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Circumcision is a painful procedure that may be performed on newborns. Pain management is provided through pharmacologic and nonpharmacological methods such as administration of anesthetics, analgesia, nutritive sucking, music, and touch during and post procedure. Pain scales may be used to assess physiologic and behavioral changes in the newborn as part of the pain management process. The role of the nurse includes assisting the provider with pain management, assessing newborn pain, and teaching the family how to care and comfort the newborn post circumcision., Competing Interests: Disclosure All authors report no commercial or financial conflicts of interest. There was no funding from any source for this publication., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Australian literature supports nurse-initiated opioid analgesia protocols may be effective, but this practice is not yet widely adopted in Canada., Local Problem: Previous quality audits of Emergency Departments (EDs) in Victoria (Canada) indicate long delays to administration of analgesia., Methods: Two tertiary care hospitals in a Canadian city of approximately 400,000 people were chosen for a quality improvement initiative. A manual retrospective chart review was conducted on a total of 122 patients which was compared to data from 125 patients from a previous audit in 2019., Interventions: ED nursing staff both hospitals were provided education and daily reminders to document pain score at triage, and to flag an acute analgesia opioid order set on the charts of patients with moderate or severe pain (greater than 4 out of 10 in the Numerical Rating Scale (NRS) or by triage nurse's clinical judgment). At Victoria General Hospital (VGH), nurses had the option of finding an emergency physician (EP) to sign the acute analgesia opioid order set, or independently administer IV opioids from a presigned order set without consulting an EP. At Royal Jubilee Hospital (RJH), nursing staff could only administer IV opioids from the order set after an EP was consulted. Median time to opioid analgesia after the intervention was compared to 2019 data for each hospital., Results: Each hospital significantly reduced median time to administration of opioids: VGH achieved 45.6 % reduction (1 h 8 min improvement, p = 0.001) and RJH achieved a 62.5 % reduction (2 h 11 min improvement, p < 0.001). Secondary outcomes indicated patients may receive analgesia faster when the opioid protocol was nurse initiated (median 43 minutes) vs physician initiated (median 1 h 1 min) at VGH. Pain score documentation at triage improved from <10 % in 2019 to >50 % in 2020 at both sites. Approximately 95 % of EP and nursing staff thought nurse-initiated opioids are safe, effective, and should be supported by regulatory boards., Conclusion: Implementing a new triage protocol to expedite initiation of an analgesic protocol was associated with significantly reduced time to analgesia for patients with moderate to severe pain. Time reductions may be greater with nurse-initiated analgesia before physician assessment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: This quality improvement project implemented an evidence-based multimodal analgesia protocol among patients undergoing outpatient spine surgery in an attempt to decrease postoperative opioid requirements, postoperative pain scores, and facility and postanesthesia care unit length of stay (LOS)., Design: Two independent samples were compared with a preimplementation and postimplementation design. There were 37 patients in the preimplementation group and 36 patients in the postimplementation group., Methods: Data were collected by a retrospective chart review of neurosurgical patients undergoing spine surgery and included postoperative opioid requirements, postoperative pain scores, facility and postanesthesia care unit LOS, and the number of protocol components implemented on each patient., Findings: Intraoperative and postoperative by mouth opioid requirements were significantly decreased postimplementation. Postoperative opioid requirements decreased, and postimplementation pain scores were reduced across all time points. LOS did not significantly change., Conclusions: This multimodal analgesia protocol significantly decreased opioid consumption among neurosurgical patients at this surgery center., (Copyright © 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Introduction: Enhanced clinical outcomes in the Paediatric Intensive Care Unit following standardisation of analgesia and sedation practice are reported. Little is known about the impact of standardisation of analgesia and sedation practice including incorporation of a validated distress assessment instrument on infants post cardiac surgery, a subset of whom have Trisomy 21. This study investigated whether the parallel introduction of nurse-led analgesia and sedation guidelines including regular distress assessment would impact on morphine administered to infants post cardiac surgery, and whether any differences observed would be amplified within the Trisomy 21 population., Methodology: A retrospective single centre before/after study design was used. Patients aged between 44 weeks postconceptual age and one year old who had open cardiothoracic surgery were included., Results: 61 patients before and 64 patients after the intervention were included. After the intervention, a reduction in the amount of morphine administered was not evident, while greater use of adjuvant sedatives and analgesics was observed. Patients with Trisomy 21 had a shorter duration of mechanical ventilation after the change in practice., Conclusion: The findings from this study affirm the importance of the nurses' role in managing prescribed analgesia and sedation supported by best available evidence. A continued education and awareness focus on analgesia and sedation management in the pursuit of best patient care is imperative., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Analgesia and sedation protocols (ASPs) reduce duration of mechanical ventilation (MV) in the medical intensive care unit (ICU), but data in the surgical ICU (SICU) are limited. The objective of this study was to determine the impact of a nursing-driven ASP with criteria for infusion initiation in the SICU., Materials and Methods: A single-center, retrospective study compared ventilator-free days at day 28 from start of MV (VFD28) before and after ASP implementation. Secondary endpoints included cumulative opioid and sedative requirements, level of sedation, incidence of delirium, SICU and hospital length of stay., Results: One hundred thirty two patients were included (66 per group). The protocol group had greater VFD28 compared to the control group (21 vs. 14.5 days, p = .04). Lower rates of benzodiazepine (42.4% vs. 84.8%, p < .001) and opioid (24.2 vs. 78.8, p < .001) infusion use occurred in the protocol group, resulting in lower cumulative doses per ventilator-day through day 7. The protocol group had more documented sedation scores within target range. There were no differences in ICU delirium, SICU or hospital length of stay., Conclusions: A nursing-driven ASP with criteria for infusion initiation in mechanically-ventilated SICU patients may increase ventilator-free time, maintain patients at the target sedation goal, and reduce opioid and benzodiazepine utilization., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Adequate analgesia and sedation is crucial in critical care. There is little knowledge on the extent of painful and stressful procedures on children admitted to a paediatric intensive care unit (PICU) and its analgesic and/or sedative management., Objective: The primary objective was to determine the number of painful and stressful procedures per patient per day in our PICU patients, including the numbers of attempts. A secondary objective was to map PICU nurses' perceptions of the painfulness of the included procedures., Methods: A prospective, single-centre observational cohort study in a tertiary PICU. All patients admitted to the PICU over a 3-month period were eligible. Readmissions, polysomnography patients, and patients without any data have been excluded. The number of painful and stressful procedures was collected daily, and use of analgesics and sedatives was assessed and recorded daily. Twenty-five randomly assigned nurses rated the painfulness of procedures based on their personal experience using a numeric rating scale from 0 to 10., Results: In a 3-month period, a total of 229 patients were included, accounting for 855 patient days. The median number of painful and stressful procedures per patient per day was 11 (interquartile range=5-23). Endotracheal suctioning was the most frequent procedure (45%), followed by oral and nasal suctioning. Arterial and lumbar puncture, peripheral IV cannula insertion, and venipuncture were scored as most painful ranging from 3 to 10. Procedural analgesia or sedation was often not used during these most painful procedures., Conclusions: Mechanically ventilated patients undergo more than twice as many painful procedures than non-ventilated patients, as endotracheal suctioning accounts for almost half of all. Nurses regarded skin-breaking procedures most painful; however, these were rarely treated by procedural analgosedation and only covered in the minority of cases by adequate background analgosedation., (Copyright © 2018 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: This paper reports a systematic literature review evaluating the impact and quality of pain management associated with nurse initiated analgesia in patients presenting to the emergency department (ED)., Background: Pain is a major presenting complaint for individuals attending the ED. Timely access to effective analgesia continues to be a global concern in the ED setting; emergency nurses are optimally positioned to improve detection and management of pain., Design: Systematic review., Databases and Data Treatment: Four databases - CINAHL, EMBASE, Medline, ProQuest - the Cochrane Library and the National Institute of Clinical Excellence were searched from date of inception to December 2017; with no language restrictions applied. Studies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published valid criteria., Results: Twelve articles met inclusion, comprising a wide range of analgesics and administration routes to manage mild to severe pain. Overall study quality was high; 7 studies included a form of comparison group. Patient outcome measures included time to analgesia (n = 12; 100%), change in pain score (n = 6; 50.0%); adverse events (n = 6; 50.0%); patient satisfaction (n = 5; 41.7%) and documenting pain assessment (n = 2; 16.7%)., Conclusion: Nurse-initiated analgesia was associated with safe, timely and effective pain relief., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

