Rectus sheath catheter infusions for post-operative pain management.

Managing pain following major abdominal surgery remains a challenge. Traditionally, patient-controlled analgesia (PCA) or epidural analgesia have been used, which have improved post-operative pain and the patient experience, but have presented some problems in recovery. PCA can cause adverse effects, including sedation, nausea, vomiting, and prolonged gastric ileus. While epidurals do have some advantages over PCA, there are risks involved related to catheter insertion and adverse effects, such as hypotension and motor blocks which limit mobility. This article examines rectus sheath catheter infusions, a relatively new and alternative technique to epidural analgesia, and presents some early audit data related to pain scores, analgesic use and mobility.

Making sense of patients' use of analgesics following day case surgery.

AIM: This paper is a report of a study exploring patients' use of analgesics following day case surgery, with particular focus on patients' decision-making about analgesic use. BACKGROUND: Day case and ambulatory surgery continue to be the preferred format for many elective surgical procedures. However, many patients' experience unacceptable postoperative pain when they return home after day surgery. Previous research investigating barriers to pain management suggests that patients may not use their analgesics appropriately. METHOD: A qualitative approach using interpretative phenomenological analysis was used to explore the experiences of 28 patients admitted for day case surgery. The patients were interviewed on the fourth postoperative day. Data were collected in 2005-06. FINDINGS: We identified an explanatory framework with three high level themes and 12 mid-level themes, with the mid-level themes broken down into a number of lower level themes. Patients' use of analgesics was a complex intentional decision-making process based on a matrix of beliefs surrounding pain, analgesics and day surgery. They did not always adhere to their analgesic regimes at home, many describing how they avoided analgesics and often withstood high levels of postoperative pain. CONCLUSION: Interventions need to go beyond the provision of pain management information (as in current practice), and overcome some of the erroneous beliefs held by patients. Further research is required to identify ways in which these erroneous beliefs can be overcome.

Exploring pain management in older people with hip fracture.

Pain following a fractured neck of femur can be severe; in addition patients often have underlying medical problems. This article examines the problems associated with good pain control for older patients following fractured neck of femur. It introduces a Changing Practice article, due to be published in next week's issue, which outlines the development of a nurse-led service to provide preoperative femoral nerve blocks.

A nurse-led service for pre-operative pain management in hip fracture.

This article follows an In-depth piece published in last week's issue, which explored issues around pain management in older people following fractured neck of femur. It also discussed using femoral nerve block for pain relief in this group of patients. This Changing Practice article outlines the establishment of a nurse-led service to improve pre-operative pain management using femoral nerve block.

Current interventions and approaches to postoperative pain management.

Some degree of pain accompanies all surgical procedures. Current evidence informs us that patients will experience significant physiological and psychological effects if this pain is not adequately treated. These effects can cause serious harm, delay recovery from surgery, and in some cases lead to persistent post-surgical chronic pain. This article briefly discusses the importance of assessing patients preoperatively and highlights how some patients will have risk factors which may lead them to experience severe postoperative pain. Approaches to postoperative pain control are focused on ways to address the inter-patient differences in response to pain and treatments and avoid periods of ineffective pain relief. A review of the commonly used analgesics, paracetamol, non-steroidal anti-inflammatory drugs, opioids and local anaesthetics, and methods of administration, is included. The final section provides a short review of emerging trends in acute pain therapy and the implications for improving patient care.

Pain management: setting up a nurse-led femoral nerve block service.

Managing pain following a fractured neck of femur is challenging for a number of reasons. This group of patients are typically older people and frail with multiple co-morbidities and are often on numerous medications. In addition to a hip fracture, they commonly present with acute medical problems. Fractures cause significant pain, which can be difficult to manage safely and effectively with the traditional analgesics. A femoral nerve block has been shown to be a safe and effective preoperative intervention for managing pain in this patient group while they wait for surgery. This article describes how an acute pain team have developed protocols and training to establish a nurse-led service for providing preoperative femoral nerve blocks to patients with fractured neck of femur.

Improving the management of postoperative pain.

Despite developments in knowledge of pain control, many patients still experience unnecessary postoperative pain. This article reports on an audit of postoperative pain and its management in one trust. The results led to the development of a new system using standard prescriptions to empower nurses to manage patients' pain.