Nursing-led stepwise pain-management protocol improves postoperative outcomes after hepatobiliary surgery

To assess the impact of a stepwise pain-management protocol on postoperative recovery, pain control, complication rate, and resource utilization in patients undergoing hepatobiliary surgery.

This retrospective cohort study included 222 patients undergoing elective hepatobiliary surgery. Patients were assigned to a control group (n = 112) and an observation group (n = 110). The control group received routine care, while the observation group received a stepwise pain-management protocol. The primary outcome was postoperative pain intensity measured at different time points using the Numerical Rating Scale (NRS). Secondary outcomes included gastrointestinal recovery, complications, medical resource utilization, and quality of recovery, assessed using the QoR-40 questionnaire.

The stepwise pain-management protocol significantly improved perioperative outcomes. Patients in the observation group had lower NRS scores (including peak pain and activity-induced pain) at all postoperative time points (all P < 0.001). Gastrointestinal recovery was faster, and nausea scores were lower (P < 0.001). Hospital stay, ICU stay, nursing workload, and number of monitoring alarms were reduced (all P ≤ 0.001). Opioid consumption and patient-controlled analgesia usage decreased, while early mobilization ability, physical function, QoR-40 score, and safety all improved (all P < 0.001). Multivariate regression analysis confirmed that this regimen was an independent predictor of pain reduction (β = -2.155, P < 0.001).

This study demonstrates that a series of pain management protocols can significantly improve postoperative outcomes in patients undergoing hepatobiliary surgery, reduce pain, shorten recovery time, and decrease complications.