In the framework of the management of patients receiving hyperbaric oxygen therapy, hypnoanalgesia is a complementary pain management tool, notably during the changing of dressings. Trained in this management of care-related pain, the teams of the hypebaric medicine centre in Lyon share their experience., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: The emergency department (ED) setting is an environment where children may experience intense physical pain and emotional stress. This study sought to determine the availability of pain and anxiety management practices in all Israeli emergency departments which accept children, specifically looking for differences between accredited pediatric emergency medicine departments and others., Methods: A cross-sectional survey of all Israeli emergency departments that accept children was performed. One person at each institution was approached to complete the survey. Data were collected between May and June 2016 using an electronic survey tool., Results: Responses were collected from 21 of 22 hospitals (95% response rate). Commonly available in all types of emergency departments were nurse ordered analgesia, medical clowns (in 95% of the hospitals), topical analgesia and oral sucrose solution. The accredited pediatric emergency medicine departments showed a tendency for more frequent use of all pharmacologic methods for pain and anxiety relief, specifically oxycodone and ketamine., Conclusions: Overall, Israeli emergency departments have similar access to pharmacologic and non-pharmacologic pain and anxiety management strategies in children, but gaps still exist, especially where not all attending physicians are pediatric emergency medicine trained. We suggest that certified pediatric emergency medicine physicians should advise all emergency departments that accept children to promote the use of the various methods of pain and anxiety reduction.

