Effectiveness of the Self-report Pain Intensity Scale in Pain Control After Coronary Artery Bypass Surgery

Document Type : Original Article

Authors

1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Cardio-oncology Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Ayatollah Kashani Haspital, Isfahan University of Medical Sciences, Isfahan, IR Iran.

Abstract

Background: Pain following cardiac surgery is common, and pain assessment is a precondition for adequate pain management. We designed this study to evaluate the effectiveness of pain control using the self-report pain intensity scale during the postoperative period after coronary artery bypass surgery in the cardiac ICU.
 
Methods: Of 160 patients scheduled for elective coronary revascularization, 154 patients were included in this prospective, double-blind clinical trial. The pain management program was performed on conscious patients for 48 hours. The study population was randomly divided into 2 groups. One group received analgesics as needed, based on conventional nurse-controlled analgesia (the NCA group; n=77), and the other group received analgesics based on the pain intensity score determined using the linear numerical rating scale (NRS group; n=77). In both groups, opioid and non-opioid analgesic consumption and satisfaction levels with pain relief were recorded.
 
Results: The use of the self-report pain intensity scale led to an increase in the number of recipients of analgesic drugs and a decrease in their opioid/analgesic consumption during a 48-hour period in the NRS group. Satisfaction levels with pain relief were higher in the NRS group than in the NCA group (maximum satisfaction =43 [55.8%] vs 9 [11.8%], respectively; P=0.0001).
 
Conclusions: The findings of this study showed the efficacy of the self-report pain intensity scale in controlling patients’ pain, using adequate and appropriate analgesics, prescribing accurate amounts of medication based on patients’ pain, and increasing patients’ satisfaction with pain relief. (Iranian Heart Journal 2022; 23(1): 205-213)

