Pain management following discharge after ambulatory same-day surgery.
OBJECTIVE
Same-day surgeries are becoming routine for many surgical procedures. However, the degree to which patients need help with pain management at home following laparoscopic cholecystectomy (LC), shoulder, or hand ambulatory day surgery has received minimal examination. This study examined pain and related interference, analgesic use and adverse events, complications and resources utilized, and adequacy of postdischarge information at four time periods.


METHODS
Data were collected from 180 patients by telephone interviews at 24, 48 and 72 hours, and 7 days after discharge. Patients (n = 78 hand, 48 shoulder, 54 LC surgery) were on average 41 years old.


RESULTS
For all patients, worst 24-hour pain was reported as moderate to severe at all time periods. Using repeated measures anova demonstrated that shoulder patients had significantly more pain and overall pain-related interference, particularly in sleep and work, from 24 hours to day 7 than did hand or LC patients. The main analgesic taken was acetaminophen (paracetamol) with codeine 30 mg; 50% took no analgesia from 72 hours. About 20% experienced analgesic adverse events within 72 hours, mainly constipation and nausea. Only </=6% used non-pharmacological strategies. Bleeding (4%) and sore throat (11%) at 24-48 hours were identified as complications; six patients (4%) called their physician. Most patients received no information about analgesic use with inadequate pain relief and/or adverse events.


CONCLUSIONS
Despite the considerable pain reported across all time periods, analgesic use and other interventions were minimal. Adverse events, which were problematic for some, may explain why patients stopped analgesics despite pain. These data support further research on more effective pain interventions and related education for day-surgery patients after discharge.
Watt-Watson
Judy
J
Faculty of Nursing, and Centre for the Study of Pain, University of Toronto, Ontario, Canada. j.watt.watson@utoronto.ca
Chung
Frances
F
Chan
Vincent W S
VW
McGillion
Michael
M
D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000451:nursing; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000704:Analysis of Variance; D001294:Attitude to Health; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000451:nursing; D005260:Female; D006225:Hand / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015403:Nursing Evaluation Research; D009864:Ontario / Q000453:epidemiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000592:standards; D015995:Prevalence; D011446:Prospective Studies; D012648:Self Care / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D012782:Shoulder / Q000601:surgery; D011795:Surveys and Questionnaires
D000700:Analgesics