[Ambulatory surgery and anaesthesia]

The effects of a psycho-educational intervention to improve pain management after day surgery: A randomised clinical trial

AIMS AND OBJECTIVES

To evaluate the effectiveness of a psycho-educational intervention for shoulder and breast day surgery patients in decreasing pain intensity and pain interference with function and strengthening adherence with the analgesic regimen; and further to identify factors that influence average pain intensity and pain interference with function.

BACKGROUND

Pain is one of the most prevalent symptoms after day surgery. However, pain management is left to the patients and family, and interventions to help patients are needed.

DESIGN

Randomised clinical trial with an intervention (n = 101) and a usual care group (n = 119) using multiple measurements during 6 months postoperatively. The CONSORT checklist is used.

METHODS

Patients in the intervention group received a booklet about pain and pain management and coaching by research nurses on postoperative days 2, 3 and 7. Differences between groups were identified using the chi-squared analysis and t tests. Changes with time were identified using a linear mixed model with repeated measures.

RESULTS

After controlling for covariates, group differences at any time in average pain intensity and pain interference with function were not statistically significant. Changes over time within any one group in average pain intensity and pain interference with function were statistically significant and decreased with time. Higher levels of average pain intensity and pain interference over time were associated with shoulder surgery, female, younger, pain expectation, preoperative pain and poorer adherence.

CONCLUSIONS

No group differences related to the intervention were revealed, and preoperative teaching together with a pain management booklet and coaching may help to strengthen the intervention's effects. Further research on interventions directed towards pain management is needed.

RELEVANCE TO CLINICAL PRACTICE

Day surgery patients' postoperative pain and pain management is not satisfactorily handled. To encourage and educate patients to use the prescribed analgesics in the immediate postoperative days may be necessary to enhance pain management.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT01595035).

A planned but vulnerable pathway towards self-management following day surgery. Orthopaedic patients' experiences

INTRODUCTION

An increasing share of surgical activity is organised as day surgery, thus giving more responsibility for care to patients and their next of kin.

PURPOSE

To obtain increased understanding of orthopaedic day surgery patients' experiences with self-management.

METHODS

A descriptive interview study. Eleven men and five women aged 18-78 years, who had undergone arthroscopic knee surgery in rural Norway participated in qualitative individual interviews during autumn 2018. Systematic text condensation was used as analysis strategy.

RESULTS

The main theme a planned but vulnerable pathway towards self-management and five subthemes were highlighted. The interviewees were satisfied with most aspects of the day surgery. However, challenges in adapting oral and written information to self-management postdischarge, a need for further self-management support at home, and strenuous travel increased the strain.

CONCLUSION

The written and oral information and support that was planned and provided by the hospital did not meet the patients' needs for self-management support postdischarge. The day surgery care pathway seemed to lack effective educational interventions for strengthening the patients' self-efficacy and control and to have potential for improvements.