Objectives: Although acute pain is a common presentation in the Emergency Department (ED), analgesics are often delayed until the patient is seen by a physician. We assessed the effect of a medical directive for nurse-initiated analgesia on time to first dose of analgesics, proportion of patients receiving analgesics in less than 30min, and total length of stay in the ED., Methods: A medical directive for nurse-initiated analgesia was introduced in our ED in October 2011. This before-after health record review included all patients presenting to the ED with musculoskeletal back pain in 4month periods before and after implementation of the medical directive., Results: A total of 524 cases were reviewed, of which 401 were included - 201 and 200 in the before and after implementation groups respectively. After implementation there was a shorter time to first dose of analgesic (mean of 118 vs 160min, p<0.001), and a higher proportion of patients receiving analgesics in the first 30min (20% vs 4%, p<0.001). However there was no difference in total proportion of patients receiving analgesics (71% vs 67%, p=0.46) or total length of stay in the ED (337 vs 323min, p=0.51)., Conclusions: A medical directive for nurse-initiated analgesia in the ED was associated with significantly reduced time to the first dose of analgesic, and increased the proportion of patients receiving analgesics within 30min. We can conclude that medical directives for nurse-initiated analgesia effectively improve the timeliness and quality of care for patients with acute pain., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Review Question/objective: The objective is to evaluate the effectiveness of nurse-initiated interventions (NIIs) on patient outcomes in the emergency department (ED).More specifically, the objectives are to identify the effectiveness of NIIs, including but not limited to, nurse-initiated medications, nurse-initiated intravenous fluid therapy and nurse-initiated pathology on patient waiting time, time to treatment, length of stay, pain levels, symptom relief, patient satisfaction, leave without being seen rates and mortality rates in ED settings.

Background: Procedural pain reduces the quality of life of cancer patients. Although there are recommendations for its prevention, there are some obstacles for its management. The purpose of this study was to analyze the barriers to procedural pain prophylaxis in cancer patients reflecting the views of the nurses., Methods: We used qualitative methodology based on semi-structured interviews conducted with nurses, focusing on practices of venipuncture-induced and needle change for implantable central venous access port (ICVAP) pain management in cancer patients. A thematic analysis approach informed the data analysis., Results: Interviews were conducted with 17 nurses. The study highlighted 4 main themes; technical and relational obstacles, nurses' professional recognition, the role of the team, and organizational issues. Participants understood the painful nature of venipuncture. Despite being aware of the benefits of the anesthetic patch, they did not utilize it in a systematic way. We identified several barriers at different levels: technical, relational and previous experience of incident pain. Several organizational issues were also highlighted (e.g. lack of protocol, lack of time)., Conclusions: The prevention of venipuncture-induced cancer pain requires a structured training program, which should reflect the views of nurses in clinical practice.

