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Abstract
Purpose of Review We review the relevance of quantitative sensory testing (QST) in light of acute and chronic postoperative pain and associated challenges. Recent Findings Predicting the occurrence of acute and chronic postoperative pain with QST can help identify patients at risk and allows proactive preventive management. Generally, central QST testing, such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), appear to be the most promising modalities for reliable prediction of postoperative pain by QST. Overall, QST testing has the best predictive value in patients undergoing orthopedic procedures. Summary Current evidence underlines the potential of preoperative QST to predict postoperative pain in patients undergoing elective surgery. Implementing QST in routine preoperative screening can help advancing traditional pain therapy toward personalized perioperative pain medicine.
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Ursavaş FE, Yaradılmış YU. Relationship Between Pain Beliefs and Postoperative Pain Outcomes After Total Knee and Hip Replacement Surgery. J Perianesth Nurs 2020; 36:187-193. [PMID: 33358319 DOI: 10.1016/j.jopan.2020.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to investigate the relationship between pain beliefs and postoperative pain outcomes in patients who underwent total knee replacement or total hip replacement. DESIGN This was a descriptive, prospective, and cross-sectional study. METHODS The study population included all patients who met the sampling criteria and agreed to participate in the study between April 2019 and January 2020 (N = 91). Data were collected using a sociodemographic and clinical characteristics form, the Pain Beliefs Questionnaire (PBQ), and the Turkish Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R-TR). Sociodemographic and clinical data and PBQ scores were obtained preoperatively, and the APS-POQ-R-TR was applied 24 hours after surgery. FINDINGS In the first 24 hours, the mean lowest pain level was 2.96 ± 2.29; mean highest pain level was 8.05 ± 2.66. In the evaluation of the relationships between patients' sociodemographic characteristics and mean PBQ organic and psychological beliefs scores, statistically significant differences were observed according to income and education level. Mean PBQ organic and psychological beliefs scores were not significantly associated with APS-POQ-R-TR total scores or subscale scores for pain severity, activity interference, sleep interference, and perception of care; affective effect of pain; or adverse effects of pain treatment. CONCLUSIONS The results of our study indicate that education level and socioeconomic status were associated with patients' pain beliefs, but we observed no relationship between pain beliefs and perceived pain outcomes.
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Affiliation(s)
- Figen Erol Ursavaş
- Department of Surgical Nursing, Faculty of Health Science, Çankırı Karatekin University, Çankırı, Turkey.
| | - Yüksel Uğur Yaradılmış
- Department of Orthopaedics and Traumatology, University of Health Sciences, Keçiören Health Practice and Research Center, Ankara, Turkey
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Undesirable Postoperative Anesthesia Outcomes at Two National Referral Hospitals: A Cross-Sectional Study in Eritrea. Anesthesiol Res Pract 2020; 2020:9792170. [PMID: 33014042 PMCID: PMC7512041 DOI: 10.1155/2020/9792170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/17/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
Background Postoperative undesirable anesthesia outcomes are common among patients undergoing surgery. They may affect body systems and lead into more serious postoperative problems. This research is conducted in the Eritrean National Referral Hospitals with the aim of assessing the prevalence of undesirable anesthesia outcomes during the postoperative period. Method A cross-sectional study design was applied on 470 patients who underwent different types of surgeries within a three-month period. Patients were interviewed 24 hours after operation (POD 1) using the Leiden Perioperative care Patient Satisfaction questionnaire (LPPSq). This study reports one component of a large study conducted. The dimension "Discomfort and needs" of the LPPSq was considered, and the measurements of that dimension are presented in this report. Items of the dimension were standardized and measured using a five-point Likert scale from "Not at all" to "Extremely." Multivariable logistic regression was used to look for the association of the outcomes with the types of surgery and types of anesthesia using SPSS (Version 22). Results The prevalence were computed in two manners, prevalence of those with 'at least a little bit' outcomes, which was computed to see the total occurrence of these outcomes, and prevalence of those having 'more than moderate' outcomes to see the severe experience of these outcomes. Prevalence of the predominant undesirable outcome, postoperative pain, for 'at least a little bit' and 'more than moderate' were 82.6% and 43.6%, respectively. The rest of the postoperative undesirable outcomes were less frequently reported. Conclusion Postoperative pain was found to be the most prevalent undesirable outcome. Enhancement of proper assessment and management of postoperative pain through the development and implementation of specific pain management modalities is needed.
