no pain to promote good health in women after … borghi.pdf · in women after surgery in ferrara...
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NO PAIN TO PROMOTE GOOD HEALTH
IN WOMEN AFTER SURGERY IN FERRARA UNIVERSITY HOSPITAL.
(Emilia Romagna Region, Italy)-PRELIMINARY RESULTS-
Chiara BORGHI, Ruby MARTINELLO, Alfredo PATELLA, Gianemilio
FURICCHIA, Roberto ZOPPELLARI, Paola ANTONIOLI, Paola
CAPONCELLI, Giuseppe GILLI, Teresa MATARAZZO, Gabriele RINALDI
SERVIZIO SANITARIO REGIONALE
EMILIA-ROMAGNA
Azienda Ospedaliero – Universitaria di Ferrara
19th International Conference on Health Promoting Hospitals & Health Services Turku, 01-03 June 2011
The project: “Pain-Free Hospital and Land”
Provision 24/05/2001, GU n. 149, 29/06/2001
Law 15 March 2010, n. 38, GU n. 65, 19 marzo 2010
evaluate, monitor and treat pain
sensitize sanitary operators and patients about pain
guarantee humanization of health care service
promotion of health
guarantee continuity in assistance and tratment
avoid or minimize adverse reactions, reduce mortality / morbidity
Aim: promote a systematic and adequate management of any kind of
pain, especially in women after surgery
The dedicated form:
Treating Pain Together
Treating Pain Together
Graphical representation of pain
Pain scales chosen by our hospital
Numerical Rating ScaleNRS
Faces Pain ScaleFPS
Pain Assessment in Advanced Dementia PAINAD
Behavioural Pain ScaleBPS
Pain-free Hospital and Land CommitteeEmilia Romagna Region, dossier 194 / 2010
Face 0
Face muscles
relaxed
1
Facial muscle
tension, frown,
grimace
2
Frequent to
constant frown,
clenched jaw
Face
score:
Restlessness 0
Quiet, relaxed
appearance,
normal
movement
1
Occasional
restless
movement,
shifting position
2
Frequent restless
movement may
include
extremities or
head
Restlessn
ess score:
Muscle tone* 0
Normal muscle
tone
1
Increased tone,
flexion of fingers
and toes
2
Rigid tone
Muscle
tone
score:
Vocalisation** 0
No abnormal
sounds
1
Occasional
moans, cries,
whimpers an\d
grunts
2
Frequent or
continuous
moans, cries,
whimpers or
grunts
Vocalisati
on score:
Consolability 0
Content,
relaxed
1
Reassured by
touch, distractible
2
Difficult to comfort
by touch or talk
Consolab
ility
score:
Behavioural pain assessment scale total (0–10) /10
Post-operative Pain
acute pain in the pre-surgery setting:
“pain that is present in a surgical patient because of
preexisting disease, the surgical procedure
(with associated drains, chest or nasogastric tubes, or
complications), or a combination of disease-related and
procedure-related sources”
American Society of Anesthesiologists (ASA), 2004, 100: 1573-81
Gynecologic surgery for gynecologic diseases
transversallaparotomy(Pfannenstiel incision)
mini-laparotomy
longitudinallaparotomy
vaginal access
AIM OF THE STUDY
Evaluate the prevalence and intensity of pain in hospitalized
women who undergo surgery for gynecologic disease, using a
dedicated form, called “Treating pain together”;
Evaluate the efficacy of the used pain therapy protocols, made on
the base of expected pain;
Evaluate the adherence of operators to the form
METHODS
Period: 1st February - 31 December 2010
Sample: 156 women
Planned surgical interventions for gynecologic diseases.
Adequately informed about the hospital project on pain.
The control of pain was performed using a protocol of therapy decided
on the base of the expected pain (moderate intensity).
Pain was monitored using the form “Treating pain together”, at least
three times a day, during the whole hospitalization.
Statistic analysis done on days 0, 1, 2
RESULTS
The sample:156 women Hysterectomy +/- adnexectomy
adnexectomy
myomectomy
- mean age 56,7 (20-83) years, median 55 (ds 13,8)
- surgical access: - transversal laparotomy (TL) n= 76
- longitudinal laparotomy (LL) n= 42
- vaginal (VAG) n= 38
- demolishing / non demolishing
- anaesthesia
- analgesics:
• elastomeric pump: continuous infusion of analgesics
• prescription of analgesics: due hours or rescue doses
TL(tot 76)
LL(tot 42)
VAG(tot 38)
PAIN ON DAY 0
n° % n° % n° %
NO episodes 64 84,2 34 81 26 68,4
≥1 episodes 12 15,8 8 19 12 31,6
DAY 0
χ2 : episodes – surgical access: p<0,14
Uni-multivariate logistic regression:
- VAG access: p<0,06
VARIABLE p O.R. 95%
age3 0,66 -
demolishing (no) 0,11 2,8 (9,9-0,8)
LL 0,66 -
VAG 0,06 2,5 (6,2-0,98)
anesthesia lrb 0,09 2,3 (5,2-1,04)
due hours 0,14 0,55 (1,2-0,25)
DAY 0intensity of pain
p< 0,01
DAY 1
Uni-multivariate logistic regression :
- VAG access: (p<0,005)
- due hour: (p<0,001)
TL(tot 76)
LL(tot 42)
VAG(tot 38)
PAIN ON DAY 1
n° % n° % n° %
NO episodes 34 44,7 20 47,6 28 73,7
≥1 episodes 42 55,3 22 52,4 10 26,3
χ2 : episodes – surgical access: p<0,02
VARIABLE p O.R. 95%
age3 0,26 -
demolishing (no) 0,36 -
LL 0,77 -
VAG 0,004 0,29 (0,68-0,12)
anesthesia lrb 0,41 -
due hours 0,001 0,20 (0,50-0,08)
DAY 2
TL(tot 76)
LL(tot 42)
VAG(tot 38)
PAIN ON DAY 2
n° % n° % n° %
NO episodes 55 72,4 21 50 29 76,3
≥1 episodes 21 27,6 21 50 9 23,7
χ2 : episodes – surgical access: p<0,02
0
1
2
3
4
5
6
7
8
NR
S lt tr
lt lo
vag
DAY 0 DAY 1 DAY 2
TL
LL
VAG
p<0,01 n.s.n.s.
PREVALENCE of painand surgical access in the first three days aftersurgery
0%
10%
20%
30%
40%
50%
60%%
p
ati
ents
wit
hp
ain
lt tr
lt lo
vag
DAY 0 DAY 1 DAY 2
p<0,02
p<0,02
n.s.
INTENSITY of pain and surgical access
in the first three daysafter surgery
TL
LL
VAG
The control of pain was adequate for the 40% of the sample
(operated women)
60 % of women complained about pain during the first three days
after surgery:
• 89% moderate pain (NRS 4-7)
• 11% severe pain (NRS 8-10)
The few studies in the gynecology ward have provided
superimposable datas in terms of moderate pain.
Our results seem to be better than other studies about severe pain.
CONCLUSIONS
The form “Treating pain together” is a useful tool to continuosly
assess pain level and to treat it in a better way.
Sanitary staff has actively contributed to the company project
with an high interest in improving the approach of pain.
Continous education of the sanitary operators is foundamental.
Audit to improve analgesic therapy for:
Peaks of severe pain in group VAG on day 0
Women with TL on day 1
Women with LL on days 1 and 2
Continue the monitoring of pain in women in our department
including, if possible, another increasing group of operated
women, those who undergo laparoscopic surgery.
FUTURE
