Pain Characteristics and Pain Interference Among Patients Undergoing Open Cardiac Surgery

Surgical Patients' Evaluation of Pain Management Quality and Surgical Nurses' Pain-Related Knowledge and Attitudes

PURPOSE

The present study was aimed at investigating the quality of pain management evaluated by inpatients in surgical clinics, and pain-related knowledge and attitudes of nurses working in surgical clinics, surgical units, or emergency services.

METHODS

The study was conducted as a descriptive and cross-sectional study. The study data were collected from inpatients in surgical clinics (N = 306), and from nurses working in surgical clinics, surgical units, or emergency services (N = 57) between January 2020 and September 2020. The Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) and Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP) were the tools used for data collection.

RESULTS

The mean scores the participants obtained from the severity of worst pain, pain relief, and satisfaction with pain treatment components of the APS-POQ-R were 6.14 ± 2.59, 59.28 ± 22.26, and 8.99 ± 1.62, respectively. There were significant differences between many components of the APS-POQ-R in terms of such variables as age, sex, undergoing previous surgery, presence of pain before surgery, surgery performed, and type of anesthesia (p < .05). The mean score the participants obtained from the NKASRP was 15.35 ± 3.87.

CONCLUSIONS

It was concluded that the patients' pain was relieved moderately, that they were very highly satisfied with pain treatment, and that the nurses' pain-related knowledge and attitude levels were below the moderate level.

CLINICAL IMPLICATIONS

Nurses should support patients whose in-bed activities were prevented due to pain, involve them in pain treatment decisions, advise them about pain treatment options, and encourage them to use nonpharmacological methods.

Pain Intensity After Cardiac Surgery and its Association With Kinesiophobia: A Descriptive Study

PURPOSE

Severe pain and fear of pain may decrease physical activity and restrict movements after cardiac surgery. This study aimed to determine pain intensity after cardiac surgery and its association with kinesiophobia.

DESIGN

This was a descriptive and correlational study.

METHODS

The study was conducted with cardiac surgery patients (n = 170). The sample size was calculated by using the G*POWER 3.1 program. According to the power analysis, the sample size was calculated as 170, taking into account the dependent variable with the largest sample size (kinesiophobia) and 20% loss. The outcome measures were pain and kinesiophobia collected using the Visual Analog Scale and Tampa Kinesiophobia Scale.

FINDINGS

Married patients were at the greatest risk for kinesiophobia, higher than that for single patients (β = -3.765, β = -3.609; P < .05). Obese patients were at the greatest risk for kinesiophobia higher when compared to patients of normal weight (β = -2.907, P < .05). No statistically significant correlation was found between the pain intensity and kinesiophobia scores (P > 0.05).

CONCLUSIONS

Kinesiophobia was higher in patients after cardiac surgery. Married and obese patients were predictors of kinesiophobia; however, pain was not associated with kinesiophobia.

Pain perception of patients in intensive care unit after cardiac surgery: A qualitative study using Roy's Adaptation Model

BACKGROUND

Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes.

AIM

This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM).

STUDY DESIGN

A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM.

RESULTS

The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain).

CONCLUSIONS

The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated.

RELEVANCE TO CLINICAL PRACTICE

Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically.

Perspectives of patients, families and nurses on pain after cardiac surgery: A qualitative study

BACKGROUND

Post-cardiac surgery pain affects patients, family caregivers and nurses. The pain experiences of patients, caregivers and nurses remain largely unknown. Therefore, it is important to examine the experiences of patients, caregivers and nurses in depth to ensure effective pain management.

AIM

The aim of this study is to examine post-cardiac surgery pain from the perspectives of patients, caregivers and nurses.

STUDY DESIGN

A descriptive qualitative research design was used. The study was carried out in the cardiovascular surgery ward of a tertiary hospital in Türkiye between June and December 2022. The data-driven triangulation method was used in the research. The study sample consisted of eight patients who had undergone cardiac surgery in the tertiary hospital, eight family caregivers and nine nurses who provided care for these individuals. A 'semi-structured interview form' was used to collect data through face-to-face and in-depth interviews. The data were analysed using the thematic analysis method. The COREQ checklist was used for reporting the study.

RESULTS

As a result of the interviews, six themes were elicited from the data. These themes were 'explaining pain', 'assessment of pain', 'responses to pain', 'effect of pain on activities of daily living', 'expectations in painful situations' and 'pain management'.

