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Abstract

AIM: the aims of this study were to test the efficacy of a training program in order to reduce pain intensity in surgical ICU patients and improving postoperative pain assessment and management. 

METHODS: longitudinal, before and after experimental study. A total of 261 patients, 126 in Group A (before intervention) and 135 in Group B (after intervention) were included. Data were collected prospectively before and after a training intervention and the implementation of a pain management protocol. 

RESULTS: a significant reduction was observed in pain intensity scores collected at 6 hours (p=.016) 12 hours (p<.001) and 48 hours (p=.005) postoperatively. Intense pain was most observed in Group A than Group B (RR=1.98; 95% CI= 1.05-3.71, p=.0302). A significantly smaller proportion of patients treated after intervention received morphine (p=.036) and propofol (p=.045). Although there has been no increase in pain assessments, the interval (hours/minutes) between drugs administrations was reduced (Group A 6.35 +1.19 vs Group B 6.21 +0.5) (p=.006). Mechanical ventilation lasted longer in Group A (3.67 days + 6.6 vs 2.44 days + 4.45) (MD = 1.23; 95% CI= -0.1541- 2.6141) (p=.0415). 

CONCLUSION: the implementation of the organizational changes on pain prevention in this ICU, using standardized education, led to less pain in surgical ICU patients. However further randomized studies and with larger patient samples are needed. 

KEYWORDS: Analgesia, Education, Intensive care, Pain. 

Gli effetti di un intervento clinico organizzativo sulla valutazione e gestione del dolore postoperatorio in terapia intensiva: studio before-after sull'intensití  di dolore e uso dell'analgesia 

OBIETTIVI: gli obiettivi di questo studio erano di testare l'efficacia di un programma formativo sulla riduzione del dolore in terapia intensiva e sul miglioramento nella valutazione e gestione del dolore postoperatorio. 

METODI: studio longitudinale before and after. Sono stati inclusi 261 pazienti, 126 nel gruppo A (prima dell'intervento) e 135 nel gruppo B (dopo l'intervento). I dati sono stati raccolti in modo prospettico prima e dopo l'intervento di formazione e l'implementazione di un protocollo di gestione del dolore. 

RISULTATI: è stata osservata una riduzione significativa nei punteggi di intensití  del dolore raccolti a 6 ore (p=.016) 12 ore (p<.001) e 48 ore (p=.005) dopo l'intervento. Il dolore intenso è stato osservato maggiormente nel gruppo A rispetto al gruppo B (RR=1.98; 95% CI= 1.05-3.71, p=.0302). E'stata osservata una significativa riduzione nell'uso di morfina (p=.036) e propofol (p=.045) dopo l'intervento. Nonostante non ci sia stato un incremento nelle valutazioni del dolore, l'intervallo (ore/minuti) tra le somministrazioni dei farmaci è stato ridotto (Gruppo A 6.35 +1.19 vs Gruppo B 6,21 +0.5 (p=.006). La ventilazione meccanica è durata più a lungo nel gruppo A (3.67 giorni + 6.6 contro 2.44 giorni + 4,45) (MD = 1.23; IC 95% = -0.1541- 2.6141) (p=.00415). 

CONCLUSIONI: l'implementazione dei cambiamenti organizzativi sulla prevenzione del dolore in questa terapia intensiva, unita ad un'istruzione standardizzata, ha portato a una riduzione del dolore in terapia intensiva. Tuttavia, sono necessari ulteriori studi randomizzati e con campioni di pazienti più grandi. 

PAROLE CHIAVE: Analgesia, Dolore, Formazione, Terapia Intensiva 

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Damico, V., Murano, L., Manzoni, L., Riggio, M., & Dal Molin, A. (2020). The effects of a clinical therapeutic intervention in pain assessment and management in surgical ICU patients: a before-and-after intervention study on pain intensity and use of analgesia. PROFESSIONI INFERMIERISTICHE, 73(2). Recuperato da https://profinf.net/pro3/index.php/IN/article/view/767
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