Keywords

References

  1. Brunner LS, Smeltzer SCC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-surgical Nursing: Suzanne C. Lippincott Williams & Wilkins; 2014. 321-327
  2. Choiniere, J. Watt-Watson, J.C. Victor, et al., Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study, Can. Med. Assoc J 2014 186 (7) E213–E223, https://doi.org/10.1503/cmaj.131012.
  3. V, Mirmansouri.A, Mohammadzadeh Jouryabi.A , Naderi Nabi.B, Kanani.GhR , Nassiri Sheikhani.N, Atrkarroushan.Z, Ghazanfar.S. Comparing the Effectiveness of Patient Control Analgesia Pump and Bolus Morphine in Controlling Pain After Cardiopulmonary Bypass Graft Surgery. Anesth Pain Med. 2017 October; 7(5):e12756. doi:10.5812/aapm.12756.
  4. Hamid M, Gangwani AL, Akhtar MI. A Quality Improvement Survey to Assess Pain Management in Cardiac Surgery Patients. Open J Anesthesiol. 2015;05(05):105–1 doi:10.4236/ojanes.2015.55020.
  5. Coventry LL, Siffleet JM, Williams AM. Review of analgesia use in the intensive care unit after heart surgery. Crit Care Resusc 2006; 8(2): 135-40.
  6. N; Yazdanian; Faritus.SZ. Sedative Efficacy of Propofol in Patients Intubated/Ventilated after Coronary Artery Bypass Graft Surgery. Anesth Pain Med. 2014 February; 4(1): e17109. DOI:10.5812/aapm.17109
  7. Greisen, T. Grøfte, P.O. Hansen, T.S. Jensen, H. Vilstrup, Acute non-traumatic pain increases the hepatic amino- to urea-N conversion in normal man, J. Hepatol. 1999 31 (4) 647–655, http://www.ncbi.nlm.nih.gov/pubmed/10551388. Accessed June 16, 2018.
  8. T. Mangano, D. Siliciano, M. Hollenberg, et al., Postoperative myocardial ischemia. Therapeutic trials using intensive analgesia following surgery. The Study of Perioperative Ischemia (SPI) Research Group, Anesthesiology 1992 76 (3) 342–353, http://www.ncbi.nlm.nih.gov/pubmed/1531742. Accessed June 16, 2018.
  9. Huang AP, Sakata RK. [Pain after sternotomy - review]. Rev Bras Anestesiol. 2016;66(4):395–401. doi:10.1016/j.bjan.2014.09.003. [PubMed: 25796483].
  10. Lahtinen P, Kokki H,HynynenM. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006;105(4):794–800. [PubMed: 17006079].
  11. Totonchi Z, Seifi S, Chitsazan M, Alizadeh Ghavidel A, Baazm F, Faritus SZ. Pain location and intensity during the first week following coronary artery bypass graft surgery. Anesth Pain Med. 2014;4(1):e10386. doi:10.5812/aapm.10386. [PubMed: 24660142].
  12. Tsang J, Brush B. Patient-controlled analgesia in postoperative cardiac surgery. Anaesth Intensive Care. 1999;27(5):464–70. [PubMed:10520385].
  13. Diby M, Romand JA, Frick S, Heidegger CP,Walder B. Reducing pain in patients undergoing cardiac surgery after implementation of a quality improvement postoperative pain treatment program. J Crit Care.2008;23(3):359–71. doi:10.1016/j.jcrc.2007.11.005. [PubMed: 18725042].
  14. Jayakumar, M. Borrelli, Z. Milan, G. Kunst, D. Whitaker. Optimising pain management protocols following cardiac surgery:A protocol for a national quality improvement study. International Journal of Surgery Protocols 2019 14: 1–8, (http://creativecommons.org/licenses/by/4.0/).
  15. Parizad R, Abdolahzadeh F, Mousavi-Shabestari M. Pain after Cardiac Surgery: A Review of the Assessment and Management. Crescent J Med Biol Sci. 2014;1(4):113–7.
  16. Rafiq S, Steinbruchel DA,Wanscher MJ, Andersen LW,Navne A, Lilleoer NB, et al. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial. J Cardiothorac Surg. 2014;9:52. doi: 10.1186/1749-8090-9-52. [PubMed: 24650125].
  17. E. Bigeleisen, N. Goehner, Novel approaches in pain management in cardiac surgery, Curr. Opin. Anaesthesiol. 2015 28 (1): 89–94, https://doi.org/ 10.1097/ACO.0000000000000147.
  18. E. Macintyre, S.M. Walker, The scientific evidence for acute pain treatment, Curr. Opin. Anaesthesiol. 2010 23 (5): 623–628, https://doi.org/10.1097/ ACO.0b013e32833c33ed.
  19. M, Mehrabanian.MJ, Faritus.SZ , Khazaei Koohpar.M, Ferasatkish.R, Hosseinnejad.H, et al. Premedication With Oral Pregabalin for the Prevention of Acute Postsurgical Pain in Coronary Artery Bypass Surgery. Anesth Pain Med. 2015 Feb; 5(1): e24837. doi: 10.5812/aapm.24837
  20. Yorke J, Wallis M, McLean B. Patients' perceptions of pain management after cardiac surgery in an Australian critical care unit. Heart Lung 2004; 33(1): 33-41.
  21. Diby M, Romand JA, Frick S, Heidegger CP, Walder B. Reducing pain in patients undergoing cardiac surgery after implementation of a quality improvement postoperative pain treatment program. J Crit Care 2008; 23(3): 359-71.
  22. Watt-Watson J, Stevens B, Garfinkel P, Streiner D, Gallop R. Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients. J Adv Nurs 2001; 36(4): 535-45.
  23. Watt-Watson J, Stevens B, Katz J, Costello J, Reid GJ, David T. Impact of preoperative education on pain outcomes after coronary artery bypass graft surgery. Pain 2004; 109(1-2): 73- 85.
  24. Barr J, Fraser GL, Puntillo K, Ely EW et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41: 263–306
  25. M, Azarfarin.R, Totonchi.Z, Tavakoli.F, Alizadehasl.A , Teymouri.M . Comparison of Two Pain Assessment Tools, "Facial Expression" and "Critical Care Pain Observation Tool" in Intubated Patients After Cardiac Surgery. Anesth Pain Med  2016 Jan 18; 6(1):e33434. doi:10.5812/aapm.33434
  26. Payen JF, Chanques G, Mantz J et al. Current practices in sedation and analgesia for mechanicall ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 2007; 106: 687–95)
  27. DAS-Taskforce (2015) Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline)
  28. Klein DG,, Dumpe M,, Katz E,, et al. Pain assessment in the intensive care unit: Development and psychometric testing of the nonverbal pain assessment tool. Heart Lung. 2010; 39((6):):521-–528.. [PubMed] [Google Scholar]
  29. C , Gélinas.C , Michaud.C. Impact of the Implementation of the Critical-Care Pain Observation Tool (CPOT) on Pain Management and Clinical Outcomes in Mechanically Ventilated Trauma Intensive Care Unit Patients: A Pilot Study. Journal of Trauma Nursing. 2011 18(1):52–60, JANUARY/MARCH. DOI:10.1097/JTN.0b013e3181ff2675
  30. Topolovec-Vranic, J., Canzian, S., Innis, J., Pollmann-Mudryj, M. A., Mcfarland, A. W. & Baker, A. J. Patient satisfaction and documentation of pain assessments and management after implementingthe adult nonverbal pain scale. American Journal of Critical Care, 2010 19, 345-354.
  31. Sattari M, Baghdadchi ME, Kheyri M, Khakzadi H, Ozar Ma­shayekhi S. Study of patient pain management after heart sur­gery. Adv Pharm Bull. 2013; 3(2):373–7.
  32. Jahangiri Fard.A; Babaee.T; Alavi.SM; NasiriAA; Ghoreishi.SMM; Noori.NM; Mahjoubifard.M. Intravenous Patient-Controlled Remifentanil Versus Paracetamol in Post- Operative Pain Management in Patients Undergoing Coronary Artery Bypass Graft Surgery. Anesth Pain Med. 2014 December; 4(5): e19862. DOI: 10.5812/aapm.19862
  33. Eremenko AA, Kuslieva EV. [Analgesic and opioid-sparing effects of intravenous paracetamol in the early period after aortocoronary bypass surgery]. Anesteziol Reanimatol. 2008(5):11–4.
  34. Mccarthy, D., Reichert, D., Vaidiyanathan, S., Ranganath, A. & Beleil, M. Review of post operative analgesia in cardiac surgery patients in the intensive care unit: 14AP9.1. European Journal of Anaesthesiology (EJA) 2010 27, 214.
Iranian Heart Journal
Volume 23, Issue 1
January 2022
Pages 205-213

Files

Share

How to cite

Statistics