An Exploration of the Post-Anesthesia Care Unit (PACU) Nurses’ Knowledge Level of Sedation Scoring and Pain Management Options

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Younger patients (<40 years) (P=0.042) and those took regular benzodiazepine at bedtime (P=0.043) anticipated significantly higher pain levels. Male patients anticipated significantly lower pain intensities than females (odd ratio 1.710; 95% CI 1.254-2.331, P=0.001). Patients who scheduled for laparotomies (P=0.037), orthopedic surgeries (P=0.040) or long procedures (P<0.001) reported higher anticipated pain. Although higher anticipated pain scores were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that patients who are female, younger age (<40 years), use regular benzodiazepines at bedtime and scheduled for long procedures (>2 h), laparotomies or orthopedic surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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Pain management of patients in post anesthesia care unit

Journal of PeriAnesthesia Nursing ◽

10.1016/j.jopan.2004.06.033 ◽

2004 ◽

Vol 19 (4) ◽

pp. 267

Author(s):

Herminia Robles ◽

Pamela E Windle ◽

Rebecca Krepper ◽

Jackie Anderson

Keyword(s):

Pain Management ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

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Efficacy of methadone for the management of postoperative pain in laparoscopic cholecystectomy: A randomized clinical trial

Medwave ◽

10.5867/medwave.2021.02.8134 ◽

2021 ◽

Vol 21 (02) ◽

pp. e8134-e8134

Author(s):

Nicolás Arriaza ◽

Cristian Papuzinski ◽

Matías Kirmayr ◽

Marcelo Matta ◽

Fernando Aranda ◽

...

Keyword(s):

Clinical Trial ◽

Laparoscopic Cholecystectomy ◽

Pain Management ◽

Postoperative Pain ◽

Randomized Clinical Trial ◽

Postoperative Pain Management ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Methadone Group ◽

Eye Opening

Background Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. Methods We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). Results Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. Conclusion Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.

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Emergency nurses´ knowledge, attitude and perceived barriers regarding pain Management in Resource-Limited Settings: cross-sectional study

BMC Nursing ◽

10.1186/s12912-019-0380-9 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 5

Author(s):

Desale Tewelde Kahsay ◽

Marianne Pitkäjärvi

Keyword(s):

Pain Management ◽

Pain Assessment ◽

Emergency Departments ◽

Perceived Barriers ◽

Knowledge Level ◽

Emergency Nurses ◽

Cross Sectional ◽

Knowledge And Attitude ◽

Previous Training ◽

Nurses Knowledge

Abstract Background Pain is a common phenomenon among emergency patients which may lead to chronic pain conditions and alteration of physiological function. However, it is widely reported that proper pain assessment and management, which is often accomplished by adequately trained nurses reduce the suffering of patients. Therefore, the aim of this study was to assess the emergency nurses´ knowledge, attitude and perceived barriers regarding pain management. Methods A cross-sectional quantitative study design was applied to determine the nurses´ knowledge level, attitude and the perceived barriers related to pain management. Hundred twenty-six nurses from the emergency departments of seven referral hospitals of Eritrea participated in the study. Data were collected in August and September 2017. Both descriptive and inferential statistics were used to summarize and elaborate on the results. Result In general, the knowledge level and attitude of the emergency nurses was poor. The participants’ correct mean score was 49.5%. Nurses with Bachelor’s Degree had significantly higher knowledge and attitude level compared to the nurses at the Diploma and Certificate level of professional preparation (95% CI = 7.1–16.7 and 9.4–19.1; p < 0.001) respectively. Similarly, nurses who had previous training regarding pain scored significantly higher knowledge level compared to those without training (95% CI =1.82–8.99; p = 0.003). The highest perceived barriers to adequate pain management in emergency departments were measured to be overcrowding of the emergency department (2.57 ± 1.25), lack of protocols for pain assessment (2.45 ± 1.52), nursing workload (2.44 ± 1.29) and lack of pain assessment tools (2.43 ± 1.43). There was no significant difference in perceived barriers among nurses with different demographic characteristics. Conclusion The emergency nurses’ knowledge and attitude regarding pain management were poor. Nurses with higher educational level and nurses with previous training scored significantly higher knowledge level. This indicates the need for nursing schools and the ministry of health to work together to educate nurses to a higher level of preparation for pain assessment and management.

