Authors (including presenting author) :
CHAN OL (1), LAM CWF (1)
Affiliation :
(1) Anaesthesiology and Operating Theatre Services, Kwong Wah Hospital
Introduction :
Effective postoperative management can facilitate rehabilitation. Standard analgesic regime includes multimodal analgesia which combines various groups of medications for pain relief has been implemented in KWH. With NAPS, the nurse reviews patients daily until POD3 to ensure satisfactory pain relief is achieved during mobilization and physiotherapy. If pain control remains suboptimal or side effects of drug are observed, nurse provides education on analgesic regime and initiates the analgesic titration
Objectives :
The study was undertaken to determine the impact of NAPS on postoperative pain management with standard analgesic protocol.
Methodology :
A retrospective study was carried out in KWH from January 2021 - March 2023, 128 patients with KJR receiving NAPS and requiring the titration from standard protocol with completed data collection were selected (N=69, 53%). A comparison, paired t-test for same patient, were done before and after protocol changed initiated by nurses. Numerical Rating Scale (NRS) from score 0 to 10, self-rated pain severity during resting and movement, was adopted as assessment tool to determine the significant of the primary outcome.
Result & Outcome :
In the study group, male: female = 23 (33.3%): 46 (66.7%). The mean age was 70.54 years old (SD=7.12). Intraoperative local anaesthetic drugs given was 60(86.96%). Modes of anaesthesia, Regional anaesthesia: General anaesthesia: Combined general and regional anaesthesia = 44(63.77%): 20 (28.98%): 5(7.25%) respectively. Patients who reported severe opioid-related adverse drug effects was 1(1.45%). 35(36%) patients reported severe pain and needed to titrate up analgesia. Mean resting NRS, before: after intervention = 4.14(SD=8.21): 1.87(SD=4.85), resting NRS was significant improvement when nurse intervention given (t(68)=5.76, p<.001, one-tailed). Mean movement NRS, before: after intervention = 6.45(SD=5.31): 5.04(SD=4.19), movement NRS was significant improvement when nurse intervention given (t(68)=5.25, p<.001, one-tailed). Pain perception is individual and multifactorial. Standard protocol may benefit most patients. Our study demonstrated that NAPS could enhance the quality of acute pain management and patient’s knowledge among KJR patients, suggesting that such a model can be an effective intervention for better pain control among postsurgical patients. Modified analgesic regime have been revised after reporting the above finding to stockholders since Jan 24. Further studies, including pre-operative education, intraoperative drugs used, and range of movement, are warranted to confirm the result.
