Nurse-led post-thoracic surgery pain management programme: its outcomes in a Nigerian Hospital.

AIM: The overarching aim of this study was to investigate the effects of a nurse-led pain management programme on pain intensity, side effects of treatment, shoulder range of motion and length of stay after thoracic surgery. BACKGROUND: Post-thoracic surgical pain is a major source of stress and distress for patients. It has profound effects ranging from increased risks in developing chronic post-thoracic surgery pain to an increased length of stay after surgery. The post-thoracic surgical pain management in the Nigerian context is based on the traditional approach that is dependent on the attending medical and nursing staff. METHODS: The study was a quasi-experimental design (two-group post-test only). The study was conducted in a Nigerian hospital. Forty-two patients were recruited and consecutively assigned into either the usual pain management group or the intervention group after they had met the inclusion criteria. Data were collected utilizing the following: (1) the modified McGill Pain Questionnaire; (2) a Numeric Rating Scale; (3) the documentation form for thoracic surgery pain management outcomes and (4) a goniometer. RESULTS: The findings indicated that pain intensity, nausea and drowsiness were significantly reduced among the patients in the experimental group than the control group, while the duration of stay after surgery and the shoulder range of motion were not different between the groups. CONCLUSION: This study's results suggest that the intervention in question for patients undergoing thoracic surgery had a positive effect on reducing pain intensity, nausea and drowsiness but not the shoulder range of motion and length of stay after surgery. IMPLICATIONS FOR NURSING POLICY: Nursing policymakers may need to give a serious consideration to the revision of policies related to the nursing education curriculum as well as the in-service training curriculum regarding pain management by nurses especially after surgery. Likewise, future research on other populations employing an improved methodology as well as utilizing up-to-date evidence by nurses across different hospitals may be necessary.

Safety and efficacy of intensive intraoperative glycaemic control in cardiopulmonary bypass surgery: a randomised trial.

BACKGROUND: This study aimed to determine the safety and efficacy of intraoperative intensive glycaemic treatment with modified glucose-insulin-potassium solution by hyperinsulinemic normoglycaemic clamp in cardiopulmonary bypass surgery patients. We hypothesised that the treatment would reduce infection rates in this group of patients. METHODS: A prospective, randomised, double-blind trial was conducted in cardiopulmonary bypass surgery patients. A total of 199 adult patients (out of a planned 400) were randomly allocated to intensive or conventional treatment with target glucose levels of 4.4-8.3 mmol/l and < 13.8 mmol/l, respectively. The primary outcomes were clinical infection and cytokine levels, including interleukin (IL)-6 and IL-10. The secondary outcomes were morbidity and mortality. RESULTS: The study was terminated early because of safety concerns (hypoglycaemia). The clinical post-operative infection rate was 17% in the intensive group and 13% in the conventional group (P = 0.53). The proportion of patients with hypoglycaemia was significantly higher in the intensive group (23%) compared with the conventional group (3%) (P < 0.001). Morbidity and mortality rates were similar for both groups. Anaesthetic duration > 2 h (vs. ≤ 2 h), pre-operative IL-6 level > 15 pg/ml (vs. ≤ 15 pg/ml) and post-operative IL-6 level 56-110 pg/ml (vs. ≤ 55 pg/ml) were independent predictors for post-operative infection. CONCLUSIONS: Intraoperative intensive glycaemic treatment significantly increased the risk of hypoglycaemia, but its effect on post-operative infection by clinical assessment could not be determined. Anaesthetic duration, pre-operative and post-operative IL-6 levels can independently predict post-operative infection.