common symptoms experienced in adults, even
though spinal anesthesia has many advantages compared to other types of anesthesia.(3) Back pain (also known
"dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other
structures in the spine. Back pain is one of the humanity’s most frequent complaints. About nine out of ten adults
experience back pain at some point in their life, and five out of ten working adults have back pain every year.
Hence there is a need to find remedial measures to resolve the low back pain. Lumbar support is the
process of providing adequate support to the muscles and skeletal structure of the lower back. Types of lumbar
supports are lumbar support belt, lumbar support cushion, lumbar support chair, lumbar support pillow, lumbar
support massage and so on. In many instances, the focus of lumbar support is on providing adequate support for
the lower back while the individual is in a seated position. Among the types of lumbar supports, lumbar massage
is a traditional one and it is still used today for treating a wide range of ages from babies to seniors - in a variety
of intensive care, health club, and health clinic and hospital settings.(4)
6.1 NEED FOR THE STUDY:
“To keep the body in good health is a duty, for otherwise we shall not be able to trim the lamp of wisdom,
and keep our mind strong and clear. Water surrounds the lotus flower, but does not wet its petals.”
- Buddha.
According to the latest data from the National Center for Health Statistics, 40.3 million inpatient surgical
procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient surgeries.
Other 1996 surgical statistics for both in- and outpatient procedures include: The Nervous System Surgeries:
2.18 million, Eye Surgeries: 5.5 million, Ear Surgeries: 899.000, Nose, Mouth, and Pharynx Surgeries: 2.32
million, Respiratory System Surgeries: 1.47 million, Cardiovascular System Surgeries: 6.34 million, Digestive
System Surgeries: 11 million, Urinary System Surgeries: 2.5 million, Musculoskeletal System Surgeries: 7.3
million. Integumentary (Skin) System Surgeries: 3.5 million (5) .In that, most of the cases need spinal anaesthesia.
Spinal anaesthesia is a type of regional anaesthesia for surgeries below the umbilicus. A very thin needle
is inserted between the vertebrae, through the dura, and into the fluid-filled subarachnoid space. A small amount
of local anaesthetic drug is injected into the fluid to numb the nerves from the waist down to the toes for a period
of 4-6 hours.(3) This form of anaesthesia is easy to be administered and is ideally suited for surgeries performed
in the lower parts of the body.
A study conducted on a healthy 39-yr-old woman who experienced neurogenic back and leg pain after
spinal anesthesia. The patient experienced discomfort during suturing of the peritoneum and surgery was
completed under general anesthesia. Recovery was uncomplicated until 13 hr after intrathecal injection, when the
patient complained of burning pain in her back extending to the front of the abdomen and similar pain in her
thighs. (6)
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A research conducted on a 72-year-old man, weighing 75 kg; who had undergone 2 surgical procedures
previously: lower limb amputation in December 1980 and radical prostatectomy for prostate cancer in January
2003, both under general anesthesia, without complication. But when spinal anesthesia was given, a minute after,
the patient reported a severe burning pain sensation in his anatomically absent left lower limb, very similar to his
previously phantom pain accompanied by spontaneous contractions of his thigh. (7)
A study conducted to assess the effectiveness of massage therapy as a component in increasing range of
motion (ROM), decreasing pain and assisting in healing of a client with low back pain (LBP) and sciatica
symptoms and this study suggested that massage therapy was effective at reducing LBP intensity and increasing
ROM. (8)
Popović DB, et al, developed the STIMBELT, an electrical stimulation system that comprises a lumbar
belt with up to eight pairs of embedded electrodes and an eight-channel electronic stimulator to relieve pain,
reduce muscle spasms, increase strength and range of motion, and educate individuals with low back pain in
reducing the chances of its reoccurrence and this was effective.(9)
As soon as nurses receive the postoperative patients it becomes their responsibility to take care of the
clients and avoid further complications. One of the main complications of the clients those who are undergoing
spinal anaesthesia is back pain. Hence the researcher is interested to take up this study to find out effective
interventions to reduce back pain.
