Nursing Reports 2014; volume 4:3225 Pain management after their pain management. As part of quality care assurance, the overall purpose of this study Correspondence: Margareta Warrén Stomberg, lung surgery was to explore patients’ experience of pain University of Gothenburg/The Sahlgrenska after lung surgery and, from their perspective, Academy, Institute of Health and Care Sciences, Maria Frödin,1 evaluate the quality as well as satisfaction PO Box 457, SE 405 30 Gothenburg, Sweden. Margareta Warrén Stomberg2 regarding the postoperative pain management. Tel.: +46.31.7866026 - Fax: +46.31.7866050. E-mail: [email protected] 1Sahlgrenska University Hospital/Mölndal, Mölndal; 2University of Surgical procedure and Key words: postoperative pain management, lung Gothenburg/The Sahlgrenska Academy, pain managements surgery, satisfaction, expectation. Institute of Health and Care Sciences, In lung surgery, the surgical technique is either Contributions: MWS, study design, manuscript Gothenburg, Sweden an open one via thoracotomy or video-assisted analysis, preparation and final editing; MF, design, thoracic surgery (VATS) using a minimally data collection, data analysis and manuscript invasive endoscopic procedure. Thoracic preparation. Both authors read and approved the epidural analgesia (TEA), has been the golden final manuscript, as well as the revision. Abstract standard of pain management after lung sur- gery via thoracotomy.6,7 However, paravertebral Conflict of interests: the authors declare no block, (PVB), has been shown to provide compa- potential conflict of interests. Pain management is an integral challenge in rable pain relief to TEA, but with fewer side nursing and includes the responsibility of Received for publication: 11 March 2014. effects.7,8 If TEA or PVB are not suitable, inter- managing patients’ pain, evaluating pain Revision received: 29 May 2014. costal nerve blocks, bolus and continuous infu- therapy and ensuring the quality of care. The Accepted for publication: 30 May 2014. sion, combined with IV analgesic, are recom- aims of this study were to explore patients’ mended. Complementary medications as part of This work is licensed under a Creative Commons experiences of pain after lung surgery and multimodal analgesia, such as paracetamol, Attribution NonCommercial 3.0 License (CC BY- evaluate their satisfaction with the postoper- weak opioids and non-steroidal anti-inflamma- NC 3.0). ative pain management. A descriptive design tory drugs, are also recommended.9,7 was used which studied 51 participants only©Copyright M. Frödin and M. Warrén Stomberg, undergoing lung surgery. The incidence of 2014 moderate postoperative pain varied from 36- Acute and prolonged Licensee PAGEPress, Italy 58% among the participants and severe pain post-surgical pain Nursing Reports 2014; 4:3225 doi:10.4081/nursrep.2014.3225 from 11-26%, during their hospital stay. A prolonged and high impulse flow inuse a nerve Thirty-nine percent had more pain than can lead to a persistent up-regulation of activ- expected. After three months, 20% experi- ity, from the spine and inwardly. This refers to enced moderate pain and 4% experienced be wind-up, indicating the pain has been sus- lems arising from POPM,13 which also affect severe pain, while after six months, 16% taining and strengthened as well. A central patients’ experiences of and satisfaction with experienced moderate pain. The desired sensitization may also appear with increased the nursing care provided. quality of care goal was not fully achieved. sensitivity in the receptors around the injured Wilson14 showed that specialist nurses have a We conclude that a large number of patients area, which leads to a conversion of pressure more comprehensive knowledge base in gen- experienced moderate and severe postopera- and touch signals to nociceptive signals, which eral pain management, compared to general tive pain and more than one third had more in turn indicate pain. Offensive and multi- nurses. It seems this knowledge base was pain than expected. However, 88% were satis- modal pain management minimizes the risk of fied with the pain management. The findings secondary hyperalgesia and the wind-up phe- influenced by the specialist nurses’ education confirm the severity of pain experienced nomena and therefore the development of rather than their experience of years working 11,15 after lung surgery and facilitate the apparent chronic pain.6 Steegers et al.10 found that up to in the nursing profession. Other studies need for the continued improvement of post- half of the patients with chronic pain did not have found a discrepancy between patients’ operative pain management following this have a neuropathic pain component, which and nurses’ pain reports. The result indicated procedure. suggests other causes for the chronic pain, that nurses overestimated mild pain and Non-commercialsuch as a visceral pain component. underestimated severe pain.11 Dihle et al.15 Furthermore, a number of predisposing factors observed nurses’ actions and after interview- for the development of chronic pain and