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Younger patients and smokers report a higher level of pain after knee arthroscopy: a clinical and experimental study including synovial metabolism. Knee Surg Sports Traumatol Arthrosc 2019; 27:471-477. [PMID: 30194469 PMCID: PMC6394548 DOI: 10.1007/s00167-018-5125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 08/28/2018] [Indexed: 12/04/2022]
Abstract
PURPOSE Factors associated with post-surgical pain are not fully explored. The aim of this study was to identify determinants of postoperative pain after arthroscopic surgery of the knee. Synovial tissue metabolism was analysed by microdialysis and the association with individual and peri-surgical factors to identify determinants important for pain management and thus patient satisfaction. METHODS Cross-sectional study of 57 patients (22 women) with median age of 39 years. All patients were operated on with arthroscopic surgery of the knee and monitored postoperatively with synovial microdialysis. The cross-sectional cohort was investigated to determine local tissue levels of inflammatory and metabolic compounds along with postoperative pain experience. MEASUREMENTS pain was determined by visual analogue scale (VAS). Postoperative synovial tissue levels of prostaglandin E2 (PGE2), glucose, and glycerol were measured by microdialysis in the knee synovium. Patients reporting VAS ≥ 4 received rescue pain medication with systemic opioids. RESULTS Initial results indicated that patients with pain (interpreted as having VAS ≥ 4), i.e. those receiving rescue medication with systemic opioids, were of a younger age (p = 0.04), lower body weight (p = 0.02), had a lower BMI (p = 0.04) and/or were smokers (p = 0.02). A closer analysis using multinomial logistic regression showed a significantly higher amount of pain in smokers (p = 0.01) and patients of a younger age (p = 0.02). A significant correlation was also found between VAS and duration of surgery (p = 0.007). No significant correlation could be found between VAS and synovial levels of PGE2, glycerol and glucose, but a statistically significant decline with time of PGE2 in both groups. CONCLUSIONS The results from this study show a significantly higher frequency of pain, post-surgery among younger patients (p = 0.02) and smokers (p = 0.01), as well as an association between pain and length of surgery (p = 0.007). These findings point out individual factors useful for the prediction of postoperative pain after arthroscopic surgery and are clinically important for personalized pain management. LEVEL OF EVIDENCE II.
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Friedrichsdorf SJ, Eull D, Weidner C, Postier A. A hospital-wide initiative to eliminate or reduce needle pain in children using lean methodology. Pain Rep 2018; 3:e671. [PMID: 30324169 PMCID: PMC6172821 DOI: 10.1097/pr9.0000000000000671] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/08/2018] [Accepted: 06/13/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pain remains common, underrecognized, and undertreated in children's hospitals and pediatric clinics. Over 200,000 patients experience needle pain annually in our institution, caused by blood draws, intravenous access, vaccinations, and injections on all inpatient units, emergency departments, outpatient laboratories, and ambulatory clinics. OBJECTIVES We implemented a hospital-based, system-wide initiative called the "Children's Comfort Promise," and created a new standard of care for needle procedures that required staff to consistently offer 4 strategies: (1) topical anesthetics, (2) sucrose or breastfeeding for infants 0 to 12 months, (3) comfort positioning (including swaddling, skin-to-skin, or facilitated tucking for infants; sitting upright for children), and (4) age-appropriate distraction. METHODS The protocol was established system-wide in one of the largest children's hospitals in the United States using a staggered implementation approach over a 3-year period to allow for unit-specific customization and facilitation of knowledge transfer from one unit to another. All departments were required to offer all 4 strategies with appropriate education at least 95% of the time. RESULTS Comparison of baseline audits with continuous postimplementation audits revealed that wait times for services decreased, patient satisfaction increased, and staff concerns about implementation were allayed (eg, concerns about wait times and success rates of venipuncture after topical anesthesia). CONCLUSION This is the first report of a successful system-wide protocol implementation to reduce or eliminate needle pain, including pain from vaccinations, in a children's hospital across all inpatient units, emergency departments, outpatient laboratories, and ambulatory clinics through consistent use of topical anesthesia, sucrose/breastfeeding, positioning, and distraction.
