Routine postoperative care of patients undergoing coronary artery bypass grafting on cardiopulmonary bypass

Patient Experience of Pain Management Following Cardiac Surgery: A Mixed Methods Study

PURPOSE

Recovery following cardiac surgery via sternotomy involves weaning from invasive mechanical ventilation, maintaining hemodynamic stability, and preventing complications. In the early postoperative period, a key priority is adequate pain control to allow patients to actively participate in exercise. The purpose of this study was to (i) describe analgesic prescribing and administration practices following cardiac surgery via sternotomy and (ii) explore patients' pain experience and how this impacted participation in early postoperative care.

METHODS

This research project was a pilot descriptive exploratory study using multiple methods and conducted within a single site. A medical record chart audit was performed to obtain details of prescribed and administered multimodal analgesics and pain intensity scores over the first 3 days following surgery. Semi-structured interviews and responses to validated questionnaires were obtained from 20 postoperative patients on days 3-4 following cardiac surgery to determine pain experience and the impact of pain on participation in recovery.

RESULTS

Patients had a varied experience of pain intensity during their recovery. A total of 19 patients (95%) received 100% of their fixed daily dose of analgesics, but only 22% of available as needed opioids were administered on day 1 and only 12% were administered on day 2. Many patients experienced higher levels of pain at both rest and movement in the 24 hours prior to interview than were recorded in their medical records.

CONCLUSIONS

Patients can experience significant pain following major cardiac surgery, and this pain can hinder their ability to participate in important activities, such as deep breathing and coughing and mobilizing, that are central to their recovery. Gaps in the management of breakthrough pain in the early postoperative period were identified. To promote optimal recovery following cardiac surgery, nurses need to assess pain at both rest and movement and administer effective doses of as needed analgesia to manage the occurrence of breakthrough pain. Additionally, patients need to be more informed to understand the link between well controlled pain and their ability to participate in their recovery.

CLINICAL IMPLICATIONS

To promote optimal recovery following cardiac surgery, nurses need to assess pain at both rest and movement and administer effective doses of as needed analgesia to manage the occurrence of breakthrough pain. Additionally, patients need to be more informed to understand the link between well controlled pain and their ability to participate in their recovery.