6.2 REVIEW OF LITERATURE:
A study conducted with fifty-four patients, aged between 27–90 years, who were given spinal
anaesthesia. Thirteen of these patients experienced pain in the legs or back after recovery from anesthesia. This
study illustrated leg or back pain was associated with the intrathecal use of hyperbaric 5% lignocaine. (10)
A research described a case involving a healthy 61-year-old woman with a varicose vein that was
scheduled for phlebotomy under spinal anaesthesia. Two days after spinal anesthesia, the patient experienced
severe lower back pain that was markedly aggravated by twisting and extension of the spine, but subsided with
rest. Immediately after a lumbar medial branch block was performed at the area of tenderness the pain subsided.
These results suggested that immediate treatment of acute lower back pain is important for preventing
progression to chronic low back pain. (11)
A study conducted to assess the effects of massage therapy for nonspecific low back pain. They included
thirteen randomized trials. Massage was compared to an inert therapy (sham treatment) in 2 studies that showed
that massage was superior for pain and function on both short- and long-term follow-ups. In 8 studies, massage
was compared to other active treatments, they showed that massage was similar to exercises, and massage was
superior to joint mobilization, relaxation therapy, physical therapy, acupuncture, and self-care education. One
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study showed that reflexology on the feet had no effect on pain and functioning. The beneficial effects of
massage in patients with chronic low back pain lasted at least 1 year after the end of the treatment. Two studies
compared 2 different techniques of massage; one concluded that acupuncture massage produces better results
than classic (Swedish) massage and another concluded that, Thai massage produces similar results to classic
(Swedish) massage. So they concluded massage might be beneficial for patients with sub acute and chronic
nonspecific low back pain, especially when combined with exercises and education. (12)
A study conducted to assess the effects of lumbar supports for prevention and treatment of non-specific
low back pain. They included five randomized and two nonrandomized controlled preventive trials and six
randomized therapeutic trials. The systematic review of therapeutic trials showed that there was limited evidence
that lumbar supports were more effective than no treatment, while it was still unclear if lumbar supports were
more effective than other interventions for treatment of low back pain. They concluded that there was still a
need for high quality randomised trials on the effectiveness of lumbar supports. (13)
A research conducted to study the role of the belt used in prevention of low back fatigue of drivers during
driving. They assessed the changes in median frequency (MF), mean power frequency (MPF) of surface
electromyogram (SEMG), and flicker frequency, visuognosis persistence of drivers with and without protective
belt in simulated driving. There were significant differences in MF [(47.35 +/- 6.07), (39.26 +/- 5.79), (47.21 +/6.02), (43.44 +/- 6.26) Hz respectively], MPF [(69.86 +/- 7.08), (59.12 +/- 7.19), (69.86 +/- 7.08), (63.88 +/7.49) Hz respectively] between before and after simulated driving without or with the special belt (P < 0.01). But
no differences in MF or MPF between without and with the belt before simulated driving were found (P > 0.05).
The flicker frequency [(35.64 +/- 2.82), (42.31 +/- 4.68), (35.96 +/- 3.05), (39.79 +/- 3.36) Hz], visuognosis
persistence (65.77% +/- 3.94%, 56.83% +/- 5.68%, 65.88% +/- 3.92%, 62.27% +/- 2.91%) had some changes
too. They concluded that simulated diving could induce fatigue of back muscle in drivers. However, the
protective belt could effectively prevent low back fatigue of drivers in simulated driving (14).
A study conducted about the effectiveness of a lumbar belt in subacute low back pain. They included One
hundred ninety-seven patients and divided into two groups, one group was treated with a lumbar belt (BWG) and
a control group (CG). They came to the conclusion that lumbar belt wearing is effective in reducing the subacute
low back pain and improve significantly the functional status. (15)
A study conducted on lumbar supports to prevent recurrent low back pain among home care workers. 360
home care workers with self-reported history of low back pain had participated in this study. They divided
clients into two groups, with or without client-directed use of lumbar support. Over 12 months, participants in
the lumbar support group reported an average of fewer days with low back pain than participants who received
only the short course. The study came to the conclusion that client-directed use of lumbar supports to a short
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course on healthy working methods reduced the number of days when low back pain occurs, among home care
workers with previous low back pain. (16)
6.3 OBJECTIVES OF THE STUDY:
1. To assess the level of pain in experimental and control group.
2. To administer lumbar support to the experimental group.
3. To assess the effectiveness of lumbar support in experimental group.
4. To administer post test in control group.
5. To compare pre and post pain level among experimental and control group.
6. To find out the association between pain level and selected demographic variables.
6.4 OPERATIONAL DEFINITIONS:
a) Effectiveness: In this study effectiveness refers to usefulness of lumbar support in decreasing backache as
evidenced by reduction in pain scores.