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Affiliation(s)
- Stefan J. Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Donna Eull
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Christian Weidner
- Lean Resource Office, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Andrea Postier
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
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Mazilu DC, Zazu M, Nedelcu V, Sfetcu R. Effectiveness of pain management educational interventions on nurses' knowledge and attitudes regarding postoperative pain management: a systematic review protocol. ACTA ACUST UNITED AC 2018; 16:303-307. [PMID: 29419615 DOI: 10.11124/jbisrir-2017-003414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify the effectiveness of pain management education programs (PMEPs) in improving the level of knowledge and the attitudes of nurses working in adult surgical departments and intensive care units on postoperative pain management.
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Affiliation(s)
- Doina Carmen Mazilu
- The Romanian Centre for Evidence Based Nursing: a Joanna Briggs Centre of Excellence.,School of Nursing, Faculty of Nursing and Midwifery, Carol Davila University, Bucharest, Romania
| | - Mariana Zazu
- The Romanian Centre for Evidence Based Nursing: a Joanna Briggs Centre of Excellence.,School of Biology, Faculty of Natural and Agricultural Sciences, Ovidius University, Constanţa, Romania
| | - Viorica Nedelcu
- The Romanian Centre for Evidence Based Nursing: a Joanna Briggs Centre of Excellence
| | - Raluca Sfetcu
- The Romanian Centre for Evidence Based Nursing: a Joanna Briggs Centre of Excellence.,School of Psychology, Faculty of Psychology and Educational Sciences, Spiru Haret University, Bucharest, Romania
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Wynne R, Lui N, Tytler K, Koffsovitz C, Kirwa V, Riedel B, Ryan S. The Trajectory of Postoperative Pain Following Mastectomy with and without Paravertebral Block. Pain Manag Nurs 2017; 18:234-242. [PMID: 28601480 DOI: 10.1016/j.pmn.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 11/21/2016] [Accepted: 03/08/2017] [Indexed: 11/18/2022]
Abstract
Evidence to support the argument that general anesthesia (GA) with paravertebral block (PVB) provides better pain relief for mastectomy patients than GA alone is contradictory. The aim of this study was to explore pain and analgesia after mastectomy with or without PVB during acute inpatient recovery. A retrospective study was conducted in a single hospital providing specialist cancer services in metropolitan Melbourne, Australia. We explored pain and concomitant analgesic administration in 80 consecutive women recovering from mastectomy who underwent GA with (n = 40) or without (n = 40) PVB. A pain management index (PMI) was derived to illustrate the efficacy of management from day of surgery (DOS) to postoperative day (POD) 3. Patients who reported no pain progressively increased from DOS (n = 12, 15%) to POD 3 (n = 54, 67.5%). Most patients were administered analgesics as a combination of acetaminophen and a strong opioid on DOS (n = 53, 66.2%), POD 1 (n = 45, 56.2%), POD 2 (n = 33, 41.2%), and POD 3 (n = 21, 26.2%). Less than 6% of patients on any POD were administered multimodal anlagesics. PMI scores indicate some pain in the context of receiving weak and strong opioids for GA patients and more frequent use of nonopioid analgesics in PVB patients during recovery. These findings highlight the need for data describing patterns of analgesic administration in addition to reports of postoperative pain to determine the most effective means of avoiding postoperative pain in patients who require mastectomy.
