A Global Evaluation of Multimodal Nursing Led Pain Management Programs in the Peri-Operative Period

To identify, evaluate, and synthesize the effects of non-pharmacological nursing interventions on postoperative pain relief in patients undergoing abdominal surgery, and to examine whether intervention timing and physiological and psychosocial components are associated with differences in pain outcomes.

Systematic review and meta-analysis of experimental and quasi-experimental studies conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

A comprehensive search was conducted in five electronic databases (Scopus, PubMed, MEDLINE, Embase, and Web of Science) from database inception to October 2025. The search strategy combined controlled vocabulary and free-text terms related to nursing interventions, postoperative pain, and abdominal surgery.

Eligible studies included randomized controlled trials, controlled clinical trials, non-randomized controlled trials, and controlled before-and-after studies evaluating non-pharmacological nursing interventions for postoperative pain management in patients undergoing abdominal surgery. Study selection and data extraction were performed according to predefined eligibility criteria. Meta-analyses were conducted using pooled mean differences (MDs) with 95% confidence intervals (CIs). Subgroup analyses were performed according to the timing of intervention delivery and the physiological and psychosocial dimensions targeted by the interventions.

A total of 118 studies involving 14,570 patients were included. The studies evaluated 31 categories of nursing and non-pharmacological interventions. Overall, these interventions were associated with a significant reduction in postoperative pain intensity, with a pooled MD in visual analog scale (VAS) pain scores of -4.55 (95% CI: -5.20 to -3.89). Subgroup analysis indicated that interventions delivered across multiple perioperative phases (preoperative, intraoperative, and postoperative) were associated with a greater reduction in pain scores (MD: -5.45; 95% CI: -6.83 to -4.08) than interventions delivered during a single perioperative phase. Interventions addressing both physiological and psychosocial dimensions were also associated with a greater reduction in pain scores (MD: -5.00; 95% CI: -5.32 to -4.68) than interventions targeting physiological or psychosocial factors alone.

Non-pharmacological nursing interventions were associated with reduced postoperative pain among patients undergoing abdominal surgery. Interventions incorporating multiple perioperative phases and addressing both physiological and psychosocial dimensions were associated with larger reductions in pain scores. However, substantial heterogeneity across patient populations, surgical procedures, intervention characteristics, outcome assessment, and study methodologies warrants cautious interpretation of subgroup findings. These findings should not be interpreted as definitive evidence of superiority of any specific intervention strategy.

Non-pharmacological nursing interventions may provide an important component of multimodal postoperative pain management following abdominal surgery. Nurses may consider integrating interventions that address both physiological and psychosocial needs and, where clinically feasible, implementing supportive strategies across multiple perioperative phases. Standardized protocols should be developed cautiously and adapted to patient characteristics, surgical context, and available resources. Further high-quality comparative research is needed to determine the optimal combination, timing, and delivery of nursing interventions and to support evidence-based perioperative nursing care pathways.