ARTICLE CRITIQUE 1

Article Review

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Article Review

Introduction

This study examined and described the attitudes and practices of Certified Registered

Nurse Anesthetists about the administration of opioids versus nonopioid or opioid-sparing

techniques to treat intraoperative pain. We used a qualitative research design and carried out

semi-structured interviews as part of our research. Participants in the study were asked to explain

their thoughts and approaches to addressing intraoperative discomfort. Barriers to intraoperative

opioid-alternative delivery and facilitators of intraoperative opioid-alternative administration

were identified as the two primary topics of this research. Superiority of opioid, the effects of

interoperative opioid alternatives which were found out to be inconsistent, limited expertise with

opioid options, limited resources that could be used to investigate on opioid alternatives,

intraoperative opioid-alternative administration experiences turned out to be negative, and

comorbidities of the patients were cited as some barriers the participants in the study identified.

Facilitators mentioned by participants in the survey included the unfavorable effects of opioids,

the policies and procedures of the institution, positive changes that were realized with delivery of

opioid-alternatives, and the superiority of regional anesthetic.

Summary of the Article

The piece of writing titled "Barriers and Facilitators to Intraoperative Alternatives to

Opioids: Examining CRNA Perspectives and Practices" examines both the pros and cons of

using opioids during surgery. This research, which was authored by Velasco et al. (2019),

investigates the opinions of certified registered nurse anesthetists (CRNAs) regarding the

utilization of intraoperative alternatives to opioids. The authors carried out a qualitative study

consisting of in-depth interviews with 15 CRNAs. The authors carried out in-depth interviews
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with 15 CRNAs using a qualitative research technique. The authors chose people willing to talk

about their experiences with alternatives to opioids through a process called purposive sampling.

The interview questions were standardized across all participants thanks to the author's use of a

comprehensive interview guide. The writers examined the data via the lens of thematic analysis.

The authors did an excellent job of providing a detailed analysis of the data and detailing the

technique employed in the study.

The authors discovered that the CRNAs were aware of the possible dangers connected

with intraoperative opioid alternatives and the risks associated with opioids. However, the

CRNAs found several obstacles preventing the intraoperative use of alternatives to opioids.

These obstacles include a lack of awareness about other options, a lack of access to resorts, and

patient education regarding other options. The authors also identified various facilitators that

could help increase the utilization of intraoperative alternatives to opioids. These facilitators

include support from colleagues and institutions and patients' demands. The authors recommend

that in the future, research should concentrate on developing educational interventions to

improve knowledge about alternatives to opioids and evaluating the effectiveness of these

programs. The findings of this study provide valuable insights into the perspectives of CRNAs

on the use of intraoperative options for opioids. Furthermore, the study highlights the need for

further research on using intraoperative alternatives to opioids to develop effective educational

interventions and increase knowledge about these alternatives.

The study's authors did not mention any particular restrictions that applied to it. On the

other hand, some potential limits should be taken into consideration. To begin with, there was a

limited number of people who took part in the sample, which may make it tedious to make the

findings become general to the other people. Second, the research was only done using certified
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registered nurse anesthetists (CRNAs) from one state, which may make it difficult to generalize

the results. Third, the study made use of self-reported data, which is likely to be prone to

memory bias due to the nature of the data. Fourth, the research didn't contain a control group, so

it's challenging to evaluate whether or not the interventions the authors advised were beneficial.

This is a significant limitation of the study.

Overall, this was a very well-executed qualitative study that yielded helpful insights into

the viewpoints of CRNAs regarding the utilization of intraoperative alternatives to opioids. This

study underscores the need for more research on the usage of alternatives to opioids to develop

effective educational interventions and to promote understanding of these alternatives.

Critique of the Article

The article "Barriers and Facilitators to Intraoperative Alternatives to Opioids:

Examining CRNA Perspectives and Practices" is a qualitative study exploring the barriers and

facilitators to using intraoperative alternatives to opioids from the perspective of certified

registered nurse anesthetists (CRNAs). The study was titled "Examining CRNA Perspectives and

Practices" (CRNAs). According to the study's findings, the most prevalent barrier to the

utilization of alternatives to opioids was a lack of awareness of these possibilities. This was

followed by a lack of access to these options and a lack of training in utilizing these alternatives.

