| Citation
|
|
Management
of Acute Post Operative Pain. Washington, DC: VA/DoD Clinical Practice
Guideline Working Group, Veterans Health Administration, Department
of Veterans Affairs and Health Affairs, Department of Defense, October
2001. Office of Quality and Performance publication 10Q-CPG/Pain-01 |
| Completion
Date: |
|
October
2001 |
| Release
Date: |
|
October
2001 |
| Source(s):
|
|
The
Management of Postoperative Pain Guideline was developed by and written
for clinicians by clinical experts from the DoD, VHA, academia, a
team of guideline facilitators from the private sector. An experienced
moderator facilitated the multidisciplinary working group that included
anesthesiologists, internists, nurses, pharmacists, and expert consultants
in the field of guideline and algorithm development. |
| Adaptation: |
|
The development process
of the guideline incorporated information from several sources into
a format which maximally facilitated clinical decision-making (Woolf,
1992). This effort drew, among others, from the following sources:
Acute Pain Management Guideline Panel. Acute Pain Management: Operative
or Medical Procedures and Trauma. Clinical Practice Guideline. AHCPR
pub. No. 92-0032. Rockville, MD: Agency for Health Care Policy and
Research, Public Health Service, U.S. Department of Health and Human
Services. Feb 1992. VHA, Pain as the 5th Vital Sign Toolkit, Washington,
DC: National Pain Management Coordinating Committee, October 2000.
Pain Standards for 2001, Joint Commission on Accreditation of Healthcare
Organizations, 2001, http://www.jcaho.org/standard/stds2001_mpfrm.html.
|
| Guideline Status: |
|
This is the current release
of the guideline. An update is targeted for 2004. |
| Developer(s): |
|
Veterans Health Administration
(VHA), Department of Veterans Affairs (VA) - Federal Government Agency
[U.S.] Department of Defense (DoD) - Federal Government Agency [U.S.] |
| Funding Source: |
|
United States Government
|
| Committee: |
|
Management of Postoperative
Pain Working Group |
| Group Composition: |
|
Pain
contributors |
| Disease Condition: |
|
Management of Postoperative
Pain |
| Category: |
|
Assessment, Diagnosis, Treatment,
Management and Follow -up |
| Intended Users: |
|
Designed for use by medical
care providers. The guideline can also be used to coordinate, and
standardize care and as teaching tools for students and house staff. |
| Target Population: |
|
Persons eligible for care
in the VA or DoD health care delivery system. |
| VHA Contact Person(s): |
|
VHA :
Jane H. Tollett, PhD, RN
National Director, Pain Management Strategy
VHA Headquarters (114)
810 Vermont Ave., NW
Washington, DC 20420
202-273-8537
202-273-9131 (fax)
jane.tollett@mail.va.gov
DoD:
Andrew Kowal, MAJ,MC, USA
Chief, Pain Clinic
Madigan Army Medical Center
10907 SW 232 Street
Vashon, WA 98070
253-968-1085
253-968-0525 (fax)
yakowal@nwlink.com
|
OBJECTIVES
- To promote evidence-based
management of individuals postoperative pain
- To identify the critical decision points
in management of patients with postoperative pain
- To develop a collaborative pain management
plan with the patient.
- To provide appropriate patient and family
education.
- To optimize the use of therapy to control
symptoms.
- To reduce the incidence and severity of patients'
postoperative pain.
- To minimize preventable postoperative complications
and morbidity.
- To improve local management of patients
with postoperative pain and thereby improve patient outcomes
|
INTERVENTIONS
AND PRACTICES
The guidelines are meant to assist medical care
providers in all aspects of care for patients with postoperative
pain through assessment, special needs, interventions, and planning
for pain management
|
OUTCOMES CONSIDERED
The goal for the management of patients with
postoperative pain is to improve the postoperative experience, and
to reduce the morbidity that is associated with unmanaged pain.
|
MAJOR RECOMMENDATIONS
The guideline is presented in an algorithmic
format and is intended to provide a systematic approach to the evaluation
and management of patients with postoperative pain
|
|
CLINICAL ALGORITHMS
Preoperative
Pain Algorithm 1
Postoperative
Pain Algorithm 2
|
TYPE OF EVIDENCE
The development process for the Guideline was
evidence-based whenever possible. Evidence-based practice integrates
clinical expertise with the best available clinical evidence derived
from systematic research. Where evidence is ambiguous or conflicting,
or scientific data are lacking, the clinical experience within the
multidisciplinary group guided the development of consensus-based
recommendations.
|
DESCRIPTION
OF METHODS TO COLLECT EVIDENCE
The working group leaders were solicited for
input on focal issues prior to a review of the literature, and a
working list of questions was generated. Electronic searches of
the Cochrane Controlled Trials Register (Cochrane Reviews) were
undertaken. Full texts or abstracts of the Cochrane reviews were
provided to the experts at the May 2000 meeting. In addition, a
search was carried out using the National Library of Medicine's
(NLM) MEDLINE database. Papers selected for further review were
those published in English-language peer-reviewed journals between
1980 and 2000. Preference was given to papers based on randomized,
controlled clinical trials, or nonrandomized case-control studies.
Studies involving meta-analysis were also reviewed.
|
METHODS TO ASSESS
THE QUALITY AND STRENGTH OF THE EVIDENCE
The literature was critically analyzed with evidence grading.
The rating scale used for this document was based on the evidence
rating used by U.S. Preventative Services Task Force (http://text.nlm.nih.gov/cps/www/cps.3.html).
The Grading Scheme Used for the
Guideline
Table I: Evidence Grading Table
|
Quality of Evidence (QE)
|
| Grade |
Description |
| I |
Evidence is obtained from at
least one properly randomized controlled trial. |
| II-1 |
Evidence is obtained from well-designed
controlled trials without randomization. |
| II-2 |
Evidence is obtained from well-designed
cohort or case-control analytic studies, preferably from more
than one center or research group. |
| II-3 |
Evidence is obtained from multiple
time series with or without the intervention. Dramatic results
in uncontrolled experiments could also be regarded as this type
of evidence. |
| III |
Opinions of respected
authorities are based on clinical experience, descriptive studies
in case reports, or reports of expert committees. |
Table 2. Recommendation Rating
Scheme
|
Recommendation
|
| Grade |
Description |
| A |
There is good evidence to support
the recommendation that the condition be specifically considered. |
| B |
There is fair evidence to support
the recommendation that the condition be specifically considered
|
| C |
There is insufficient evidence
to recommend for or against the inclusion of the condition,
but a recommendation may be based on other grounds. |
| D |
There is fair evidence to support
the recommendation that the condition be excluded from consideration
|
| E |
There is good evidence to support
the recommendation that the condition be excluded from consideration
|
|
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