A Nurse-Led Pain Service After Major Abdominal Surgery

This project aimed to improve epidural catheter (EC) utilization, reduce opioids, and enhance postoperative outcomes through bedside education facilitated by a nurse-led pain service within the standardized emergency abdominal surgery program.

This is a nurse-led, single-group, post-test-only quality-improvement project. A specialized pain nurse provided daily ward visits, including targeted education for staff caring for OMEGA patients with an EC. Data was collected from October 2019 to November 2020. Outcomes included: the proportion of patients achieving adequate pain control Numeric Rating Scale (NRS ≤3) on postoperative days (POD) 1-5, daily use of analgesics, mobilization, side effects, and length of stay.

A total of 110 patients were included. Adequate pain control was achieved in 76%-94% of patients at rest and 76%-82% during mobilization (POD 1-5). Median opioid consumption remained low (POD 0: 10 mg IV morphine equivalents; POD 1-5: 0-6.7 mg). EC use declined postoperatively (POD 1: 95%; POD 5: 10%). Mobilization rates increased progressively (POD 1: 64%; POD 5: 91%). A few opioid-related side effects were detected. The median length of stay was 6 days.

This nurse-led quality improvement project describes the implementation of a structured, nurse-led pain service for patients undergoing major emergency abdominal surgery. The project provides descriptive insight into postoperative pain management practices, including epidural catheter management, opioid use, and mobilization, and highlights variability in adherence to the multimodal analgesic regimen.

The findings underscore the importance of structured support and targeted education for surgical ward nurses involved in epidural catheter management and postoperative pain care. Strengthening nursing competencies and implementation support may contribute to more consistent application of multimodal pain management practices in emergency surgical settings.