• Kathleen A Puntillo, Lorie Rietman Wild, Ann Bonham Morris, Julie Stanik-Hutt, Carol Lynn Thompson, and Cheri White.
• Department of Physiological Nursing, University of California, San Francisco, USA.
• Am. J. Crit. Care. 2002 Sep 1;11(5):415-29; quiz 430-1.

BackgroundResearch is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths.ObjectivesTo determine types of analgesics administered for procedures, the prevalence and amounts of drugs given, and factors predictive of analgesic administration.MethodsPain was assessed before and immediately after procedures. Analgesic, sedative, and anesthetic agents administered within 1 hour before and/or during each procedure were notedResultsA total of 5957 adult patients at 164 national and 5 international sites participated. Pain intensity increased at the time of procedure for all procedures. More than 63% of patients received no analgesics. Less than 20% received opiates; mean total dose of opiate was 6.44 mg (SD, 8.96 mg). Only 10% of patients received combination therapy. Factors associated with the likelihood of receiving opiates were pain intensity before a procedure, femoral sheath removal, being white, and the duration of a procedure. Patients less likely to receive opiates had a medical diagnosis or were having tracheal suctioning. Only 14.5% of the variance in the amount of opiate administered was explained by factors entered into multiple regression models. Type of procedure was the only significant predictor of amount of opiate administered.ConclusionsMost patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.

33 keywords...

hide…