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Affiliation(s)
- Rochelle Wynne
- School of Nursing & Midwifery, Deakin University, Geelong, Australia.
| | - Natalie Lui
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kristen Tytler
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Carol Koffsovitz
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victor Kirwa
- Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bernhard Riedel
- Department of Anaesthesia, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shane Ryan
- Department of Anaesthesia, Peter MacCallum Cancer Centre, Melbourne, Australia
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Sangesland A, Støren C, Vaegter HB. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review. Scand J Pain 2016; 15:44-52. [PMID: 28850344 DOI: 10.1016/j.sjpain.2016.12.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pain after surgery is not uncommon with 30% of patients reporting moderate to severe postoperative pain. Early identification of patients prone to postoperative pain may be a step forward towards individualized pain medicine providing a basis for improved clinical management through treatment strategies targeting relevant pain mechanisms in each patient. Assessment of pain processing by quantitative sensory testing (QST) prior to surgery has been proposed as a method to identify patients at risk for postoperative pain, although results have been conflicting. Since the last systematic review, several studies investigating the association between postoperative pain and more dynamic measures of pain processing like temporal summation of pain and conditioned pain modulation have been conducted. OBJECTIVES According to the PRISMA guidelines, the aim of this systematic review was to evaluate whether assessment of experimental pain processing including measures of central pain mechanisms prior to surgery was associated with pain intensity after surgery. METHODS Systematic database searches in PubMed and EMBASE with the following search components: QST, association, and postoperative pain, for studies that assessed the association between QST and pain after surgery were performed. Two authors independently reviewed all titles and abstracts to assess their relevance for inclusion. Studies were included if (1) QST was performed prior to surgery, (2) pain was assessed after surgery, and (3) the association between QST and pain after surgery was investigated. Forty-four unique studies were identified, with 30 studies on 2738 subjects meeting inclusion criteria. The methodological quality of the include studies was assessed and data extraction included study population, type of surgery, QST variables, clinical pain outcome measure and main result. RESULTS Most studies showed moderate to high risk of bias. Type of surgery investigated include 7 studies on total knee replacement, 5 studies on caesarean section, 4 studies on thoracic surgery, 2 studies on herniotomy, 2 studies on hysterectomy/myomectomy, 1 study on tubal ligation, 1 study on gynecologic laparoscopy, 1 study on arthroscopic knee surgery, 1 study on shoulder surgery, 1 study on disc herniation surgery, 1 study on cholecystectomy, 1 study on percutaneous nephrolithotomy, 1 study on molar surgery, 1 study on abdominal surgery, and 1 study on total knee replacement and total hip replacement. The majority of the preoperative QST variables showed no consistent association with pain intensity after surgery. Thermal heat pain above the pain threshold and temporal summation of pressure pain were the QST variables, which showed the most consistent association with acute or chronic pain after surgery. CONCLUSIONS QST before surgery does not consistently predict pain after surgery. High quality studies investigating the presence of different QST variables in combination or along with other pain-related psychosocial factors are warranted to confirm the clinical relevance of QST prior to surgery. IMPLICATIONS Although preoperative QST does not show consistent results, future studies in this area should include assessment of central pain mechanisms like temporal summation of pressure pain, conditioned pain modulation, and responses to pain above the pain threshold since these variables show promising associations to pain after surgery.
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Affiliation(s)
- Anders Sangesland
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, odense, Denmark
| | - Carl Støren
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, odense, Denmark
| | - Henrik B Vaegter
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, odense, Denmark.,Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark
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Lanitis S, Mimigianni C, Raptis D, Sourtse G, Sgourakis G, Karaliotas C. The Impact of Educational Status on the Postoperative Perception of Pain. Korean J Pain 2015; 28:265-74. [PMID: 26495081 PMCID: PMC4610940 DOI: 10.3344/kjp.2015.28.4.265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 11/05/2022] Open
Abstract
Background Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. Methods This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1st PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. Results There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2nd to the 6th). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. Conclusions The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.
