Nurse practitioner led pain management the day after caesarean section: A randomised controlled trial and follow-up study.

BACKGROUND: Pain on the day after caesarean section is often treated with controlled-release oxycodone to supplement the decline in analgesia from intrathecal opioids. Evidence suggests that caesarean birth is a biopsychosocial experience where a comprehensive approach is needed that promotes control and participation in pain management. OBJECTIVES: This study compared immediate-release oxycodone integrated with supportive educational strategies to controlled-release oxycodone. A follow-up phase aimed to explore pain over three months. DESIGN: This study was a two-group parallel randomised controlled trial. SETTING: A metropolitan hospital in Australia with a birthing suite, operating rooms, and a postnatal unit. PARTICIPANTS: English-speaking women scheduled for elective caesarean section were mailed trial information. Exclusion criteria included contraindications to intrathecal analgesia, herpes simplex infection, a history of chronic pain, opioid tolerance, or substance abuse. A total of 131 participants were recruited and randomised out of 298 eligible participants. METHODS: Group allocation was undertaken using sequentially numbered opaque sealed envelopes. The nurse practitioner intervention commenced on the day after surgery with immediate-release oxycodone alongside supportive strategies. The control group received scheduled doses of controlled-release oxycodone. All participants could request additional oxycodone or tramadol. Primary outcomes were pain intensity and secondary outcomes included patient global impression of change, pain interference, opioid consumption, and maternal perception of control. A follow-up phase evaluated pain outcomes over three months. RESULTS: The final sample size was 122, with 61 participants in each group. Pain intensity scores were analysed by linear mixed regression models. There were no statistical differences over 24h between the control and intervention groups at rest (p=0.40, 95% CI - 4.8mm, 11.9mm) or on sitting or moving (p=0.561, 95% CI -15.2mm, 8.3mm). Patient global impression of change was significant over three hours (p=0.014, OR=2.5, 95% CI 1.2, 5.3). The intervention group reported less pain interference while consuming less oxycodone (p<0.05). There was no difference between groups in terms of perceived control over pain management (p=0.273, 95% CI -16.2mm, 4.6mm). The follow-up analysis graded 5.9% of participants as experiencing severe pain interference. Chronic pain following caesarean was associated with postnatal depression (p<0.001). CONCLUSIONS: The research showed that a nurse practitioner intervention can improve pain management following caesarean section. The results underscore the influence of biological, psychological, and social factors on acute pain. Hence, this study reinforces the need for a biopsychosocial approach to acute pain management following caesarean delivery.

Two hundred days of nurse practitioner prescribing and role development: a case study report from a hospital-based acute pain management team.

PURPOSE: This report evaluates a beginning Nurse Practitioner (NP) role in Acute Pain Management. HEALTHCARE SETTING: The role was implemented within an anaesthesiology-based pain service. The NP author developed this pain service in 2002 and was endorsed as an NP 6 years later. The NP reviews all clients undergoing major surgery or trauma and provides pain management to women for caesarean section. Prior to this role, there were significant delays for some patients requiring prompt analgesia. This was because of the decreased availability of anaesthetists to fully participate in the pain service due to the demand for complex anaesthesiology practice. METHOD OF DATA COLLECTION: Data were conveniently collected by the NP on prescription and service provision over 200 working days. MAIN FINDINGS: Therapeutic activity reflected contemporary pain management practice and espouse the NP as a safe and effective clinician. The role has improved patient access to pain management through the prompt use of non-pharmacological interventions, drugs used to treat analgesic side effects, opioids and non-opioid analgesics. PRINCIPAL CONCLUSIONS: These initial positive outcomes are consistent with NP role development described elsewhere in Australia and overseas across a variety of healthcare settings. To sustain this role, robust continuing education and clinical support is required.

Acute pain in surgical patients.

PURPOSE: The aim of this study was to assess experiences of acute surgical pain by patient description of pain intensity and patient satisfaction with peri-operative pain management in a variety of adult surgical patients prior to the appointment of an acute pain nurse in a hospital in Queensland, Australia. METHOD: One hundred and seventeen patients who underwent various surgical procedures were surveyed using a pain rating scale (0-10) and a scale assessing their perceptions of the treatment they received for their post-operative pain. FINDINGS: The results provide baseline data about the adequacy of acute pain management within the hospital prior to the implementation of an acute pain service and an acute pain nurse. Overall, patients reported considerable pain postoperatively, yet were satisfied with the way their pain was treated. CONCLUSION: These findings are consistent with previous research highlighting that acute pain management continues to be a serious clinical issue and that high satisfaction ratings should be viewed with suspicion. The study supports the need for a stronger clinical focus on managing acute pain, with suggested areas for improvement including better educational support for patients, clinician education and thorough assessment and planning throughout the patients' experience.