Post‐operative pain management: a literature review

Abstract

The appropriateness of any set of criteria generated to measure the quality of a particular intervention is dependent upon a thorough, up-to-date assessment of the current state-of-the-art. Few areas in nursing have received as much research attention as that of pain control, particularly post-operative pain control. The following review of the literature* on this subject complements earlier reviews undertaken by Seers (1988) by organizing the information according to four distinct categories, namely environmental issues, nursing actions, patient outcomes and a review of a number of pain measures. This particular format was selected in order to help in the development of structure, process and outcome criteria on the topic of post-operative pain management. The section on measurement is to inform practitioners about pain-assessment charts and provide ideas about auditing this area.

Thinking of the future and walking back to normal: an exploratory study of patients’ experiences during recovery from lower limb fracture

“…Lower limb fracture nolol medication. Propranolol is known to induce fatigue, insomnia, depression and hypotension as a direct consequence of beta-adrenergic receptor blockade (Govoni & Hayes 1990, Jordan & Torrance 1995, Hoffman & Lefkowitz 1996, British National Formulary 1997 While our respondents felt that the personal attributes of their nurses strengthened their psychological coping mechanisms, closer observation of symptoms and side effects would have pre-empted much of the pain, nausea and fatigue described here (Holmes & Eburn 1989, Kitson 1994. Patients most appreciate practical help in minimizing stress and strengthening coping mechanisms (Larson 1984, Mayer 1987, Cochran & Ganong 1989, Von Essen & Sjoden 1991a, 1991b.…”

Why is pain management suboptimal on surgical wards?

“…Many even recommend that this process be formalized through the use of assessment tools. However, and despite an abundance of studies that have explored factors affecting nurses’ pain assessment and analgesic decisions (Harrison 1991, Kitson 1994, Allcock 1996), no study has explored directly why nurses decide not to ask patients about their pain. Furthermore, published studies have not explored the interplay between barriers posed by nurses themselves (ones they may not be aware of), and those added by the ward setting and policies, within which they practise (barriers nurses are likely to recognize).…”

AHCPR clinical practice guideline on surgical pain management: Adoption and outcomes

“…In surveys of surgical patients, it has been found that approximately half of all hospitalized postoperative patients failed to receive adequate pain relief ( Jacox, Ferrell, Heidrich, Hester, & Miaskowski, 1992;Jurf & Nirschl, 1993). Patients reporting moderate to high levels of pain received less than half of the pain medication that was ordered (Kitson, 1994;Tittle & McMillan, 1994). This underutilization of prescribed medications may be related to the fact that health care professionals often evaluated pain at lower levels than patients re-ported and used objective symptoms rather than the patient's self-report to assess the patient's pain (Bowman, 1994;Mateo & Krenzischek, 1992;Olden, Jordan, Sakima, & Grass, 1995;Paice, Mahon, & Faut-Callahan, 1995;Stephenson, 1994;Webb & Kennedy, 1994;Zalon, 1993).…”