According to the study's findings, certified registered nurse anesthetists (CRNAs) need more

training, additional research, and practical experience with opioid substitutes "to increase their

capacity to safely and effectively incorporate them into their practice."

Even though the research mainly focused on intraoperative alternatives to opioids, one of

the secondary objectives of the study was to determine whether or not CRNAs would consider

using ketamine for analgesia in a setting that was not a hospital. In their research, the authors
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discovered that "CRNAs were generally unaware of ketamine's analgesic properties, safety

profile, and adverse effect profile." As a result, they concluded that "CRNAs may not be

comfortable prescribing ketamine in non-hospitalized patients to decrease discomfort." Having a

favorable attitude toward possible alternatives to opioids was the factor that was found to be the

most influential in encouraging people to use these options, followed by having an adequate

understanding of these options and adequate access to these options.

This research aims to accomplish two different things. First, this project aims to increase

awareness about chronic pain, a primary cause of morbidity and mortality in adult humans.

Second, to emphasize that pain at any stage of life is not just a social problem but also a medical

condition that requires treatment by trained professionals to ensure that the benefits outweigh the

risks. In this sense, training nurses in critical care to manage pain can prevent chronic pain and

its interference with many aspects of life.

The study contains several important caveats. One of the caveats is that it is derived from

the opinions of CRNAs that they have reported to themselves, which may not be indicative of the

thoughts held by all nurses. In addition, the research did not consider additional challenges

associated with using alternatives to opioids, such as reimbursement or acceptance from peers. In

addition, the study did not investigate if there were any benefits to utilizing opioid replacement

therapies instead. Because access to a drug and understanding of that medication are two distinct

concerns, it is not apparent how one affects the other in terms of how a medication is used.

Several facilitators encourage Certified Registered Nurse Anesthetists and Nurse

Practitioners (CRNAs) to employ alternatives for opioids. These facilitators include their

favorable attitude toward these options, access to them, and knowledge. Second, since the

research lacked a control group, it is difficult to evaluate whether the hurdles and opportunities
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described by the CRNAs in the survey are connected with using options other than opioids. In

conclusion, the article did not consider other challenges associated with using alternative opioids,

such as reimbursement or acceptance from peers.

According to the results of this research, there is a pressing need for collecting well-

planned data that considers all available alternatives to opioids and evaluates the obstacles and

opportunities associated with their utilization. There is a need for additional research to assess

whether or not adverse outcomes occur when nurses use these medicines without proper training.

It's possible that if CRNAs received more education, study, and experience with opioid

alternatives to painkillers, they'd be better able to safely and effectively incorporate them into

their practice safely and effectively.

Conclusion

This qualitative study aimed to investigate and explain the opinions and practices of

CRNAs about the administration of opioids versus opioid-sparing techniques to treat

intraoperative pain. It found the primary hurdles and also the facilitators which affected CRNAs'

utilization of opioid-alternative techniques intraoperatively and categorized them accordingly.

This study has given additional reinforcement to enhance institutional policies, education and

training in favor of opioid-alternative drugs and tactics. The findings if this study can assist

leaders in practice and leaders of organizations in directing efforts made in the future towards

increasing the use of nonopioid drugs to treat intraoperative pain and better resist from making

the patients addicted to the drug.

The research challenges highlighted, such as the limited number of respondents who

participated in the research, limited the type of responses obtained, making the study challenging

to follow. The method of data collection that was also used in the study made it difficult for the
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researchers to predict the outcome of the research when conducted in an area with a large data

sample or with a large group of people who were used as the participants of the investigation.

With the research challenges, the data collection method and the sample size should be adjusted

to make the research reliable, primarily when used to test a hypothesis in a group of participants

sampled to represent a bigger group of people tested for the theory. With a large group of

participants used in the study, the conclusion made from the research will be reliable for use in

the other related areas because the diversity and variation of the results that are obtained from a

large group will be nearly similar to the one that will be obtained from a group of people living

in the same region; say in a population within an area. It is commendable, however, to note that

the design and the outline of the research was done to the best, and that the arrangements for the

study and the way the researchers collected data was great in relation to the way the study had

been outlined.
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Reference

Velasco, D., Simonovich, S., Krawczyk, S., & Roche, B. (2019). Barriers and Facilitators to

Intraoperative Alternatives to Opioids: Examining CRNA Perspectives and Practices. AANA

Journal December, 87(6).