Pain Management of Post-operative Open Heart Surgery Patients Utilizing Preemptive and Multimodal Analgesia

2.50
Hdl Handle:
http://hdl.handle.net/10755/156980
Category:
Abstract
Type:
Presentation
Title:
Pain Management of Post-operative Open Heart Surgery Patients Utilizing Preemptive and Multimodal Analgesia
Author(s):
Fuller, Melinda S.; Audette, Deborah
Author Details:
Melinda S. Fuller, RN, CCRN-CSC, BSN, York Hospital, Wellspan Health, York, Pennsylvania, USA, email: mfuller@wellspan.org; Deborah Audette
Abstract:
POSTER PURPOSE: To compare baseline, intervention I, and intervention II pain management protocols to determine the effectiveness of preemptive and multimodal analgesia on adult postoperative cardiac surgery patients. Postoperative pain control affects all aspects of care of cardiac surgery patients. The variables measured are pain scores (numeric rating scale), daily opioid use (intravenous morphine equivalence), and incidence of adverse effects (sedation). BACKGROUND/SIGNIFICANCE:Our baseline pain management immediately following surgery used a single opioid agent. Research was conducted to determine the best medications for preemptive and multimodal analgesia protocol. Intervention I revealed that gabapentin-related sedation caused a considerable number of doses to be withheld and that a dosage reduction was warranted. Intervention II decreased the total dosage of gabapentin, maintained patient-controlled administration of morphine or dilaudid and oxycodone when the patient-controlled analgesia was stopped. METHOD: This descriptive correlational study included 193 chart reviews. The baseline (n=64), intervention I (n=64), and intervention II (n =65) groups consisted of sternotomy patients. Patients in the intervention I and intervention II groups received preoperative gabapentin and acetaminophen. Following surgery in the intervention II group, patients received gabapentin and acetaminophen (both lower doses) and patient-controlled analgesia. The charts were reviewed for pain scores, daily opioid use (intravenous morphine equivalence), adverse effects (sedation), and length of stay in the intensive care unit and hospital. RESULTS: Baseline mean pain scores on days 1 and 2 were 7.52 and 7.39, respectively. The intervention II mean pain scores for days 1 and 2 were 4.28 and 5.58, respectively. Pain scores were essentially unchanged from the intervention I and II group. There was a reduction in parenteral morphine equivalent (PME) use on day 1 in both intervention groups over the baseline group. Baseline means for PME on days 1 and 2 were 57.42 and 27.19, respectively. Intervention I means for PME on days 1 and 2 were 20.28 and 11.47, respectively. Intervention II means for PME for days 1 and 2 were 17.65 and 18.48, respectively. Intervention II had less sedation, with 12.3% doses withheld compared with 32.8% in the intervention I group. CONCLUSIONS: Pain management in this population of patients is a challenge. The concept of preemptive treatment and use of multimodal treatment has lead to a significant reduction in pain. Reduction in pain improved patientsÆ mobility and their participation in breathing exercises and decreased length of stay in the intensive care unit. From baseline to interventions I and II, patients maintained low pain scores on the numeric rating scale and decreased opioid use with fewer adverse events.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titlePain Management of Post-operative Open Heart Surgery Patients Utilizing Preemptive and Multimodal Analgesiaen_GB
dc.contributor.authorFuller, Melinda S.en_GB
dc.contributor.authorAudette, Deborahen_GB
dc.author.detailsMelinda S. Fuller, RN, CCRN-CSC, BSN, York Hospital, Wellspan Health, York, Pennsylvania, USA, email: mfuller@wellspan.org; Deborah Audetteen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156980-
dc.description.abstractPOSTER PURPOSE: To compare baseline, intervention I, and intervention II pain management protocols to determine the effectiveness of preemptive and multimodal analgesia on adult postoperative cardiac surgery patients. Postoperative pain control affects all aspects of care of cardiac surgery patients. The variables measured are pain scores (numeric rating scale), daily opioid use (intravenous morphine equivalence), and incidence of adverse effects (sedation). BACKGROUND/SIGNIFICANCE:Our baseline pain management immediately following surgery used a single opioid agent. Research was conducted to determine the best medications for preemptive and multimodal analgesia protocol. Intervention I revealed that gabapentin-related sedation caused a considerable number of doses to be withheld and that a dosage reduction was warranted. Intervention II decreased the total dosage of gabapentin, maintained patient-controlled administration of morphine or dilaudid and oxycodone when the patient-controlled analgesia was stopped. METHOD: This descriptive correlational study included 193 chart reviews. The baseline (n=64), intervention I (n=64), and intervention II (n =65) groups consisted of sternotomy patients. Patients in the intervention I and intervention II groups received preoperative gabapentin and acetaminophen. Following surgery in the intervention II group, patients received gabapentin and acetaminophen (both lower doses) and patient-controlled analgesia. The charts were reviewed for pain scores, daily opioid use (intravenous morphine equivalence), adverse effects (sedation), and length of stay in the intensive care unit and hospital. RESULTS: Baseline mean pain scores on days 1 and 2 were 7.52 and 7.39, respectively. The intervention II mean pain scores for days 1 and 2 were 4.28 and 5.58, respectively. Pain scores were essentially unchanged from the intervention I and II group. There was a reduction in parenteral morphine equivalent (PME) use on day 1 in both intervention groups over the baseline group. Baseline means for PME on days 1 and 2 were 57.42 and 27.19, respectively. Intervention I means for PME on days 1 and 2 were 20.28 and 11.47, respectively. Intervention II means for PME for days 1 and 2 were 17.65 and 18.48, respectively. Intervention II had less sedation, with 12.3% doses withheld compared with 32.8% in the intervention I group. CONCLUSIONS: Pain management in this population of patients is a challenge. The concept of preemptive treatment and use of multimodal treatment has lead to a significant reduction in pain. Reduction in pain improved patientsÆ mobility and their participation in breathing exercises and decreased length of stay in the intensive care unit. From baseline to interventions I and II, patients maintained low pain scores on the numeric rating scale and decreased opioid use with fewer adverse events.en_GB
dc.date.available2011-10-26T19:18:53Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:18:53Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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