Objective: To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation)., Methods: We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint. The study sample was randomly selected from a list of all eligible patients. Data were extracted electronically from the ED records and by explicit extraction from the medical record. Logistic regression models were constructed to assess associations with the three binary study end points., Results: 1289 patients were enrolled. Patients were less likely to receive any analgesia if they presented 08:00-15:59 hours (OR 0.67, 95% CI 0.46 to 0.98) or 16:00-24:00 hours (OR 0.55, 95% CI 0.37 to 0.80) were triage category 5 (OR 0.20, 95% CI 0.08 to 0.49) or required an interpreter (OR 0.34, 95% CI 0.14 to 0.86). Patients were less likely to receive NIA or early analgesia if they were aged 56 years or more (OR 0.70 and 0.63; OR 0.57 and 0.21, respectively) or if they had received ambulance analgesia (OR 0.59, 95% CI 0.36 to 0.95; OR 0.38, 95% CI 0.20 to 0.74, respectively)., Conclusions: Patients who present during the daytime, have a triage category of 5 or require an interpreter are less likely to receive analgesia. Older patients and those who received ambulance analgesia are less likely to receive NIA or early analgesia., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Despite recent advances in perioperative patient care, postsurgical pain continues to be undermanaged. There is increasing acceptance of the concept that effective postsurgical pain management is best achieved through combined use of more than one analgesic agent or technique, and overreliance on opioids produces unwanted side effects limiting their utility. Accordingly, a balanced, multimodal approach to pain management within the larger framework of an Enhanced Recovery After Surgery (ERAS) pathway has become standard at many institutions for perioperative care, to control postsurgical pain, reduce opioid-related adverse events, hasten postsurgical recovery, and shorten length of hospital stay. The success of ERAS is dependent on nurses and the multidisciplinary team to execute its standardized processes across the care continuum, including patient education, perioperative care, and postsurgical evaluation. Here, we review current concepts related to multimodal analgesia and ERAS regarding care of adult surgical patients and discuss the perioperative nurse's role within this paradigm., (Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.)

Problem: This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed., Method: The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management?, Results: Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future., Discussion: The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.

Acute pain relief is an ongoing challenge for both nurses and emergency physicians. Its management remains suboptimal or delayed, despite the existence of valid recommendations. The complexity of the emergency department and the diversity of encountered situations justify a tailored approach, taking into account the patient's clinical characteristics and needs. Such an approach must, under safety conditions assign sufficient autonomy to care providers in order to achieve pain relief. The benefits of an optimal analgesia are numerous. They include a greater patient satisfaction, a reduced length of stay, and a rapid return to mobility. This article highlights the key elements of acute pain management in the emergency department of the Geneva University Hospitals.

