A Quality Improvement Survey to Assess Pain Management in Cardiac Surgery Patients

Mohammad Hamid, Amar Lal Gangwani, Mohammad Irfan Akhtar

Aga Khan University, Karachi, Pakistan.

DOI: 10.4236/ojanes.2015.55020                

Abstract

Objective: To evaluate the quality of pain management in cardiac ICU patients by using a questionnaire. Methodology: All post cardiac surgery patients between 18 and 75 years old were included in this survey. Chronic pain patients, paediatric patients, emergency surgeries were excluded. A predesigned proforma was prepared according to American Pain Society recommendations and distributed among Cardiac ICU patients after 24 hours of extubation. This proforma was explained to the patients and collected later. The questionnaire was related to pain severity, aggravating and relieving factors, side effects of analgesics, affective experience and satisfaction with pain management. Results: Total 308 patients participated in one year period. 243 (78.9%) were male and 65 (21.1%) were female. Multimodal analgesia was used in most of the patients. Severity of pain was described as mild 70% and moderate 28.6%. Most of the patients complained of sharp pain 100 (37.5%), mainly at the site of incision 129 (41.9%). The main aggravating factor associated with increased pain was deep breathing 118 (39.8%) while pain was minimized by taking pain medications 40.6%. A significant association was found between preoperative counseling about pain options and satisfaction. 96.8% reported satisfaction with pain management. Conclusion: Although overall pain control was reported as adequate and patients were highly satisfied, there were areas which need further improvement. These include strategies to provide preoperative information about postoperative pain management and better training of medical staff to assess and manage pain. Additionally, the concerns and fears of patients about pain treatment need to be addressed.

