Team effort reduces pain, sends patients home early

January 15, 2007
A team effort among doctors and nursing staff has produced a better way to manage pain after hysterectomy surgery at New Hanover Regional Medical Center, allowing women to return home sooner and healthier.

The change in post-surgery pain management strategy was inspired in part by the success of orthopedic surgeons at the medical center, who understood that the sooner patients get out of bed and become mobile, the better their recovery will go.

“It’s Nursing 101 combined with medical treatment to help us provide care,” said Barbara Buechler, RN, Director of Women’s and Children’s Services at New Hanover Regional. “Nurses know that improved mobility reduces complications.”

Hysterectomy patients formerly were given general anesthesia during surgery and a pump to self-administer narcotics for pain after surgery. The drugs eased the pain, but the patient was slow to eat, walk and return to normal function.

A group of gynecological surgeons, anesthesiologists, registered nurses and a clinical pharmacist took on a quality improvement project to come up with a better, more efficient way to manage pain. Dr. Henry Temple, a gynecological surgeon with the Coastal Area Health Education Center, is credited with the suggestion that set the new protocols in place.

Under the new protocols, which began about 18 months ago, patients are injected with a long-acting morphine in their spine, much like an epidural during labor – something many of the hysterectomy patients already know about. Physicians typically use the same pain management strategy for Caeserean delivery, knowing the body returns to normal function more readily from the regional anesthesia than general.

After surgery, patients require little or no narcotics to manage their pain. Instead, patients are given aspirin, ibuprofen or other non-steroidal, anti-inflammatory pain relievers. The more alert patient is able to move around, eat regular food and get ready to go home much sooner.

Since the project began, the average length of stay for hysterectomy patients has dropped from 3.3 days to less than 2.5 days.

“Patients are up and about sooner, and are much more comfortable in the post-op period,” said Dr. Josh Vogel, one of the physicians who worked on the new protocol. “Every aspect of their recovery is better. They’re able to get back to eating and driving sooner. It’s been everything we hoped it would be.”

The success raises the possibility of similar pain relief strategies for other surgeries. The approach would not be feasible with outpatient surgery, but could be for many inpatient procedures.

“It’s likely to be generalized to other abdominal surgery,” Dr. Vogel said.

Ask your surgeon, in consultation with an anesthesiologist, about the best strategy for post-surgical pain relief