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Affiliation(s)
- Sophocles Lanitis
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Christina Mimigianni
- Department of Anaesthesiology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Demetris Raptis
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Gionous Sourtse
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - George Sgourakis
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Constantine Karaliotas
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
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Ruben MA, van Osch M, Blanch-Hartigan D. Healthcare providers' accuracy in assessing patients' pain: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1197-206. [PMID: 26223850 DOI: 10.1016/j.pec.2015.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Healthcare providers satisfy an important role in providing appropriate care in the prevention and management of acute and chronic pain, highlighting the importance of providers' abilities to accurately assess patients' pain. We systematically reviewed the literature on healthcare providers' pain assessment accuracy. METHODS A systematic literature search was conducted in PubMed and PsycINFO to identify studies addressing providers' pain assessment accuracy, or studies that compared patients' self-report of pain with providers' assessment of pain. RESULTS 60 studies met the inclusion criteria. Healthcare providers had moderate to good pain assessment accuracy. Physicians and nurses showed similar pain assessment accuracy. Differences in pain assessment accuracy were found according to providers' clinical experience, the timing of the pain assessment, vulnerable patient populations and patients' pain intensity. CONCLUSION Education and training aimed at improving providers with poor pain assessment accuracy is discussed especially in relation to those with limited clinical experience (<4 years) or a great deal of clinical experience (>10 years) and those providing care for vulnerable patient populations. PRACTICE IMPLICATIONS More research on characteristics that influence providers' pain assessment accuracy and trainings to improve pain assessment accuracy in medical and continuing education may improve pain treatment for patients.
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Affiliation(s)
- Mollie A Ruben
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
| | - Mara van Osch
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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A randomized double-blind clinical trial of a continuous 96-hour levobupivacaine infiltration after open or laparoscopic colorectal surgery for postoperative pain management--including clinically important changes in protein binding. Ther Drug Monit 2015; 36:202-10. [PMID: 24089075 DOI: 10.1097/ftd.0b013e3182a3772e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Continuous local anesthetic infiltration has been used for pain management after open colorectal surgery. However, its application to patients undergoing laparoscopic colorectal surgery has not been examined. The aim of this prospective, randomized, double-blind, placebo-controlled clinical trial was to study the use of a commercial infiltration device in patients undergoing open or laparoscopic colorectal surgery, along with plasma concentrations of levobupivacaine, its acute-phase binding protein (alpha-1 acid glycoprotein, AAG), and the stress marker, cortisol. METHODS Eligible patients were randomized (2:1) to receive a continuous infiltration of either levobupivacaine or placebo using a commercial device (ON-Q PainBuster) inserted in the preperitoneal layer at the end of surgery. Blood was sampled for determination of levobupivacaine and AAG and cortisol concentrations. Other outcomes measured were pain scores, morbidity and mortality, time to bowel movement, mobilization, and length of hospitalization. RESULTS In patients having open surgery, the levobupivacaine treatment showed a trend toward reduced total opioid consumption. No patients reported adverse effects attributable to levobupivacaine, despite 11 patients having concentrations at some time(s) during the 96-hour infiltration of up to 5.5 mg/L exceeding a putative toxicity threshold of 2.7 mg/L. AAG concentrations measured postsurgery increased by a mean of 55% (P < 0.001) at 48 hours. Cortisol concentrations also increased significantly by a mean of 191% at 1 hour. CONCLUSIONS Continuous local anesthetic infiltration may be more beneficial in open surgery. The threshold for adverse effects from highly bound local anesthetic drugs established in healthy volunteers is of limited usefulness in clinical scenarios in which AAG concentration increases in response to surgical stress. Hence, there is scope to adopt higher doses to enhance therapeutic benefit.
