Pain Assessments

Guidelines:

• Narcotics to be minimized wherever possible
• Increase use of blocks where appropriate
• Consider alternative treatment options where appropriate
• Longer acting pain control
  • Avoid peaks and valleys
• Ongoing participation in continuing education and pain control development

Considerations:

• Patient fear of pain
• Opioids increase post op nausea
• Blocks can be performed intra-op
  • TAP blocks
  • Needs consent!

Nurse’s role:

• Advocate for reduction in opioid use
• Patient education on pain control and alternative techniques
  • Preop and PACU
• Be expert in block care and spinal assisting
  • Cat back
  • Reassurance
• Blocks take time, anticipate and reduce delays for more adoption
• OR interview before block!
  • Typically given versed if needed during block
  • Can no longer consent

Pitfalls:

• Blocks cause delays, incentivizing avoidance
• Opioids are easy for PACU discharge
  • Typically 20 min stay after dosing
• Conversion to open procedure without tap block consent
  • Anticipate!
• Unaccounted for narcotics
  • Anesthesia carts
• Block before interview

Examples:

• Patient with extreme pain in PACU despite narcotic dosing (consider admission, consult surgeon, anticipate return to OR if warranted)
• OR has 2 blocked cases and one traditional case (traditional case first, to give time for block to be placed before surgery time)

Linchpins (Key Points):

• Opioids to be avoided wherever possible, with new techniques finding adaptation into existing OR practice