A Nurse-Led Pain Service After Major Abdominal Surgery

Area of Science:

• Anesthesiology and Pain Management
• Surgical Nursing
• Quality Improvement in Healthcare

Background:

• Effective postoperative pain management is crucial for patient recovery after major abdominal surgery.
• Epidural catheters (EC) are utilized for pain control, but optimizing their use and minimizing opioid dependence presents challenges.
• Standardized emergency abdominal surgery programs require robust pain management strategies.

Purpose of the Study:

• To enhance epidural catheter (EC) utilization and optimize postoperative pain management.
• To reduce reliance on opioid analgesics in patients undergoing emergency abdominal surgery.
• To improve overall postoperative outcomes through targeted, nurse-led bedside education.

Main Methods:

• A nurse-led, single-group, post-test-only quality improvement project.
• Specialized pain nurses provided daily ward visits and education to staff caring for patients with ECs.
• Data collected from October 2019 to November 2020 on pain control (NRS ≤3), analgesic use, mobilization, side effects, and length of stay.

Main Results:

• Adequate pain control (NRS ≤3) achieved in 76%-94% of patients (rest) and 76%-82% (mobilization) on postoperative days (POD) 1-5.
• Low median opioid consumption (POD 0: 10 mg; POD 1-5: 0-6.7 mg) and declining EC use postoperatively (POD 1: 95%; POD 5: 10%).
• Increased mobilization rates (POD 1: 64%; POD 5: 91%) with minimal opioid-related side effects; median length of stay was 6 days.

Conclusions:

• Implementation of a structured, nurse-led pain service effectively managed postoperative pain in major emergency abdominal surgery.
• Descriptive insights into EC management, opioid use, and mobilization highlight variability in multimodal analgesic regimen adherence.
• Targeted education and structured support for surgical nurses are vital for consistent multimodal pain management in emergency surgical settings.