title: Improved analgesia after the realisation of a pain management programme in ICU patients after cardiac surgery.
abstract: OBJECTIVE
  Although clinical guidelines recommend systematic evaluation of pain in ICU patients, we know little about the effects from such systematic pain evaluation. This study aims to quantify the effect of a pain management programme in the ICU.
  
  
  METHODS
  In this prospective two-phase study, pain levels scored by ICU patients after cardiac surgery through sternotomy were compared before and after the implementation of a pain management programme. The pain management programme consisted of a three-fold strategy; all staff was trained in assessing pain and in providing adequate analgesia, a new patient data management system obliged nurses to ask patients for their pain score three times a day and the preferred analgesic treatment was optimised. The numeric rating scale (NRS 0-10) was used by 190 patients. A NRS at least 4 was considered unacceptable. A generalised linear mixed-effects model was used for analysing repeated measurements data.
  
  
  RESULTS
  The occurrence of unacceptable pain (NRS > or = 4) was significantly lower in the intervention group [odds ratio 2.54 (95% confidence interval 1.22-5.65; P = 0.01) for the control group]. Patients in the intervention group received significantly more morphine (29.3 vs. 22.6 mg a day, P<0.01), with higher morphine amounts administered to patients with higher NRS scores (P = 0.01). In the control group, no such relationship was observed (P = 0.66). There was no difference in length of stay in the ICU or in ventilation time.
  
  
  CONCLUSIONS
  The intervention programme successfully reduced the occurrence of unacceptable pain. Further improvement of pain management should focus on the prevention of pain.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Management, St Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: van Gulik
authors.forename: Sabine J
authors.initials: SJ
authors.lastname: Ahlers
authors.forename: Zina
authors.initials: Z
authors.lastname: Brkić
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Belitser
authors.forename: Wim J
authors.initials: WJ
authors.lastname: van Boven
authors.forename: Eric P
authors.initials: EP
authors.lastname: van Dongen
authors.forename: Catherijne A
authors.initials: CA
authors.lastname: Knibbe
authors.forename: Peter
authors.initials: P
authors.lastname: Bruins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D056346:Sternotomy / Q000009:adverse effects / Q000379:methods
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D009020:Morphine