Examination of Pain Assessment and Multimodal Analgesia Records in Trauma Patients

Abstract

Objective: This study aimed to reduce the side effects of multiple pain sources and investigate the effectiveness of multiple analgesics in trauma pain. Materıals and Methods: The research was conducted with nurse observation forms of 190 trauma patients hospitalised in the emergency unit of a university hospital between March 1 and September 30, 2019. In the statistical analysis, per cent mean, min-max values and standard deviation were used for descriptive data. Paired Simle t-test was used for repeated measurements of the double-dependent variable. Results: The mean age of the patients included in the study was 40.94±15.18 years, and 65.8% were male. While the cause of 47.9% of traumas is traffic accidents, 37.9% of the patients have multiple traumas. The pain was evaluated in 55.7% of the patients, and multimodal analgesia was applied in 71.6% of the patients, and it was determined that the pain of the patients decreased. Conclusions: Accordingly, this study supports the treatment of trauma pain with multiple sources of pain with a multimodal analgesia approach. In addition, the pain was not appropriately assessed as recommended in the acute pain guidelines. Therefore, nurses should increase awareness of pain assessment records for effective pain management.

Keywords

• Emergency department
• multimodal analgesia
• nursing
• pain

Travma Hastalarında Multimodal Analjezi ve Ağrı Değerlendirme Kayıtlarının İncelenmesi

Öz

Amaç: Bu çalışmada, travma hastalarında ağrı değerlendirmesi ve multimodal analjezi kayıtlarının incelenmesi amaçlanmıştır. Materyal ve Metot: Araştırma 1 Mart-30 Eylül 2019 tarihleri arasında, bir üniversite hastanesinin acil ünitesinde yatan, 190 travmalı hastanın hemşire gözlem formlarıyla yapıldı. Araştırmanın verileri Hasta Bilgi Formu ve Multimodal Analjezi Değerlendirme Formu ile toplanmıştır. Verilerin istatistiksel analizinde tanımlayıcı verilerde yüzde ortalama, min-maks değerleri ve standart sapma kullanıldı. İkili bağımlı değişkene ait tekrarlı ölçümler için Paired Simle t- testi kullanıldı. Bulgular: Araştırmaya dâhil edilen hastaların yaş ortalaması 40,94±15,18 olup, %65,8’i erkektir. Travmaların %47,9’unun nedeni trafik kazaları iken, hastaların %37,9’unda multiple travma mevcuttur. Hastaların %55,7’sine ağrı değerlendirmesi yapılmış olup, %71,6’sına multimodal analjezi uygulandığı ve hastaların ağrısının azaldığı saptandı. Ayrıca, gözlem formlarında farmakolojik olmayan ağrı tedavisine ilişkin hemşire kaydına rastlanmadı. Sonuç: Buna göre, bu çalışma travma ağrısının çoklu ağrı kaynakları ile multimodal analjezi yaklaşımı ile tedavisini desteklemektedir. Ek olarak, ağrı, akut ağrı kılavuzlarında önerildiği gibi uygun şekilde değerlendirilmemiştir. Bu nedenle hemşireler, etkili ağrı yönetimi için ağrı değerlendirme kayıtlarının farkındalığını arttırmalıdır.

