RESEARCH – June 2011

Development, implementation and assessment of the guideline for treatment of postoperative pain in the orthopaedic ward of the North Estonia Medical Centre (NEMC)


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Aim. To evaluate the impact of implementation of the postoperative pain treatment guideline on pain treatment quality in the orthopaedic wards of NEMC measured as a decrease in mean reported pain intensity as measured by using the numerical rating scale (NRS) and change in the use and selection of analgesics.

Methods. We conducted an interventional prospective study in two stages between September 2005 and Apri l 2006. In the first stage we measured pain intensity in patients in all three orthopaedic wards, who had undergone primary total hip or knee arthroplasty, and measured the use of analgesics. In the second stage we implemented the postoperative pain treatment guideline in orthopaedic ward III. Pain management in post-arthroplasty patients in wards I and II remained the same as it had been prior to the study.

Results. We analysed the data of a total of 206 patients: 104 in the first and 102 in the second stage. Pain intensity decreased in the intervention ward after the implementation of the guideline but the change was not found to be statistically significant. The consumption of analgesics changed markedly in the intervention group after the implementation of the guideline: the use of intramuscular analgesics decreased and per oral analgesics use increased.

Conclusion. This study demonstrated a positive effect of postoperative pain treatment guidelines on the quality of pain management. However, the effect of the guideline on the intensity of pain observed in the study can be considered modest.

The impact of the guideline was more evident in the selection and use of analgesics than in changes in the intensity of pain.