Pain management nursing : official journal of the American Society of Pain Management Nurses
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Delirium is a reversible cognitive disorder that has a rapid onset. Delirium risk factors include older age, severity of illness, poorer baseline functional status, comorbid medical conditions, and dementia. There are adverse consequences of delirium, including increased length of stay and increased mortality. ⋯ Early detection is crucial to reduce the adverse consequences of delirium. Once a client is found to be experiencing delirium, a treatment plan can be established using both nonpharmacologic and pharmacologic interventions. In addition, the identification and the correction of etiologies of delirium can shorten the course of delirium.
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Despite many advances in the pharmacologic treatment of pain, the issue of unresolved postoperative pain continues to plague patients and health care professionals. Little seems to be known about the reasons why nonpharmacologic methods are not more widely used, particularly as they are commonly low in cost, easy to use, and largely free of adverse side effects. ⋯ Results of the teaching pilot showed significant post-teaching changes in subjects' knowledge and attitudes about nonpharmacologic methods for pain management, high satisfaction with the nonpharmacologic methods they chose, and incrementally greater use of the nonpharmacologic methods over the course of the hospital stay. A randomized controlled trial of the study is now in the early planning stages in an effort to obtain generalizable results that will help solidify evidence of the impact of music, imagery, and slow-stroke massage on pain management and confirm the value of patient teaching as an important means of offering patients more options for managing their own pain.
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Randomized Controlled Trial
Low-dose ketamine via intravenous patient-controlled analgesia device after various transthoracic procedures improves analgesia and patient and family satisfaction.
Ketamine was recently shown to attenuate postoperative pain when used in combination with morphine in patients who had undergone general and orthopedic surgery. We assessed its effects in 46 patients undergoing minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, or thoracotomy and correlated them with patient and family satisfaction. Patient-controlled analgesia (PCA) was available for 72 hours. ⋯ There was an inverted and statistically significant correlation between the patients' level of satisfaction on the second postoperative day (POD) and the satisfaction of their families on POD 2, 3, and 7 and the POD 3 patients' pain assessment in the MK group but not in the MO group. There were no differences in hemodynamic, respiratory, side effects, or complication rates between the groups. The conclusion is that the effects of adding a small ketamine dose to half of the standard morphine dose via IV-PCA after thoracotomy was superior to the standard morphine dose in terms of the patients' self-reported pain score and satisfaction, as well as the family satisfaction rate.
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Randomized Controlled Trial
The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study.
The aim of this study was to investigate the effect of cold application on pain and anxiety during chest tube removal (CTR) in patients who had undergone cardiac surgery. A single-blinded randomized design was used in this study. Ninety patients aged 18-74 years, hospitalized in the intensive care unit (ICU), who had a chest tube for a duration of at least 24 hours were used for this convenience sample. ⋯ The application of cold prolonged the length of time until analgesics were needed after CTR. Results showed that cold application reduced patients' intensity of pain due to CTR but did not affect anxiety levels or the type of pain. Cold application is recommended as a pain-relieving technique during CTR.
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Comparative Study
Pain assessment tool in the critically ill post-open heart surgery patient population.
Critical-care patients are at higher risk for untreated pain, because they are often unable to communicate owing to altered mental status, mechanical ventilation, and sedation. Pain that is persistent and untreated affects most body systems and results in development of complications chronic pain, and increased length of stay. This descriptive repeated-measures study compared three pain assessment tools in nonverbal critically ill patients in a cardiac postanesthesia care unit (n=24). ⋯ Both scales adequately capture pain in the nonverbal sedated critically ill patient based on assessment of patients' face, body movements, muscle tension, and respirations, with the NVPS also considering vital signs. Pictures depicting facial expressions for scoring purposes are helpful. Adequate education and understanding of use of the scales is critical for accurate assessment and subsequent interventions.