Background: Knowledge of current trends in nurse-administered procedural sedation and analgesia (PSA) in the cardiac catheterisation laboratory (CCL) may provide important insights into how to improve safety and effectiveness of this practice., Objective: To characterise current practice as well as education and competency standards regarding nurse-administered PSA in Australian and New Zealand CCLs., Design: A quantitative, cross-sectional, descriptive survey design was used., Methods: Data were collected using a web-based questionnaire on practice, educational standards and protocols related to nurse-administered PSA. Descriptive statistics were used to analyse data., Results: A sample of 62 nurses, each from a different CCL, completed a questionnaire that focused on PSA practice. Over half of the estimated total number of CCLs in Australia and New Zealand was represented. Nurse-administered PSA was used in 94% (n=58) of respondents CCLs. All respondents indicated that benzodiazepines, opioids or a combination of both is used for PSA (n=58). One respondent indicated that propofol was also used. 20% (n=12) indicated that deep sedation is purposefully induced for defibrillation threshold testing and cardioversion without a second medical practitioner present. Sedation monitoring practices vary considerably between institutions. 31% (n=18) indicated that comprehensive education about PSA is provided. 45% (n=26) indicated that nurses who administer PSA should undergo competency assessment., Conclusion: By characterising nurse-administered PSA in Australian and New Zealand CCLs, a baseline for future studies has been established. Areas of particular importance to improve include protocols for patient monitoring and comprehensive PSA education for CCL nurses in Australia and New Zealand., (Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: The study aims to evaluate the impact of a nurse-initiated analgesia pathway (NIAP) intervention for paediatric patients in the ED., Methods: We undertook a pre- and post-intervention trial in a large, tertiary referral, mixed ED. The intervention comprised development and implementation of a comprehensive NIA Standing Order. In addition to paracetamol, which nurses could initiate pre-intervention, they were authorised to administer ibuprofen, paracetamol/codeine combinations and topical local anaesthetics prior to a doctor assessing the patient. All nurses were trained and credentialed prior to administering the NIAP. Patients aged 5-17 years with a triage pain score of ≥4 (Wong-Baker or numerical rating scale) were eligible for enrolment. The primary outcome was time to analgesia. Secondary outcomes were the proportion of patients who received 'adequate analgesia' and parental satisfaction with ED pain management (measured 48 h post-discharge)., Results: Fifty-one children were enrolled in both the pre- and post-intervention periods. Patient sex and mean age, weight and triage pain score did not differ between the groups (P > 0.05). At post-intervention, significantly more patients received nurse-initiated analgesia (3.0% vs 43.9%; P < 0.001) and the median time to analgesia was significantly reduced (58 min vs 23 min; P < 0.01). Also, significantly more patients received 'adequate analgesia' post-intervention (41.2% vs 72.5%; P < 0.001). At follow up, the proportion of parents who were very satisfied with their child's overall pain management trended upwards in the post-intervention period (47.1% vs 66.7%; P = 0.07). No adverse events were observed during either period., Conclusion: The NIAP significantly reduced time to analgesia. It was associated with high levels of parental satisfaction., (© 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.)

Objective: To determine whether patient-controlled analgesia or scheduled intravenous analgesia provides superior pain relief and satisfaction with pain control after vaginal reconstructive surgery., Study Design: Fifty-nine women scheduled for vaginal reconstructive surgery were enrolled in this randomized trial. Operative procedures and postoperative orders were standardized. Visual analog scales for pain and satisfaction with pain control were recorded during the hospital stay and 2 weeks after surgery., Results: Patients receiving patient-controlled analgesia had less pain on postoperative day 1, 25 mm vs 39 mm, on visual analog scales (P = .007). Although this group used twice as much hydromorphone (3.57 mg vs 1.48 mg, P < .001), there was no difference in side effects, length of hospital stay, or complications. For the sample overall, larger amounts of narcotic used correlated with higher pain scores (r = 0.364, P = .009) and worse satisfaction scores (r = -0.348, P = .012)., Conclusion: In patients undergoing vaginal surgery, patient-controlled analgesia offers superior pain relief on postoperative day 1 when compared with scheduled, nurse-administered hydromorphone., (Copyright © 2012 Mosby, Inc. All rights reserved.)

The interplay of pain, discomfort, and fear can cause agitation in critically ill children. Therefore, sedation and analgesia are essential components in the intensive care unit setting and are best managed with a multidisciplinary team approach. No one standard approach exists to assess and manage pain and anxiety. Many tools are available for the assessment of pain and sedation, but each tool has its advantages and disadvantages. Clinicians should consider adopting a validated tool for routine continuous assessment. Multiple pharmacological therapies are available to manage pain, anxiety, fear, and agitation. Dosing of these agents can be influenced by age-related pharmacokinetic and pharmacodynamic changes. Agents should be selected on the basis of the child's disease state, desired level of sedation, and cardiac and respiratory status.

Many hospitalized patients report moderate-to-severe pain despite the use of epidural or patient-controlled analgesia. This article will explore the use of multimodal options for analgesia in hospitalized patients and focus on a difficult-to-treat acute pain condition, abdominal pain.

