The Perioperative Pain Management Bundle is Feasible

Abstract

Objectives: The quality of postoperative pain management is often poor. A ‘bundle’, a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a ‘Perioperative Pain Management Bundle’ and whether this would be associated with improved multi-dimensional pain-related Patient-Reported-Outcomes (PROs). Methods: PAIN OUT, a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the ‘perioperative pain management bundle’ into the clinical routine and collected another round of data. The bundle consists of four treatment elements: (1) a full daily dose of 1-2 non-opioid analgesics (e.g. paracetamol, NSAIDs); (2) at least one type of local/regional anesthesia; (3) pain assessment by staff; (4) offering patients information about pain management. The primary endpoint was a multi-dimensional pain composite score (PCS), evaluating pain intensity, interference and side-effects: It was compared between patients who received the full bundlevs.not. Results: Implementation of the complete bundle was associated with a significant reduction in the PCS (P<0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, non-opioid analgesics were associated with a higher PCS (i.e. poorer outcome; negligible ES); the other elements were associated with a lower PCS (all negligible-small ES). Individual PROs were consistently better in patients receiving the full bundle compared to 0-3 elements. The PCS was not associated with surgical discipline. Discussion: We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect. Trial registration: ClinicalTrials.gov identified NCT02083835

Risk Factors for Severe Pain and Impairment of Daily Life Activities after Cesarean Section—A Prospective Multi-Center Study of 11,932 Patients

“…The relation to severe pain of these measures seems obvious though. Departments monitoring pain scores after surgery and providing written analgesic prescription normally have internal protocols for postoperative analgesia, so therapy is standardized, and the clinic staff have experience in managing high pain levels [57]. Also, having some kind of monitoring system for pain allows staff to identify patients in pain before their pain levels are too high.…”