disor- ing them found a discrepancy between their Introduction der after surgery have been identified: preop- words and actions in the postoperative pain erative pain and anxiety, female sex, type of management, which demonstrated that the 1,3 Patients undergoing lung surgery run a risk of surgery, severe pain during the first few post- nurses had theoretical knowledge about suffering from postoperative pain and some operative days, depression and anxiety, young POPM, but did not always use it in the clinical 3,11 1,10,12 may develop chronic pain.1,2 Chronic pain has age, and the length of surgery. setting. Nurses with specialist training are been found in 21-61% of patients after lung closely involved in the peri-operative pain surgery.3 Furthermore, studies have found that Nursing perspective management. They have a responsibility to lung surgery may cause long-term negative in postoperative pain management effectively manage patients’ pain, offer infor- effects for the patients, in terms of suffering, Pain management for surgical patients is inte- mation and education to patients about differ- reduced quality of life and an ultimately gral to nursing. The knowledge and attitude of ent options regarding pain management, as increased cost to society.4,5 According to the nurses towards pain management will affect well as ensure that patients’ pain problems are national guidelines developed by the Swedish patients’ postoperative pain management recorded and evaluated.16 Society of Anaesthesia and Intensive Care, (POPM). Educational programs have proven to The aims of this study were to explore pain should be treated preventively, using an increase nurses’ knowledge about POPM and patients’ experience of pain after lung surgery individual approach that involves patients in their competence of managing patient prob- and from the patients’ perspective, evaluate [Nursing Reports 2014; 4:3225] [page 1] Article the quality of and satisfaction with the postop- naire, where higher values indicated higher pleted the Swedish version of the HAD scale erative pain management. quality of pain management, scored on a 5- during their preoperative ward visit. They point scale from 1=strongly disagree to also completed the HAD scale on the day of 5=strongly agree. It was suggested that a mean discharge or latest on POD 5. In order to score of >4. 5 indicated a high quality of care;17 assess the quality of postoperative pain man- Materials and Methods and <4 a low quality of care.18,19 To achieve a agement, the patients completed the Swedish high quality of care in the postoperative pain version of the SCQIPP questionnaire on the This was a descriptive study which consecu- management, the desired total mean score day of discharge or POD 5. Fifteen patients tively included participants from the waiting must be ≥63/70 (14 items ¥ 4.5). The comple- (29%) asked the data collector to read the list for lung surgery, from May to December mentary questions in the instrument were: questions and complete the answers in the 2011, at a department of vascular and cardio- Has the patient had more pain than expected? HAD scale preoperatively and five (10%) thoracic surgery, at a university hospital in rated with Yes/No. How satisfied/dissatisfied received help to complete the questionnaires southwest Sweden. was the patient with the overall pain manage- on discharge day or POD 5. ment? scored on a 5-point Likert scale ranging All the patients received the same preoperative Sample from 1=very dissatisfied to 5=very satisfied.17 information. What distinguishes the study In this study 52 patients were consecutively from the general ward routine was the regular invited to participate. Inclusion criteria were Hospital anxiety and depression measuring of the VAS score, at rest and when adult patients (aged 18 or above) undergoing scale coughing, during the hospital stay until dis- charge or POD 5. Prior to the study, the gener- elective lung surgery and able to read and The hospital anxiety and depression (HAD) al ward routine was to discontinue document- understand the questions in Swedish. Patients scale measured anxiety and depression and ing the VAS score after the chest tube had been were excluded if they were diagnosed with each item was rated between 0-3. The total mental disorders, experienced pain for more removed. score ranged from 0-21 in the each of the two On the day of the surgery, POD 0, the VAS than three months before surgery and/or had a subscales (HAD-A and HAD-D). HAD-A and/or regular intake of analgesic(s) at least three scores were measured directly at the post- HAD-D ≤7 would indicate no or very mild anx- days/week, required emergency care, and/or anesthesia care unit (PACU), at rest and when iety or depression, whereas their scores ≥8-10 coughing,only by the ICU duty nurse, and on the had lung surgery previously. Ten patients from could indicate a possible anxiety or depression the list of scheduled surgery were not invited general surgical ward by the registered nurse and scores ≥11 could indicate a probable anxi- responsible for the patients.