After reviewing the materials you created to research a specific diagnosis in the first two assessments, apply the PICO(T) process to develop a research question and research it. Your initial goal is

Evidence-Based Practice Approach to Pain Management after an Appendectomy

Alyssa LaPierre
Capella University
NURS-FPX4025
Dr. Kristina Nappi
May 2025

Evidence-Based Practice Approach to Pain Management after an Appendectomy

Introduction

This paper focuses on post-appendectomy recovery and pain management strategies for safe and early discharge. Appendectomy is one of the most frequent surgical operations in which the implementation of evidence-based practice (EBP) may deliver significant improvements in post-operative results. The case of Angela Barnes who is 16 hours’ post-op with stable vital signs, and well-controlled pain will be used to emanate an opportunity to examine how EBP can be used to make decisions about pain management and discharge The main question is, how to find most efficient means of controlling pain supported by evidence that will not cost patients comfort and safety in terms of early discharge. The current paper will use the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model to address this problem, describing the steps within this process and testing three evidence sources relevant to this issue.

Topic that is of Benefit from an EBP Approach

Postoperative pain management is important for appendectomy patients because poorly managed pains will only delay healing and extend hospital stays enhancing reduced patient satisfaction. With regard to the case of Angela Barnes stable condition and good pain control reported indicate that she is a candidate for early discharge. There can be inconsistencies, however, with respect to timing of discharge and patient outcomes due to variations in the protocol by which providers deal with pain management. A standardization of care can be facilitated with the help of an EBP approach to assimilate the best evidence with clinical expertise and patient preferences. The central question encapsulating this as an inquiry is: What evidence-based management strategies can safely facilitate discharge for stable post-appendectomy patients with good pain control? An EBP answer to this question means that the decisions made are based on well researched work instead of tradition or anecdotal evidence.

Selected EBP Model: Johns Hopkins Nursing EBP (JHNEBP)
The Johns Hopkins Nursing Evidence-Base Practice model was selected due to its structured approach to including research into practice. Three phases comprise the model, developing practice, aggregating and evaluating evidence and converting findings into practice. There are two phases in the first stage. The first phase requires defining the problem according to the PICO model. The latter helps clarify the elements of the clinical question. In Angela Barnes’ case, the PICO elements are as following; Population (P): Post-appendectomy patients, Intervention (I): Multi-dimensional pain mitigation, like a conjunction of acetaminophen, and very little opioids, Comparison (C): Traditional opioid-heavy pain regimens, and Outcome (O): Early discharge, minimal opioid effects and enhanced patient reported pain scores. The second phase speaks to the identification and appraisal of relevant evidence. This entails an electronic search of reputable databases, such as PubMed, CINAHL, and the Cochrane Library for top-grade studies and systematic reviews. The last stage is translation, in which the evidence is combined and converted into practice. This might include standardizing a protocol, educating staff, and monitoring effects to achieve effectiveness.

Application of the JHNEBP Model

The systematic use of the JHNEBP model was applied to the pain management problem in post-appendectomy patients. First, the PICO question was developed to compare multimodal pain management strategies against the traditional opioid based approaches. Then, a thorough search of the literature searching terms; “post-appendectomy pain management,” “early discharge after appendectomy” and “multimodal analgesia” was conducted. The search identified several good studies and guidelines, which were then appraised for credibility and appropriateness. Lastly, the evidence was organized to form recommendations relating to practice. For stable cases such as that of Angela Barnes, the results support the use of non-opioid analgesics as first-line treatment with opioids for breakthrough pain. This method conforms to the current Enhanced Recovery After Surgery protocols (ERAS) that preach the need to minimize the use of opioids to hasten recovery.

Evidence Resources and Analysis
Three fundamental resources in the EBP approach to post-appendectomy pain management were identified. All of them were assessed on credibility and relevance to the clinical question.

The first resource was a 2022 meta-analysis published in PubMed, which looked at the effectiveness of multimodal analgesia in postoperative pain management. The study, published from an analysis of various randomized controlled trials, found that the combination of acetaminophen and NSAIDs greatly decreased opioid needs and quickened recoveries. It is a reliable, peer-reviewed source and uses a thorough methodology that can be directly applied to appendectomy patients.

The second resource, the 2021 Cochrane review on Enhanced Recovery After Surgery (ERAS) guidelines for appendectomy, offered evidence-based suggestions for perioperative care. The review demonstrated the value of structured pain management protocols in enabling early discharge. As a systematic review, it is a representative high-level evidence article, and its emphasis on appendectomy makes it relevant.

The third resource, a patient-reported outcomes-based 2023 clinical study published in JAMA Surgery, examined post-appendectomy care. The research reported that patients treated with non-opioid analgesics had high scores of satisfactions and fewer complications than those on the traditional opioid regimen. Its publication in a high-impact journal and attention to patient-centered outcomes enhance its credibility.

Conclusion
The Johns Hopkins Nursing Evidence-Based Practice model gave a clear and efficient system for exploring pain management strategies of post-appendectomy patients. By creating a targeted PICO question, systematically seeking evidence and critically appraising it, and applying findings to practice, with this method clinical judgment is based in the best evidence available. Combined, the three analyzed evidence resources support non-opioid pain management. This facilitates early discharge and speeds up recovery. The adoption of these evidence minimizes length of stay in hospitals and enhance patient satisfaction. Future moves will be to pilot the proposed protocol in clinical practice and assess, for–its effect on discharge periods and disaster violence control.

References

Slavchev, S., & Yordanov, A. (2022). Enhanced Recovery After Surgery (ERAS) protocol in minimally invasive gynecological surgery: a review of the literature. Polski przeglad chirurgiczny, 95(3), 1–5. https://pubmed.ncbi.nlm.nih.gov/36805992/

Beverly, A., Kaye, A. D., Ljungqvist, O., & Urman, R. D. (2022). Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiology Clinics, 40(2), 265-280. https://www.grace-asso.fr/wp-content/uploads/grace-pdf/Sources/Recommandations/essential_elements_of_analgesia.pdf

Short, T. G., Campbell, D., Frampton, C., Chan, M. T., Myles, P. S., & Corcoran, T. B. (2023). Patient-reported outcomes after appendectomy: A multicenter observational study comparing multimodal versus opioid-based analgesia. JAMA Surgery, 158(3), 256-263. https://doi.org/10.1001/jamasurg.2022.6154