CARDIAC SURGERY PERIOPERATIVE PAIN MANAGEMENT BUNDLE

• Published in: Journal of cardiothoracic and vascular anesthesia 2023-10, Vol.37, p.25-26
• Main Authors: UNIC-STOJANOVIC, Dragana, RANKOVIC-NICIC, Ljiljana, MILICIC, Biljana, MILJKOVIC, Ana, ZASLANSKY, Ruth, MEISSNER, Winfried, STAMENKOVIC, Dusica
• Format: Article
• Language: English
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2023.08.062

Cardiac surgery is performed mainly via a medium sternotomy, which causes significant postoperative pain. The aim of our study was to improve pain treatment in the postoperative period by implementing a perioperative pain management bundle for cardiac surgery pain. As a part of PAIN OUT, this was a two-phased study. The initial phase involved data collection on existing pain management in the wards. In the post-interventional phase, we tested the effectiveness of the pain bundle implementation: information about pain therapy, the use of non-opioids in the maximal daily dose, surgical wound infiltration with a local anaesthetic (surgeons), and pain assessment, treatment, and reassessment (nurses). This study included 132 patients in the initial and 138 patients in the post-interventional phase on the first postoperative day after cardiac surgery. In the post-interventional phase, the worst pain and time spent in severe pain were significantly lower (Table 1), interference with coughing was less, and patients could mobilize more easily in- and out of bed (Table 2). Patient-reported higher satisfaction with pain treatment in the post-interventional phase, 9.4 ±1.0 vs. 8.4±2.3, P=0,002. We performed pain assessment in all patients during the post-interventional phase compared to none in the initial phase. The essential elements of perioperative pain bundle, including education on pain therapy, administration of full daily doses of analgesics, multimodal analgesia and wound infiltration technique, as well as the assessment and re-assessment of pain intensity in the postoperative period, resulted in effective pain relief and high patients’ satisfaction. Perioperative pain management is a teamwork.