CONCLUSIONS

This study revealed the differences between pain perceptions and coping processes of patients who experienced pain after cardiac surgery, their caregivers and nurses.

RELEVANCE TO CLINICAL PRACTICE

Considering the experiences of patients, caregivers and nurses in pain management after cardiac surgery, applications that will ensure joint participation in care practices should be planned.

Higher Cardiovagal Baroreflex Sensitivity Predicts Increased Pain Outcomes After Cardiothoracic Surgery

Excessive postoperative pain can lead to extended hospitalization and increased expenses, but factors that predict its severity are still unclear. Baroreceptor function could influence postoperative pain by modulating nociceptive processing and vagal-mediated anti-inflammatory reflexes. To investigate this relationship, we conducted a study with 55 patients undergoing minimally invasive cardiothoracic surgery to evaluate whether cardiovagal baroreflex sensitivity (BRS) can predict postoperative pain. We assessed the spontaneous cardiovagal BRS under resting pain-free conditions before surgery. We estimated postoperative pain outcomes with the Pain, Enjoyment, and General Activity scale and pressure pain thresholds on the first (POD1) and second (POD2) postoperative days and persistent pain 3 and 6 months after hospital discharge. We also measured circulating levels of relevant inflammatory biomarkers (C-reactive protein, albumin, cytokines) at baseline, POD1, and POD2 to assess the contribution of inflammation to the relationship between BRS and postoperative pain. Our mixed-effects model analysis showed a significant main effect of preoperative BRS on postoperative pain (P = .013). Linear regression analysis revealed a significant positive association between preoperative BRS and postoperative pain on POD2, even after adjusting for demographic, surgical, analgesic treatment, and psychological factors. Moreover, preoperative BRS was linked to pain interfering with general activity and enjoyment but not with other pain parameters (pain intensity and pressure pain thresholds). Preoperative BRS had modest associations with postoperative C-reactive protein and IL-10 levels, but they did not mediate its relationship with postoperative pain. These findings indicate that preoperative BRS can independently predict postoperative pain, which could serve as a modifiable criterion for optimizing postoperative pain management. PERSPECTIVE: This article shows that preoperative BRS predicts postoperative pain outcomes independently of the inflammatory response and pain sensitivity to noxious pressure stimulation. These results provide valuable insights into the role of baroreceptors in pain and suggest a helpful tool for improving postoperative pain management.

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study

OBJECTIVE

This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy.

METHODS

A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05.

RESULTS

Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up.

CONCLUSION

Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up.

Effect of listening to music on anxiety, pain, and cardiorespiratory parameters in cardiac surgery: study protocol for a randomized clinical trial

BACKGROUND

Preoperative anxiety and postoperative pain are frequent in cardiac surgeries and constitute important stressors for patients, which can cause several complications. One strategy that aims to alleviate these phenomena is listening to music as a non-pharmacological intervention. The aim of this study is to evaluate the effect of listening to music on preoperative state-anxiety, postoperative pain, at rest and when instructed to cough, and cardiorespiratory parameters in patients undergoing cardiac surgery.

METHODS

A randomized, parallel, simple masking clinical trial will be conducted with patients 18 years of age or older who have undergone elective cardiac surgery by sternotomy, who agree to participate in the research and sign a free and informed consent form. Study participants will be randomly divided, in a 1:1 ratio, to one of the two groups: experimental (subjected to listening to music for 20 min in the pre- and postoperative period) or control (standard care in the pre- and postoperative period), using a randomization scheme generated by the Randomization.com website. The sample size calculation was obtained after conducting a pilot study.

DISCUSSION

The results of the study may contribute to the implementation of non-pharmacological interventions in health services, highlighting the protocols for listening to music, to minimize anxiety and pain in cardiac surgery.

TRIAL REGISTRATION

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Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

BACKGROUND

Sedation with propofol injections is associated with a risk of addiction, but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism. Compared to remimazolam, remimazolam benzenesulfonate has a faster effect, is more quickly metabolized, produces inactive metabolites and has weak drug interactions. Thus, remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.

AIM

To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.

METHODS

A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study. Using a random number table, patients were divided into two anesthesia induction groups of 40 patients each: remimazolam (0.3 mg/kg remimazolam benzenesulfonate) and propofol (1.5 mg/kg propofol). Hemodynamic parameters, inflammatory stress response indices, respiratory function indices, perioperative indices and adverse reactions in the two groups were monitored over time for comparison.