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Bourgault P, Lavoie S, Paul-Savoie E, Grégoire M, Michaud C, Gosselin E, Johnston CC. Relationship Between Empathy and Well-Being Among Emergency Nurses. J Emerg Nurs 2015; 41:323-8. [PMID: 25583425 DOI: 10.1016/j.jen.2014.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 10/01/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION A large number of patients who are in pain upon arriving at the emergency department are still in pain when they are discharged. It is suggested that nurses' personal traits and their level of empathy can explain in part this issue in pain management. The purpose of this study was to better understand the shortfalls in pain management provided by emergency nurses by considering nurses' characteristics. METHODS A cross-sectional descriptive correlational design was used for this pilot study. French validated self-administrated questionnaires (sociodemographic characteristics, empathy, psychological distress, and well-being) were presented to 40 emergency nurses. Thirty emergency nurses completed all questionnaires during work hours. Descriptive statistics, group comparisons, and correlation analyses were used for the data analysis. RESULTS Emergency nurses appear to have low levels of empathy. High levels of psychological distress and low levels of well-being were also observed in our sample. Among these variables, only empathy and well-being appear to be related, because we found higher empathy scores in nurses with higher well-being. DISCUSSION The poor mental health we found among emergency nurses is alarming. A clear need exists for supportive interventions for nurses. Finally, well-being was the only variable related to empathy. To our knowledge, this is the first study to report this relationship in nurses.
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Subramanian P, Ramasamy S, Ng KH, Chinna K, Rosli R. Pain experience and satisfaction with postoperative pain control among surgical patients. Int J Nurs Pract 2014; 22:232-8. [PMID: 25355297 DOI: 10.1111/ijn.12363] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires (APS-POQ-R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race (P = 0.038), education level (P ≤ 0.001), previous operation status (P = 0.032) and operation status (P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery.
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Affiliation(s)
- Pathmawathi Subramanian
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Suguna Ramasamy
- Department of Nursing Science, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kwan Hoong Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Karuthan Chinna
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roshaslina Rosli
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Woldehaimanot TE, Eshetie TC, Kerie MW. Postoperative pain management among surgically treated patients in an Ethiopian hospital. PLoS One 2014; 9:e102835. [PMID: 25033399 PMCID: PMC4102595 DOI: 10.1371/journal.pone.0102835] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/24/2014] [Indexed: 11/18/2022] Open
Abstract
Background Incidence of postoperative pain has been reported to be between 47–100%. Ineffective postoperative pain management results in tangible and intangible costs. The purpose of this study was to assess the processes and outcomes of pain management in the surgical wards of Jimma University Specialized Hospital, Ethiopia. Methods and Findings A prospective cross sectional study was conducted among 252 postoperative patients during February 13 to April 30, 2012. A contextually modified and validated (Cronbach’s α coefficient of 0.78) American Pain Society Patient Outcome Questionnaire was used to assess pain experience of patients. Patients’ charts were reviewed to assess the pattern of analgesic use. Incidence of postoperative pain was 91.4%, and remained high over 3 measurements (McNemar’s; p<0.05), and 80.1% of the patients were undertreated. The mean pain intensity, and pain interference on functional status were 6.72±1.44 and 5.61±1.13 on a 10 point Numerical rating scale respectively; both being strongly correlated(r = 0.86: p<0.001). Pain intensity was varied by ethnicity, education and preoperative information (ANOVA; P<0.05). Only 50% of the patients were adequately satisfied with their pain management. As needed (prn), solo analgesic, null analgesic, and intramuscular orders were noted for 31.3%, 89.29%, 9.7% and 20.1% of the prescription orders respectively. Though under dose, diclofenac and tramadol were the top prescribed medications, and only 57% of their dose was administered. Linear regression model showed that the predictors of satisfaction were sex of an individual and pain interference with functional status. Conclusion Despite patients’ paradoxical high satisfaction with pain management, the majority of patients were inadequately and inappropriately treated. Thus, further research is needed to determine how best to break down current barriers to effective pain management.
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Vatansever NA, Akansel N. Validation study of the strategic and clinical quality indicators in postoperative pain management questionnaire in Turkish surgery patients. Pain Manag Nurs 2014; 15:871-80. [PMID: 24981119 DOI: 10.1016/j.pmn.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
Determining patient satisfaction with postoperative pain management is an important intervention to improve strategies for effective pain control. The aim of this study was to validate an English version of the 14-item Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire in Turkish language. The study included 113 patients who underwent elective surgeries at a university hospital in Bursa, Turkey. The data were collected after translation procedures and final adjustments were done on the original instrument. For the total scale, Cronbach's coefficient α was 0.81 and the main score obtained from the scale was 45.8 ± 10.8. Included were three subscales: nursing interventions, pain management, and environments. Of the patients, 40.7% reported more pain than expected in the postoperative period and their satisfaction with pain relief was 7.4 ± 2.5. This instrument is a reliable and valid instrument in Turkish language and can be used to evaluate the effectiveness of postoperative pain management.
