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American Journal of Critical Care. 2002;11: 415-429
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CE Article and Journal Club Feature

Practices and Predictors of Analgesic Interventions for Adults Undergoing Painful Procedures

By Kathleen A. Puntillo, RN, DNSc, Lorie Rietman Wild, RN, PhD, Ann Bonham Morris, RN, MSN, CPNP, Julie Stanik-Hutt, RN, PhD, ACNP, Carol Lynn Thompson, RN, PhD, CCRN, ACNP, CCNS and Cheri White, RN, PhD, CCRN. From the Department of Physiological Nursing, University of California, San Francisco (KAP), University of Washington Medical Center, Seattle, Wash (LRW), Children’s Recovery Center of Northern California, Campbell, Calif (ABM), Johns Hopkins University, School of Medicine, Baltimore, Md (JS-H), University of Tennessee Health Science Center, Memphis, Tenn (CLT), and Sutter Roseville Medical Center, Roseville, Calif (CW).

• Background Research is limited on analgesic practices associated with the commonly performed procedures of turning, inserting central venous catheters, removing wound drains, changing dressings on nonburn wounds, suctioning the trachea, and removing femoral sheaths.

• Objective To determine types of analgesics administered for procedures, the prevalence and amounts of drugs given, and factors predictive of analgesic administration.

• Methods Pain was assessed before and immediately after procedures. Analgesic, sedative, and anesthetic agents administered within 1 hour before and/or during each procedure were noted.

• Results A total of 5957 adult patients at 164 national and 5 international sites participated. Pain intensity increased at the time of procedure for all procedures. More than 63% of patients received no analgesics. Less than 20% received opiates; mean total dose of opiate was 6.44 mg (SD, 8.96 mg). Only 10% of patients received combination therapy. Factors associated with the likelihood of receiving opiates were pain intensity before a procedure, femoral sheath removal, being white, and the duration of a procedure. Patients less likely to receive opiates had a medical diagnosis or were having tracheal suctioning. Only 14.5% of the variance in the amount of opiate administered was explained by factors entered into multiple regression models. Type of procedure was the only significant predictor of amount of opiate administered.

• Conclusions Most patients were not intentionally medicated even though pain intensity increased during their procedure. When used, analgesic amounts were low, and combination therapy was infrequent. Clinical trials are needed to evaluate optimal pain management for patients undergoing procedures.

 

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