Artikel
Patients with spinal surgeries longer than two hours should be a focus for postoperative pain management
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Autoren
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Thomas Fortmann
- Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
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Walter Stummer
- Universitätsklinikum Münster, Klinik für Neurochirurgie, Münster, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Patients suffer from pain after surgery due to transsection and suturing of skin and other tissues. The aim of this study was to introduce a suitable pain medication management by improving nurses autonomy and thereby reducing patients pain.
Methods: During three time periods from December 2011 until May 2014 a total of 275 patients (112, 83, 80) were interviewed using the QUIPS-questionnaire to register pain in different situations during the first 24h after surgery, the dose of pain medication, side effects and patients’ satisfaction. Between the first and the second period all doctors and nurse were introduced to the Targin and Palladon-schemes. We also differentiated between head and spine surgery and analysed the key parameters of the performed surgeries.
Results: Although there was no significant difference between the three groups concerning different kinds of pain, patients’ satisfaction after head surgery rose significantly from 11,85 to 12,83 (p=0,004). Unfortunately these patients suffered more from nausea and vomiting (18 vs. 5%, p=0,003).
There was a significant difference (< 0,1%) between head and spine surgery in minimal pain (1,58 vs. 2,43), pain during mobilization (3,69 vs. 4,92) and the reduction of mobility (40 vs. 71%).
Especially patients with spine surgery lasting more than 2 hours had more pain during mobilization (5,39 vs. 4,21, p=0,032), more requests for pain medication (23 vs. 2%, p=0,002) and woke up more frequently due to pain (60 vs. 34%, p=0,011).
Interestingly those patients, who received opioids in the anaesthetic recovery room had far more pain problems (reduced mood 44 vs. 23%, maximum pain 6,18 vs 4,52 (p<0,1%), minimum pain 2,36 vs. 1,67, pain during mobilization, 4,73 vs. 3,87, more request for pain medication 25 vs. 10%, waking up due to pain 57 vs. 37%, reduced mobility 64 vs 48% and less satisfaction 11,28 vs. 12,03 (p<1%)).
Conclusion: Using pain medication schemes helps to improve patients' satisfaction since nurses are able to administer more pain medication in pre-determined ranges. For patients after head surgery it might be necessary to reduce the pain medication in order to reduce side effects such as nausea and vomiting. Patients after spinal procedures of longer than two hours should receive enough pain medication right away to improve their mobility and satisfaction.