Keywords

Analgesia, Cardiac Surgical Procedures, Pain Management, Questionnaires

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Lahtinen, P., Kokki, H. and Hynynen, M. (2006) Pain after Cardiac Surgery: A Prospective Cohort Study of 1-Year Incidence and Intensity. Anesthesiology, 105, 794-800. http://dx.doi.org/10.1097/00000542-200610000-00026
[2]	Cogan, J., Ouimette, M.F., Vargas-Schaffer, G., Yegin, Z., Deschamps, A. and Denault, A. (2014) Patient Attitudes and Beliefs Regarding Pain Medication after Cardiac Surgery: Barriers to Adequate Pain Management. Pain Management Nursing, 15, 574-579. http://dx.doi.org/10.1016/j.pmn.2013.01.003
[3]	Markman, P.L., Rowland, M.A., Leong, J.Y., Van Der Merwe, J., Storey, E., Marasco, S., et al. (2010) Skeletonized Internal Thoracic Artery Harvesting Reduces Chest Wall Dysesthesia after Coronary Bypass Surgery. The Journal of Thoracic and Cardiovascular Surgery, 139, 674-679. http://dx.doi.org/10.1016/j.jtcvs.2009.03.066
[4]	Gordon, D.B., Polomano, R.C., Pellino, T.A., Turk, D.C., McCracken, L.M., Sherwood, G., et al. (2010) Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for Quality Improvement of Pain Management in Hospitalized Adults: Preliminary Psychometric Eval-uation. The Journal of Pain, 11, 1172-1186. http://dx.doi.org/10.1016/j.jpain.2010.02.012
[5]	Reimer-Kent, J. (2003) From Theory to Practice: Preventing Pain after Cardiac Surgery. American Journal of Critical Care, 12, 136-143.
[6]	Cogan, J. (2010) Pain Management after Cardiac Surgery. Seminars in Cardiothoracic and Vascular Anesthesia, 14, 201-204. http://dx.doi.org/10.1177/1089253210378401
[7]	Bjornnes, A.K., Rustoen, T., Lie, I., Watt-Watson, J. and Leegaard, M. (2014) Pain Characteristics and Analgesic Intake before and Following Cardiac Surgery. European Journal of Cardiovascular Nursing.
[8]	Mueller, X.M., Tinguely, F., Tevaearai, H.T., Revelly, J.P., Chiolero, R. and von Segesser, L.K. (2000) Pain Location, Distribution, and Intensity after Cardiac Surgery. Chest, 118, 391-396. http://dx.doi.org/10.1378/chest.118.2.391
[9]	Gjeilo, K.H., Stenseth, R. and Klepstad, P. (2014) Risk Factors and Early Pharmacological Interventions to Prevent Chronic Postsurgical Pain Following Cardiac Surgery. American Journal of Cardiovascular Drugs, 14, 335-342.
[10]	Eisenberg, E., Pultorak, Y., Pud, D. and Bar-El, Y. (2001) Prevalence and Characteristics of Post Coronary Artery Bypass Graft Surgery Pain (PCP). Pain, 92, 11-17. http://dx.doi.org/10.1016/S0304-3959(00)00466-8
[11]	Choiniere, M., Watt-Watson, J., Victor, J.C., Baskett, R.J., Bussieres, J.S., Carrier, M., et al. (2014) Prevalence of and Risk Factors for Persistent Postoperative Nonanginal Pain after Cardiac Surgery: A 2-Year Prospective Multicentre Study. Canadian Medical Association Journal, 186, E213-E223.
[12]	Gelinas, C. (2007) Management of Pain in Cardiac Surgery ICU Patients: Have We Improved over Time? Intensive and Critical Care Nursing, 23, 298-303. http://dx.doi.org/10.1016/j.iccn.2007.03.002
[13]	Yorke, J., Wallis, M. and McLean, B. (2004) Patients’ Perceptions of Pain Management after Cardiac Surgery in an Australian Critical Care Unit. Heart & Lung, 33, 33-41. http://dx.doi.org/10.1016/j.hrtlng.2003.09.002
[14]	Mueller, X.M., Tinguely, F., Tevaearai, H.T., Revelly, J.P., Chiolero, R. and von Segesser, L.K. (2000) Pain Pattern and Left Internal Mammary Artery Grafting. The Annals of Thoracic Surgery, 70, 2045-2049. http://dx.doi.org/10.1016/S0003-4975(00)01947-0
[15]	Bar-El, Y., Gilboa, B., Unger, N., Pud, D. and Eisenberg, E. (2005) Skeletonized Versus Pedicled Internal Mammary Artery: Impact of Surgical Technique on Post CABG Surgery Pain. European Journal Cardio-Thoracic Surgery, 27, 1065-1069. http://dx.doi.org/10.1016/j.ejcts.2005.02.016
[16]	Cohen, A.J., Moore, P., Jones, C., Miner, T.J., Carter, W.R., Zurcher, R.P., et al. (1993) Effect of Internal Mammary Harvest on Postoperative Pain and Pulmonary Function. The Annals of Thoracic Surgery, 56, 1107-1109. http://dx.doi.org/10.1016/0003-4975(95)90025-X
[17]	Aslan, F.E., Badir, A., Arli, S.K. and Cakmakci, H. (2009) Patients’ Experience of Pain after Cardiac Surgery. Contemporary Nurse, 34, 48-54.
[18]	Mello, L.C., Rosatti, S.F. and Hortense, P. (2014) Assessment of Pain during Rest and during Activities in the Postoperative Period of Cardiac Surgery. Revista Latino-Americana Enfermagem, 22, 136-143.
[19]	Ferguson, J., Gilroy, D. and Puntillo, K. (1997) Dimensions of Pain and Analgesic Administration Associated with Coronary Artery Bypass Grafting in an Australian Intensive Care Unit. Journal of Advanced Nursing, 26, 1065-1072. http://dx.doi.org/10.1046/j.1365-2648.1997.00426.x
[20]	Diby, M., Romand, J.A., Frick, S., Heidegger, C.P. and Walder, B. (2008) Reducing Pain in Patients Undergoing Cardiac Surgery after Implementation of a Quality Improvement Postoperative Pain Treatment Program. Journal of Critical Care, 23, 359-371. http://dx.doi.org/10.1016/j.jcrc.2007.11.005
[21]	Voshall, B. (1980) The Effects of Preoperative Teaching on Postoperative Pain. Topics in Clinical Nursing, 2, 39-43.
[22]	Meehan, D.A., McRae, M.E., Rourke, D.A., Eisenring, C. and Imperial, F.A. (1995) Analgesic Administration, Pain Intensity, and Patient Satisfaction in Cardiac Surgical Patients. American Journal of Critical Care, 4, 435-442.
[23]	Raksamani, K., Wongkornrat, W., Siriboon, P. and Pantisawat, N. (2013) Pain Management after Cardiac Surgery: Are We Underestimating Post Sternotomy Pain? Journal of the Medical Association of Thailand, 96, 824-828.
[24]	Silva, M.A., Pimenta, C.A. and Cruz Dde, A. (2013) Pain Assessment and Training: The Impact on Pain Control after Cardiac Surgery. Revista da Escola de Enfermagem da USP, 47, 84-92.
[25]	Stolic, S. and Mitchell, M.L. (2010) Pain Management for Patients in Cardiac Surgical Intensive Care Units Has Not Improved Over Time. Australian Critical Care, 23, 157-159.
[26]	van Gulik, L., Ahlers, S.J., Brkic, Z., Belitser, S.V., van Boven, W.J., van Dongen, E.P., et al. (2010) Improved Analgesia after the Realisation of a Pain Management Programme in ICU Patients after Cardiac Surgery. European Journal of Anaesthesiology, 27, 900-905.