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Language-Related Disparities in Pain Management in the Post-Anesthesia Care Unit for Children Undergoing Laparoscopic Appendectomy

Children ◽

10.3390/children7100163 ◽

2020 ◽

Vol 7 (10) ◽

pp. 163

Author(s):

Anjali A. Dixit ◽

Holly Elser ◽

Catherine L. Chen ◽

Marla Ferschl ◽

Solmaz P. Manuel

Keyword(s):

Pain Management ◽

Pain Score ◽

Language Proficiency ◽

Laparoscopic Appendectomy ◽

English Language ◽

Recovery Period ◽

English Language Proficiency ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Opioid Medication

Race and ethnicity are associated with disparities in pain management in children. While low English language proficiency is correlated with minority race/ethnicity in the United States, it is less frequently explored in the study of health disparities. We therefore investigated whether English language proficiency influenced pain management in the post-anesthesia care unit (PACU) in a cohort of children who underwent laparoscopic appendectomy at our pediatric hospital in San Francisco. Our primary exposure was English language proficiency, and our primary outcome was administration of any opioid medication in the PACU. Secondary outcomes included the amount of opioid administered in the PACU and whether any pain score was recorded during the patient’s recovery period. Statistical analysis included adjusting for demographic covariates including race in estimating the effect of language proficiency on these outcomes. In our cohort of 257 pediatric patients, 57 (22.2%) had low English proficiency (LEP). While LEP and English proficient (EP) patients received the same amount of opioid medication intraoperatively, in multivariable analysis, LEP patients had more than double the odds of receiving any opioid in the PACU (OR 2.45, 95% CI 1.22–4.92). LEP patients received more oral morphine equivalents (OME) than EP patients (1.64 OME/kg, CI 0.67–3.84), and they also had almost double the odds of having no pain score recorded during their PACU recovery period (OR 1.93, CI 0.79–4.73), although the precision of these estimates was limited by small sample size. Subgroup analysis showed that children over the age of 5 years, who were presumably more verbal and would therefore undergo verbal pain assessments, had over triple the odds of having no recorded pain score (OR 3.23, CI 1.48–7.06). In summary, English language proficiency may affect the management of children’s pain in the perioperative setting. The etiology of this language-related disparity is likely multifactorial and should be investigated further.

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The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

10.21203/rs.3.rs-18199/v3 ◽

2020 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

Pain Intensity ◽

Prospective Observational Study ◽

Elective Surgery ◽

Perioperative Period ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Pain Scores

Abstract Background: Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain.Results: A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.532, 95% confidence interval 1.125-2.086; P=0.007). Patients who took regular benzodiazepine at bedtime (P=0.040) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P<0.001). Although higher anticipated pain scores (NRS³4) were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit.Conclusion: This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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Does promethazine shorten the length of stay in the post anesthesia care unit?

Journal of Perioperative Practice ◽

10.1177/1750458918776548 ◽

2018 ◽

Vol 28 (7-8) ◽

pp. 194-198

Author(s):

Jonathan P. Eskander ◽

Yury Rapoport ◽

Elyse Cornett ◽

Sonja Gennuso ◽

Michael Franklin ◽

...

Keyword(s):

Pain Management ◽

Acute Pain ◽

Case Series ◽

Abdominal Hysterectomy ◽

Anesthesia Care ◽

Clinical Effects ◽

Post Anesthesia Care Unit ◽

Acute Pain Management ◽

Healthcare Facilities ◽

Pacu Stay

The combination of promethazine and opioids is known to have an opioid-sparing effect, thereby facilitating a reduction in total patient opioid consumption. In recent years, this practice has fallen out of favor in many healthcare facilities, except primarily in the post anesthesia care unit (PACU). The goal of this study was to highlight the potential of promethazine as a direct or indirect adjuvant medication in acute pain management. The present investigation was undertaken with a case series of adult female patients who underwent open total abdominal hysterectomies. Data from the PACU was reviewed with patients being separated into two groups. Group 1 received only intravenous opioids for acute pain management. Group 2 received a combination of intravenous opioids for acute pain management and intravenous promethazine for nausea and/or vomiting. Patients were discharged from the PACU with a modified Aldrete score of 9 or 10. The study showed that patients who received promethazine in addition to opioids were discharged from the PACU an average of 19.2 minutes earlier than those patients who received only opioids (p=0.003). The time to achieve modified Aldrete score of 9 or higher was more quickly achieved when open abdominal hysterectomy patients received promethazine in addition to opioids in the PACU. The study concluded that promethazine, in combination with opioids, could potentially decrease PACU stay postoperatively. Based on the present investigation, the prospect of using promethazine in other facets of pain management are intriguing and warrant future studies. Specifically, it may be worth investigating whether promethazine is truly an adjunct in combination with opioids and to determine if there are any other antihistamines or neuroleptics which may have similar clinical effects to promethazine.

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Capnography Monitoring to Reduce Adverse Events in the Pediatric Post-Anesthesia Care Unit

PEDIATRICS ◽

10.1542/peds.137.supplement_3.189a ◽

2016 ◽

Vol 137 (Supplement 3) ◽

pp. 189A-189A

Author(s):

Melissa L. Langhan ◽

Fangyong Li ◽

Lance Lichtor

Keyword(s):

Adverse Events ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

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