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Affiliation(s)
| | - Neriman Akansel
- Department of Surgical Nursing, Uludag University School of Health, Bursa, Turkey.
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Gregory J, Waterman H. Observing pain management practice on a medical unit following changes arising from an action research study. J Clin Nurs 2012; 21:3523-31. [DOI: 10.1111/j.1365-2702.2012.04096.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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van Valen R, van Vuuren H, van Domburg RT, van der Woerd D, Hofland J, Bogers AJJC. Pain management after cardiac surgery: experience with a nurse-driven pain protocol. Eur J Cardiovasc Nurs 2012; 11:62-9. [DOI: 10.1177/1474515111430879] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard van Valen
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, the Netherlands
| | | | | | | | - Jan Hofland
- Department of Anesthesiology, Erasmus Medical Center, the Netherlands
| | - Ad JJC Bogers
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, the Netherlands
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19
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Lorentzen V, Hermansen I, Botti M. A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients. Eur J Pain 2012; 16:278-88. [DOI: 10.1016/j.ejpain.2011.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V. Lorentzen
- The Centre of Nursing Research - Viborg; Heibergs Alle 2; DK-8800; Viborg; Denmark
| | - I.L. Hermansen
- Department of Obstetrics and Gynaecology; Region Hospital Viborg, Skive, Kjellerup; Heibergs Alle; DK-8800; Viborg; Denmark
| | - M. Botti
- Epworth/Deakin Centre for Clinical Nursing Research; School of Nursing and Midwifery; Faculty of Health, Medicine; Nursing and Behavioural Sciences; Deakin University; 221 Burwood Highway; Burwood; Victoria; 3125; Australia
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20
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Bergeron DA, Leduc G, Marchand S, Bourgault P. [Descriptive study of the postoperative pain assessment and documentation process in a university hospital]. Pain Res Manag 2011; 16:81-6. [PMID: 21499582 PMCID: PMC3084408 DOI: 10.1155/2011/480479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Several studies have shown that patients often receive inadequate treatment of postoperative pain. The aim of the present descriptive study was to examine and analyze various data related to the postoperative pain assessment of 40 patients who underwent elective surgery. Pain journals were to be completed by patients during every waking hour for the first three postoperative days to assess both pain intensity and pain unpleasantness. A post hoc analysis of patient records permitted verification of pain assessment by nurses for each patient. The results showed that not only was postoperative pain rarely assessed using a valid scale, it was also poorly documented. In addition, when nurses assessed and documented postoperative pain using a numerical scale, their results were very different from patients' assessments. For the first postoperative day, the mean (± SD) pain intensity documented by nurses on a 0 to 10 numerical scale was 1.57±0.23, while the mean pain intensity noted by patients using the same scale was 3.82±0.41. Statistical analysis showed that there was no significant correlation between mean pain intensity documented by nurses and the mean pain intensity noted by patients.