Background: Pain is one of the most frequent problems among patients diagnosed with cancer. Despite the availability of effective pharmacological treatments, this group of patients often receives less than optimal treatment. Research into nurses' pain management highlights certain factors, such as lack of knowledge and attitudes and inadequate procedures for systematic pain assessment, as common barriers to effective pain management. However, educational interventions targeting nurses' pain management have shown promise. As cancer-related pain is also known to have a negative effect on vital aspects of the patient's life, as well as being commonly associated with problems such as sleep, fatigue, depression and anxiety, further development of knowledge within this area is warranted., Methods/design: A quasi-experimental study design will be used to investigate whether the implementation of guidelines for systematic daily pain assessments following a theory-based educational intervention will result in an improvement in knowledge and attitude among nurses. A further aim is to investigate whether the intervention that targets nurses' behaviour will improve hospital patients' perception of pain. Data regarding nurses' knowledge and attitudes to pain (primary outcome), patient perception regarding pain (secondary outcome), together with socio-demographic variables, will be collected at baseline and at four weeks and 12 weeks following the intervention., Discussion: Nursing care is nowadays acknowledged as an increasingly complicated activity and "nursing complexity is such that it can be seen as the quintessential complex intervention." To be able to change and improve clinical practice thus requires multiple points of attack appropriate to meet complex challenges. Consequently, we expect the theory-based intervention used in our quasi-experimental study to improve care as well as quality of life for this group of patients and we also envisage that evidence-based guidelines targeting this patient group's pain will be implemented more widely., Trial Registration Number: ClinicalTrials.gov NCT01313234.

Pain treatment of surgical patients is still a deficient area, even if there are evidence-based possibilities of pain management. The aim of this study is to identify patients with a higher risk of severe postoperative pain at an early stage and improve nurses' pain management by identifying pain predictors whilst including them in analgesic treatment. In addition to the identification of predictors by a literature review, a cross-sectional study with 84 surgical patients of a convenience sample was undertaken to find possible predictors. The enquiry was conducted by means of a questionnaire which the patient had to fill in prior surgery. The intensity of pain was surveyed in a personal interview on the first post-operative day. Correlation analysis was applied to verify the statistical significance of patient characteristics as well as surgical variables. Out of the 14 variables preoperative pain was found to increase the risk of postoperative pain. Comparison with other studies showed inconsistent results for pain predictors, and therefore nursing pain management based on pain predictors seems questionable.

Although radiofrequency ablation has been accepted as a safe and effective treatment for small hepatocellular carcinoma, there are few studies addressing periprocedural pain. Our study aims were to investigate periprocedural pain and evaluate its related factors. Ninety-nine patients diagnosed as having hepatocellular carcinoma and who underwent radiofrequency ablation were consecutively enrolled. The pain intensity, mental preparation status for radiofrequency ablation, and demographic and clinical characteristics were investigated. We used an 11-point numerical rating scale to assess for pain. Forty-three percent of subjects reported the intensity of periprocedural pain as more than a level of six (severe pain). The longer duration of ablation (r(s) = .29, p = .004), the number of ablations (r(s) = .27, p = .008), higher pain anxiety (r(s) = .42, p < .001), and difficulty sleeping on the previous day (r(s) = .24, p = .019) were factors related to experiencing more severe pain. The major related factors to severe periprocedural pain were the longer duration of ablation and the more anxiety about pain. Clinicians should offer better information to radiofrequency ablation patients regarding pain expectations and carefully consider periprocedural analgesia requirements.

Several studies have shown that patients often receive inadequate treatment of postoperative pain. The aim of the present descriptive study was to examine and analyze various data related to the postoperative pain assessment of 40 patients who underwent elective surgery. Pain journals were to be completed by patients during every waking hour for the first three postoperative days to assess both pain intensity and pain unpleasantness. A post hoc analysis of patient records permitted verification of pain assessment by nurses for each patient. The results showed that not only was postoperative pain rarely assessed using a valid scale, it was also poorly documented. In addition, when nurses assessed and documented postoperative pain using a numerical scale, their results were very different from patients' assessments. For the first postoperative day, the mean (± SD) pain intensity documented by nurses on a 0 to 10 numerical scale was 1.57±0.23, while the mean pain intensity noted by patients using the same scale was 3.82±0.41. Statistical analysis showed that there was no significant correlation between mean pain intensity documented by nurses and the mean pain intensity noted by patients.

