Pain assessment in the recovery room

Severity of Wound-Related Pain and Associated Factors Among Patients Who Underwent Wound Management at Teaching and Referral Hospital, Northwest Ethiopia

Background

Wound management is one of the commonly performed procedures in hospitals. It can be a major source of pain and pain may be a frequently experienced but under-considered component of wound management. Therefore, we aimed to determine the severity of wound-related pain and identifying factors associated with it among patients who underwent wound management.

Patients and Methods

An institutional-based, cross-sectional study was conducted from March to May, 2020 in the University of Gondar Comprehensive Specialized Hospital. A total of 424 patients were included in this study. Data were collected by direct observation, chart review, and interview of patients by using questionnaires. Statistical analysis had performed using SPSS 25.00 version statistical software. Descriptive statistics were conducted to summarize patients’ information and to determine the prevalence of pain. Bi-variable analysis was performed to determine each of the independent variables and only variables with a P-value<0.2 were entered into the multivariable analysis. The strength of the association was present by odds ratio and 95% Confidence interval. P-value<0.05 was consider as statistically significant.

Results

The prevalence of moderate-to-severe wound-related pain during wound management was 94.1% (95% CI=91.7–96.2). Anxiety (AOR=18.16; 95% CI=4.83–68.23), acute wound (AOR=11.49; 95% CI=1.013–130.2), baseline pain (AOR=3.51; 95% CI=1.18–10.46), and analgesia intake (AOR=0.026; 95% CI=0.001–0.895) were significantly associated with the severity of wound-related pain.

Conclusion

The prevalence of moderate-to-severe wound-related pain was considerably high. Anxiety, type of wound, baseline pain, and analgesia intake were the independent risk factors. Therefore, wound care providers should assess the severity of wound-related pain and manage accordingly. Additionally, more emphasis should be given for patients who have baseline pain, anxiety, and acute wound.

Promoting the dignity of patients in perioperative practice

UK health policy has increasingly recognised that the quality of patients' experiences is important and there is a clear expectation that patients' dignity should be promoted in healthcare. Patients undergoing surgery are particularly vulnerable to their dignity being diminished. Operating department staff should ensure that dignity is promoted through attention to patients' privacy and through interactions that help patients to feel comfortable, in control and valued. They should also challenge colleagues whose practice compromises patients' dignity.

Pain management in recovery

Recovery room practitioners lay the corner stone for postoperative recuperation in patients undergoing surgical procedures. This article highlights how some aspects of the role, such as pain assessment, commencement of the prescribed analgesic regimen and pain control can be very challenging, for a variety of reasons. The aim, therefore, is to follow a typical patient journey in a structured manner, beginning with a demonstration of how provision of information empowers patients during the key phase of postoperative recovery. This is followed by a description of some assessment tools best suited to patients recovering from anaesthesia who are experiencing acute, postoperative pain. Consequences of under-treated pain are discussed and treatment modalities are described.

Pain management in the critically

The treatment of pain continues to be a major concern in the critically ill patient. Despite advances in pain management, a greater understanding of the mechanisms of pain and advanced methods of analgesic delivery, the treatment of pain is not always a priority on the intensive care unit. Difficulties with pain assessment, in the critically ill ventilated, sedated patient compound the problems of pain management. Physiological signs are difficult to interpret and psychological factors must be considered.

Thoracic paravertebral block (PVB) analgesia

Paravertebral blockade is a safe and effective technique for intraoperative and postoperative management of acute surgical pain. The block may be performed as a single injection or a catheter may be inserted to allow for the continuous or bolus administration of a long acting local anaesthetic. This mode of analgesia is not considered to be a stand alone technique (in contrast to epidural analgesia) and most patients will require additional analgesia (usually parenteral patient controlled analgesia). Compared to epidural analgesia, the paravertebral administration of analgesia is considered to be safer in anti-coagulated patients, but the risk of local anaesthetic toxicity remains. There is little published about the care of patients receiving this form of analgesia. This article provides an overview of the technique of thoracic paravertebral analgesia, the choice of analgesics and side effects together with recommendations for patient care.

Principles of acute pain management

Acute pain is a predominant feature of the perioperative experience for the majority of patients. This paper aims to describe the adverse effects of poorly controlled acute, postoperative pain and provides an overview of the organisational aspects involved in pain management in hospitals. Following this there will be an examination of the role information giving has in improving the patient's perioperative experience. Pharmacological and non-pharmacological interventions to prevent or reduce pain will also be described and because of its importance in setting the standard for logical prescribing in pain, the Analgesic Ladder, devised by the World Health Organisation (WHO 1986) will be given special consideration. Finally, the importance of pain assessment and re-assessment will be discussed.