RESULTS

At pre-anesthesia induction, the remimazolam and propofol groups did not differ regarding heart rate, mean arterial pressure, cardiac index or volume per wave index. After endotracheal intubation and when the sternum was cut off, mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group (P < 0.05). After endotracheal intubation, the oxygenation index and the respiratory index did not differ between the groups. After endotracheal intubation and when the sternum was cut off, the oxygenation index values were significantly higher in the remimazolam group than in the propofol group (P < 0.05). Serum interleukin-6 and tumor necrosis factor-α levels 12 h after surgery were significantly higher than before surgery in both groups (P < 0.05). The observation indices were re-examined 2 h after surgery, and the epinephrine, cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group (P < 0.05). The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group (P < 0.05); there were significantly fewer adverse reactions in the remimazolam group (10.00%) than in the propofol group (30.00%; P < 0.05).

CONCLUSION

Compared with propofol, remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations. Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions.

Relationship Between Quality of Care and Patient Care Outcomes for Postoperative Pain in Major Orthopedic Surgery: Analytical and Cross-Sectional Study

The quality of care provided for the management of postoperative pain and patient outcomes are key criteria for healthcare institutions. This study aimed to determine the relationship between the quality of care provided for the alleviation of postoperative pain experienced among patients undergoing major orthopedic surgery and the patient care outcomes. The study was designed as an analytical and cross-sectional study. The rates of pain severity and sleep interference, activity interference, affective experiences, and adverse effects due to postoperative pain were higher in female patients than in male patients. A significant positive correlation was identified between the quality of postoperative pain care and the perception of care (p < .05). Implementing nursing interventions to improve pain management and increase the quality of care appears to be vital elements for reducing adverse effects caused by pain and increasing the satisfaction with postoperative pain care.

Ultrasound-Guided Continuous Parasternal Intercostal Block Relieves Postoperative Pain After Open Cardiac Surgery: A Case Series

Pain after open cardiac surgery can be severe and may persist for several days, potentially developing into chronic postsurgical pain. Herein the authors describe three patients who underwent open cardiac surgery via traditional median sternotomy approach. Postoperative pain was relieved in these patients via a novel, straightforward, ultrasound-guided parasternal intercostal block, peripheral regional anesthetic technique. This plane block, thus, may represent an effective regional anesthetic strategy and a valuable component of a multimodal analgesic approach for patients who have undergone open cardiac surgery with median sternotomy.

Pain Interference with Daily Living Activities and Dependency Level of Patients Undergoing CABG Surgery

BACKGROUND

Postoperative pain is one of the most intensive problems experienced by patients undergoing coronary artery bypass graft surgery. The severity of pain after surgery hinders general activity, sleep, deep breathing, and sleep quality.

AIMS

This descriptive study was done to determine the interference of postoperative pain with daily activities and dependency levels on coronary artery bypass graft surgery patients.

DESIGN

Descriptive study.

SETTINGS

Cardiovascular Surgery Ward of a university hospital.

PARTICIPANTS

Sixty five patients who undergone CABG surgery.

METHODS

The sample of the study was composed of 65 patients in the Cardiovascular Surgery Ward of a university hospital between April 15, 2016-April 15, 2017, who had undergone coronary artery bypass graft surgery and agreed to participate in the study. A Data Collection Form, the short form of Brief Pain Inventory (PI-SF), and the Katz Activities of Daily Living Index (ADL) were used to collect data. Data were collected through face-to-face interviews on postoperative day 1, and through phone interviews on postoperative days 7 and 15.

RESULTS

Patients' satisfaction with pain management was high during the postoperative period. However, most of the patients were found to have postoperative stinging pain in the sternum. The worst, least, and average pain in the last 24 hours current pain was significant in all postoperative days (p = .000). Paired comparisons of 1st-7th days were significant for the worst pain in the last 24 hours (p = .000). Average and current pain was significant in paired comparisons of all postoperative days (p = .000). Postoperative pain interfered with ADL and patients were semi-dependent on the 1st postoperative day and their independence level increased after discharge.

CONCLUSIONS

Although patients are satisfied with pain management after surgery, they continue to experience post-operative pain which interferes with activities of daily living.