b) Lumbar support: An instrument or device that is applied over the back of the postoperative patients, who
underwent spinal anaesthesia, to support the lumbar region
c) Backache: Pain felt by the patients in the back or lumbar region after surgery under spinal anaesthesia, as
measured by McGill pain questionnaire.
d) Post-operative patients: Patients who undergo surgery under spinal anaesthesia
e) Spinal anaesthesia: Spinal anaesthesia refers to an injection of anaesthetic agent between L4 and L5 in the
spinal cord
6.5 HYPOTHESIS OF THE STUDY:
Ho1: There is no significant difference between pre interventional and post operative pain scale reading
Ho2: There is no association between pre interventional pain scale reading and selected demographic
variables
6.6 ASSUMPTIONS:
♦ Patients will have backache after surgery under spinal anaesthesia
♦ Patients will have reduction of pain after using the lumbar support.
6.7 DELIMITATION:
The study is delimited to clients those who are undergoing surgery under spinal anaesthesia.
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6.8 PILOT STUDY:
The study will be conducted with 6 samples. The purpose to conduct the pilot study is to find out
the feasibility for conducting the study and design on plan of statistical analysis.
6.9 VARIABLES:

Dependent variables: Back pain after spinal anaesthesia.

Independent variables: Lumbar support.
7. MATERIALS AND METHODS:
7.1 SOURCES OF DATA:
Postoperative clients those who had undergone spinal anaesthesia in Gopala Gowda Shanthaveri
Memorial Hospital at Mysore.
7.1.1 RESEARCH DESIGN:
The research design adopted for the study is experimental in nature (pre-test post-test design with
untreated control group)
7.1.2 REASEARCH APPROACH:
Evaluative Research Approach.
7.1.3 SETTING OF THE STUDY:
The study will be conducted in Gopala Gowda Shanthaveri Memorial Hospital at Mysore.
7.1.4 POPULATION:
The population selected for the study will be the clients undergoing surgery under spinal anaesthesia in
Gopala Gowda Shanthaveri Memorial Hospital at Mysore.
7.2 METHOD OF DATA COLLECTION:
After obtaining the permission from concerned authorities and informed consent from the samples, the
investigator will collect the base line demographic data.
LEVEL 1: Pre-interventional pain scale will be measured for the clients both in control and experimental group.
LEVEL 2: Lumber support will be administered to the client in the experimental group.
LEVEL 3: Every day pain score will be measured for 5 days, after that post interventional pain score will be
compared with pre interventional pain score.
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7.2.1 SAMPLING TECHNIQE:
Purposive sampling technique will be used to select the sample.
7.2.2 SAMPLE SIZE:
In this study the sample size will be 60 clients those who undergo surgery under spinal anaesthesia in
Gopala Gowda Shanthaveri Memorial Hospital at Mysore.
SAMPLING CRITERIA:
7.2.3 INCLUSIVE CRITERIA:
- Clients who undergo spinal anaesthesia.
-Clients who are present in the hospital during the study period.
-Clients who are willing to participate in the study.
7.2.4 EXCLUSIVE CRITERIA:
-Client operated under any other types of anaesthesia.
-Clients who are having psychiatric disorders.
7.2.5 TOOL FOR DATA COLLECTION:
McGill pain scale will be used for data collection
7.2.6 DATA ANALYSIS METHOD:
Data would be analysed using Descriptive Statistics such as, Mean, Standard deviation and coefficient of
variation, and inferential statistics such as t-tests and chi-square tests.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO THE
PATIENTS OR OTHER HUMAN BEINGS OR ANIMALS?
Yes. Lumbar support will be applied to the client.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
Yes. Ethical clearance is obtained from concerned authorities.
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8. LIST OF REFERENCE: [VANCOUVER STYLE FOLLOWED]:
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