Pain management in enhanced recovery pathways

It goes without saying that reducing pain post surgery should be a principle aim of any enhanced recovery pathway. But what is the best way to do this?

This is a frequent question, and the research in this area across all of the surgical specialties is increasing. Evaluating all of this evidence can be difficult so a great resource and starting point is the PROSPECT website.

PROSPECT is a collaborative working group chaired by Henrik Kehlet, and the website is a fantastic resource of systematic literature reviews. Whilst some of the reviews need updating in light of new research over the last 2 years, it is an excellent site that has clear recommendations for practice.

Once you have considered the evidence and are developing your pain management protocol, remember that the most important element will be to agree a single approach. Keeping it as simple as possible to follow will help to ensure that it is delivered correctly across professional groups (surgeons, anaesthetists, ward doctors, pain team, nursing staff, physio’s, and pharmacists). Some other steps we have found useful in the development of pain pathways are

• Communicating the pathway widely so that everybody is familiar with what is expected – remember to include night staff and most importantly the patients. You cannot over do this. Regular updates and refreshers are crucial.
• Make it difficult not to follow the pain protocol. Methods may include pre-printed drug charts and using defaults where approriate.
• Put summary charts and prompts where people will see them. For example on the ward drug cupboard, in the anaesthetic room and also in recovery.
• Monitor and analyse the outcomes of the protocol weekly. Look at both outcomes and variances to the protocol. Put the weekly results on the wall, discuss them at weekly meetings, and make pain management everybody’s concern
• When it is time to improve the pathway, change one element at a time and monitor the effect.

If you have any other ideas or resources that you would like to share on how to improve pain management please get in touch or make a comment below.