Acute pain management clinical practice guideline: implications for nurse anesthetists

Millions of operative procedures are performed in the United States each year. One of the greatest concerns for the surgical patient is postoperative pain. Despite traditional efforts to alleviate this pain, clinical studies indicate that postoperative pain is not relieved in most patients. The federal Agency for Health Care Policy and Research (AHCPR) developed a clinical practice guideline, Acute Pain Management: Operative or Medical Procedures and Trauma to help clinicians, patients, and patient's families understand the assessment and treatment of postoperative acute pain in both adults and children. Certified registered nurse anesthetists (CRNAs) can use the guideline to improve acute pain management within their institutions. Effective pain management can be accomplished through a collaborative, interdisciplinary approach using an individualized proactive pain control plan. Frequent assessment and reassessment of pain, use of drug and nondrug therapies, and implementation of an institution-wide program using CQI/QA methods in necessary. Implications for CRNAs include providing patient and staff education, establishing standards of care for pain management, and adapting an aggressive "no pain, much gained" clinical practice.