Has the pendulum swung too far in postoperative pain control?

Taylor, Shiv; Voytovich, Anthony E.; Kozol, Robert A.

doi:10.1016/j.amjsurg.2003.07.021

Cited by 66 publications

(37 citation statements)

References 9 publications

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“…These studies show that in postoperative pain the upper boundary for mild pain is NRS 3 and for moderate pain NRS 5 or 6. These results are comparable to the findings of the (Apfelbaum et al, 2003;Chung and Lui, 2003;Dolin et al, 2002) and that nurses often underestimate the severity of postoperative pain of the patients in their care (Jamison et al, 1997;Taylor et al, 2003;Zelman et al, 2003). It is, however, uncertain to what extent the patients who indicate 'moderate' pain really suffer.…”

Section: Discussionsupporting

confidence: 77%

“…Unrelieved pain has adverse psychological and physiological consequences e.g., more complications and prolonged hospital stay (Watt-Watson et al, 1999). On the other hand, improved pain control should not jeopardize patient safety (Taylor et al, 2003). Unnecessary use of analgesics, especially opioids, increases the patient's discomfort because of the side effects, such as nausea, vomiting and pruritus.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: A cross-sectional study

Dijk

Wijck

Kappen

et al. 2012

International Journal of Nursing Studies

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What is already known about the topic?Pain assessment is the foundation of pain management when a patient is experiencing postoperative pain. A frequent and thorough assessment of patients' pain by registered nurses provides information to achieve optimal pain relief. Clinical guidelines are developed for postoperative pain management based on the patient's pain score. In these guidelines different cut-off points are used to treat the pain. What this paper addsPatients and professionals do interpret the numeric rating scores for postoperative pain differently.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: A cross-sectional study

Dijk

Wijck

Kappen

et al. 2012

International Journal of Nursing Studies

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“…6 Some practitioners maintain that efforts to provide more aggressive pain management should be exercised with caution, as increased dosing may lead to dangerous levels of sedation if the patient is not closely monitored. 7 Additional factors that may hinder adequate pain management include discrepancies between patients' and physicians' perceptions of patient pain 8 and limitations on staff time. 9 Patient-controlled analgesia (PCA) modalities, most commonly intravenous (IV) PCA, address many of the safety and efficacy issues associated with opioid use in the postoperative period.…”

mentioning

confidence: 99%

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Viscusi¹

2008

Regional Anesthesia and Pain Medicine

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Postoperative pain management has dramatically improved with the advent of patient-controlled analgesia (PCA) delivery. The optimal PCA system would encompass several key characteristics, including consistent efficacy across a number of surgeries; safety of both the analgesic drug delivered and the delivery system; ease of setup, maintenance, and administration; patient comfort during analgesic delivery; avoidance of analgesic gaps; minimal invasiveness; and it would be associated with high patient satisfaction. Existing PCA modalities (using intravenous or epidural routes) encompass some of these characteristics (e.g., they have demonstrated efficacy across a number of surgeries); however, they are limited by the need for an indwelling catheter and the time and resources required for system setup and use. Device programming-related medication errors by hospital staff are an unfortunate risk, and could lead to significant harm. New PCA technologies are on the horizon that address some of the limitations to existing modalities; however, the added complexity of these newer systems are a concern, and their benefits and drawbacks remain to be assessed. These technologies include "smart" intravenous PCA infusion pumps to improve the safety of analgesic administration; needle-free options, such as the fentanyl HCl iontophoretic transdermal system for transdermal delivery; and a number of PCA devices for intranasal delivery, as well as several new options for patient-controlled regional analgesia. This review will discuss the benefits and drawbacks of both existing and emerging PCA modalities in the context of the ideal PCA system, and provide a critical evaluation of their use in postoperative settings.

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“…Pain management based on an opioid-based protocol runs the risk of adverse drug events related to narcotics. Several recent reports have demonstrated that respiratory depression and deep levels of sedation can occur when morphine patientcontrolled analgesia (PCA) is prescribed (1)(2)(3)(4)(5)(6)(7). Th e patient with compromised pulmonary function may be at an increased risk for an adverse event.…”

mentioning

confidence: 99%

Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

Ramsay

Newman

Leeper

et al. 2014

Baylor University Medical Center Proceedings

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Has the pendulum swung too far in postoperative pain control?

Cited by 66 publications

References 9 publications

Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: A cross-sectional study

Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: A cross-sectional study

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Dexmedetomidine Infusion for Analgesia Up to 48 Hours After Lung Surgery Performed by Lateral Thoracotomy

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