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

Aims: 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.