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Affiliation(s)
- Dave A Bergeron
- École des sciences infirmières de l’Université de Sherbrooke
| | - Geneviève Leduc
- Faculté de médecine et des sciences de la santé de l’Université de Sherbrooke
| | - Serge Marchand
- Centre de recherche Étienne-Lebel du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec
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21
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Harmon JR, Higgins I, Summons P, Bellchambers H. Efficacy of the use of evidence-based algorithmic guidelines in the acute care setting for pain assessment and management in older people: a critical review of the literature. Int J Older People Nurs 2010; 7:127-40. [PMID: 21631883 DOI: 10.1111/j.1748-3743.2010.00261.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the literature review was to identify all examples of primary research using an algorithmic approach for the implementation of a clinical practice guideline relating to pain assessment and/or management within acute care, with a specific focus on older people. DESIGN Critical literature review. DATA SOURCES Inclusion criteria were; English language publications within the past 13 years; peer reviewed; research conducted within a hospital; about adult inpatients. Exclusion criteria; research located outside of a hospital context; quality improvement studies; rehabilitation studies and literature reviews. REVIEW METHODS Critical appraisal of the literature by using a qualitative interpretation of a translational approach. The literature was thematically mapped according to the criteria of credibility, transferability, plausibility and applicability. RESULTS No clinical practice guideline was found that directly related to both assessment and management of pain using an algorithm in acute care for older people. Five studies were found to have relevance and were critically evaluated. CONCLUSION A critique of the literature shows that an algorithmic approach is feasible for translation into a clinical practice guideline for assessment and management of pain in older people within the acute care setting. IMPLICATIONS FOR PRACTICE Implementation of any algorithmic approach requires consideration of the environment, culture and availability of resources.
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Affiliation(s)
- Joanne R Harmon
- Division of Surgery, School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW, Australia.
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23
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24
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Engwall M, Duppils GS. Music as a Nursing Intervention for Postoperative Pain: A Systematic Review. J Perianesth Nurs 2009; 24:370-83. [DOI: 10.1016/j.jopan.2009.10.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 06/26/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
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The influence of addiction risk on nursing students' expectations of patients' pain reports: a clinical vignette approach. Pain Res Manag 2009; 14:223-31. [PMID: 19547762 DOI: 10.1155/2009/343871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the influence of addiction risk (substance abuse history [SAH]) and pain relief (PR) on nursing and non-nursing students' perceptions of pain in a postoperative vignette patient. METHODS Using a 2 x 2 design, the independent variables SAH (present/+, absent/-) and PR (adequate, little) were varied systematically to produce four vignettes. Participants were randomly assigned to receive one of the four vignettes that described a 45-year-old man after a total hip replacement. Participants rated the vignette patient's experienced and reported pain intensity (PI) on a 0 mm to 100 mm visual analogue scale and addiction risk on a 0 mm to 100 mm visual analogue scale. A pain congruence (PC) score was calculated (PC = reported PI -- experienced PI), and was interpreted as congruent (+/-2 mm) or incongruent (+2 mm to +100 mm for expected pain over-reporting; -2 mm to -100 mm for expected pain under-reporting). RESULTS Responses from undergraduate nursing (n=89) and non-nursing (n=88) students were analyzed. The estimated addiction risk was significantly lower in nursing (14% to 45%) versus non-nursing students (50%). Nursing students' mean PC scores were not significantly altered by SAH alone. Expectations of pain over-reporting were observed under conditions of SAH+/adequate PR, but not SAH+/little PR. In non-nursing students, SAH and PR were significant and independent factors influencing mean PC scores in the direction of pain over-reporting. CONCLUSION Under most conditions, nursing students expected pain under-reporting by the postoperative vignette patient. However, nursing students did expect pain to be over-reported when addiction risk was high and PR was adequate. These data suggest that nursing students' expectations regarding pain over- and under-reporting were sensitive to perceptions of addiction risk, but involved additional factors (eg, level of PR).
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Quinlan-Colwell AD. Understanding the paradox of patient pain and patient satisfaction. J Holist Nurs 2009; 27:177-82; quiz 183-5. [PMID: 19587387 DOI: 10.1177/0898010109332758] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pain, in all probability, is the most common symptom experienced by individuals who interact with health care providers. It is understood as a complex and highly individual experience. This complexity is reflected in the paradoxical relationship between patient satisfaction and patient reported pain scores. Using a holistic, caring approach, nurses can optimize the effect of analgesia and facilitate comfort for the person living in pain. Caring for the patient in pain begins with heartfelt compassion and intention to help the person who is suffering. The author describes how the complex relationship and interchange between the patient and the holistic nurse explains the paradox.
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