Nurse Anesthetists' Perspectives on Multimodal Pain Management

Abstract

Background: Acute postoperative pain can develop into chronic pain if not managed well. Nurse anesthetists consider many factors when developing an anesthetic plan to provide optimal postoperative pain management. Multimodal pain management is recommended for managing pain in the perioperative period and this may include administering medications such as intravenous (IV) acetaminophen and IV non-steroidal anti-inflammatory drugs (NSAIDs) to the patients if not contraindicated. Even though these are valuable and daily considerations for nurse anesthetists, there is not a standard of care for addressing postoperative pain management in adult abdominal surgical procedures. Objective: The purpose of the project is to determine the perspectives of nurse anesthetists for developing postoperative pain management in adult patients having abdominal surgical procedures. Design: This is a descriptive study designed to determine if current nurse anesthetist practices are being guided by evidence-based practices and if the findings can be used to develop a standard of care. Participants: Nurse anesthetists from a local Tucson, AZ health care facility Measurements: Nurse anesthetists were interviewed in-person. They were asked six semi-structured questions and the answers were recorded and transcribed into the program NVivo. Each answer was then coded and compared for emerging common themes. Results: Five out of eleven nurse anesthetists participated in this project. Thirty-five themes were discovered and three main categories developed: 1. Nurse anesthetists consider multimodal pain management an integral part of the anesthetic plan. IV acetaminophen and IV NSAIDs are considered for every surgical patient if they are not contraindicated; 2. IV acetaminophen is used more frequently for abdominal procedures compared to IV NSAIDs because of risks for bleeding associated with IV NSAIDs; and 3. Each anesthetic plan is individualized to safely address both the patient and surgical factors. Conclusion: A multi-center study should be considered for a future project to determine if these common themes would be found consistently across health care facilities. Eventually, this information could be used to develop a standard of care for managing postoperative pain in adults having abdominal surgery. Other methods for addressing multimodal pain management such as regional blocks should be considered for future studies as well.