Phantom limb pain is common in patients who have amputations. This article outlines the different theories that explain the pathophysiology of phantom limb pain, including peripheral, spinal and central mechanisms. Treatment options are targeted at addressing these mechanisms, combining analgesic techniques with physical and psychological rehabilitation.

Obesity is a growing public health problem. This article provides an overview of the health implications associated with obesity. It describes laparoscopic Roux-en-Y gastric bypass surgery, an invasive intervention for the management of obesity. Strategies for achieving effective pain management following this procedure are discussed.

Registered nurses were queried about their knowledge and attitudes regarding pain management. Results suggest knowledge of pain management principles and interventions is insufficient.

Background: Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations., Objectives: The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: (a) pain intensity, (b) frequency of received analgesic, (c) time to analgesic, (d) transit time, and (e) patients' perceptions of the quality of care in pain management., Design: A quasi-experimental design with ABA phases was used., Setting: The study was conducted in an emergency department at a Swedish university hospital., Participants: Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10., Methods: The patients' perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic., Results: The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management., Conclusions: The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients' perceptions of the quality of care in pain management in the emergency department., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Procedural pain in adults is not well documented in the literature. This article provides practical advice for healthcare professionals on how to assess and manage pain in these patients. Pain management strategies for common procedures, such as removing a chest drain and redressing a leg ulcer, are detailed. Procedural pain in adults needs thorough assessment and treatment requires careful planning. Fast-acting and short-acting analgesics may provide the most convenient method of managing procedural pain. The possible presence of different types of pain, such as chronic and neuropathic pain, may need to be addressed when managing procedural pain in adults.

Sedation and analgesia are administered to critically ill children to provide comfort and pain relief, decrease anxiety and to promote patient safety in relation to life-saving treatments. A comprehensive practice guideline focused on ways to implement evidence-based sedation and analgesia practices was developed, disseminated and implemented by an interprofessional team in the pediatric intensive care unit (PICU) at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. The goals of this quality of care initiative were to (1) reduce inconsistent practices, (2) improve patient outcomes related to comfort, and (3) enhance collaboration among health care team members caring for critically ill children. An evidence-based sedation and analgesia management (SAM) guideline for critically ill, intubated and ventilated infants and children was developed over a six-month period by a team composed of PICU physicians, pharmacists and nurses. The quality of patient care initiative focused on consistent use of (a) validated sedation and analgesia assessment tools, (b) a goal-directed approach by identifying daily therapeutic target scores and titrating interventions accordingly, and (c) non-pharmacologic, pharmacologic and adjunctive measures. The authors describe their experience in the development, dissemination and implementation of an interprofessional guideline directed at improving sedation and analgesia and patient safety in the PICU. Tools developed to support the practice change, challenges and lessons learned are shared.

The UK population is ageing and a significant proportion of older people experience persistent pain. However, pain assessment in this group can be challenging, particularly when the older person has cognitive or communication impairment. Nurses working in primary and secondary care should take a more proactive role to help overcome patient, professional and institutional barriers to pain assessment and management. This article examines the age-related physiological changes that complicate the prescribing and administering of analgesic drugs in older patients and necessitate careful patient monitoring. It outlines the principles of medication administration for pain management in older people and provides examples of assessment tools that can be used in older patients.

A combination of pharmacological and non-pharmacological interventions can ensure the highest standard of care in the management of pain in children. Nurses are in a prime position to care for children and educate them and their parents on effective pain management strategies.

Aim: To explore nurses' knowledge and barriers regarding pain management in intensive care units., Background: Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan., Design: A cross-sectional study., Method: Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information., Results: The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category., Conclusion: Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan., Relevance to Clinical Practice: Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units., (© 2010 Blackwell Publishing Ltd.)

Analgesics and sedatives are routinely prescribed in intensive care on intubated premature newborns, to ensure their comfort and limit pain. The results of two studies show that there is no significant link between prolonged exposure to these treatments and a more unfavourable long-term neurological outcome.