Anahtar Kelimeler

• Ağrı
• acil servis
• hemşirelik
• multimodal analjezi

References

1. 1. Amini K, Fakhri AS., Salehi H, Bakhtavar EH, Rahmani F. Mortality Prediction in Multiple Trauma Patients Using GAP, RTS and NTS Models. Trauma Monthly, 2021;26(5), 252-257. 10.30491/TM.2021.262592.1212
2. 2. Yu Z, Xu F, Chen D. Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short-term prognosis of emergency trauma patients: a retrospective study. BMJ Open. 2021;11(3):e041882. Published 2021 Mar 15. doi:10.1136/bmjopen-2020-041882
3. 3. Masoudi Alavi N, Aboutalebi MS, Sadat Z. Pain management of trauma patients in the emergency department: a study in a public hospital in Iran. Int Emerg Nurs. 2017;33:53-58. doi:10.1016/j.ienj.2016.10.005.
4. 4. Pfeifer R, Pape HC. Diagnostik und Versorgungsstrategien beim polytraumatisierten Patienten [Diagnostics and treatment strategies for multiple trauma patients]. Chirurg. 2016;87(2):165-175. doi:10.1007/s00104-015-0139-0
5. 5. Wuthisuthimethawee P, Sookmee W, Damnoi S. Non-randomized comparative study on the efficacy of a trauma protocol in the emergency department. Chin J Traumatol. 2019;22(4):207-211. doi:10.1016/j.cjtee.2019.04.003
6. 6. Özveren H, Faydalı S, Gülnar E, Dokuz HF. Attitude and applications of nurses to evaluate pain. J Contemp Med 2018;8(1):60-66. https://doi.org/10.16899/gopctd.388195
7. 7. Erden S, Arslan S, Deniz S, Kaya P, Gezer D. A review of postoperative pain assessment records of nurses [published correction appears in Appl Nurs Res. 2018 Jan 10;:]. Appl Nurs Res. 2017;38:1-4. doi:10.1016/j.apnr.2017.08.003
8. 8. Reisli R, Akkaya ÖT, Arıcan Ş, et al. Akut postoperatif ağrının farmakolojik tedavisi: Türk Algoloji-Ağrı Derneği klinik uygulama kılavuzu [Pharmachologic treatment of acute postoperative pain: A clinical practice guideline of The Turkish Society of Algology]. Agri. 2021;33(Suppl 1):1-51. doi:10.14744/agri.2021.60243

9. 9. Lavelle-Henry MM. 3C Multimodal Analgesia Tried and True and Those Less Used. Pain Management Nursing, 2020; 21(2), 211. DOI:https://doi.org/10.1016/j.pmn.2020.02.024
10. 10. Varndell W, Fry M, Elliott D. Pain assessment and interventions by nurses in the emergency department: A national survey. J Clin Nurs. 2020;29(13-14):2352-2362. doi:10.1111/jocn.15247
11. 11. Acar K, Acar H, Demir F, Aslan EF. Determınıng the ıncıdence of postsurgıcal paın and amount of analgesıc use postsurgıcal paın and analgesıc. ACU Sağlık Bil Derg. 2016; (2):85-91. http://openaccess.acibadem.edu.tr:8080/xmlui/bitstream/handle/11443/491/Makale%20-%204.pdf?sequence=1&isAllowed=y
12. 12. Peek J, Smeeing DPJ, Hietbrink F, Houwert RM, Marsman M, de Jong MB. Comparison of analgesic interventions for traumatic rib fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45(4):597-622. doi:10.1007/s00068-018-0918-7
13. 13. Baker EJ, Lee GA. A Retrospective Observational Study Examining the Effect of Thoracic Epidural and Patient Controlled Analgesia on Short-term Outcomes in Blunt Thoracic Trauma Injuries [published correction appears in Medicine (Baltimore). 2016 Feb;95(8):e3857] [published correction appears in Medicine (Baltimore). 2016 Mar 03;95(8):e3857]. Medicine (Baltimore). 2016;95(2):e2374. doi:10.1097/MD.0000000000002374
14. 14. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council [published correction appears in J Pain. 2016 Apr;17(4):508-10. Dosage error in article text]. J Pain. 2016;17(2):131-157. doi:10.1016/j.jpain.2015.12.008
15. 15. Paydar S, Farhadi P, Ghaffarpasand F, Taheri A, Farbood A, Dabiri G, Abbasi HR. Acute trauma pain control algorithm. Bulletin of emergency and trauma, 2014; 2(4): 170-171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771294/pdf/bet-2-170.pdf
16. 16. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA surgery, 2017;152(7):691-697. doi:10.1001/jamasurg.2017.0898
17. 17. .Hsu JR, Mir H, Wally MK, Seymour RB. Clinical practice guidelines for pain management in acute musculoskeletal injury. J Orthop Trauma. 2019;33(5):e158-e182. doi:10.1097/BOT.0000000000001430
18. 18. 18.Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche J, Lloret‐Linares C. Acute pain Factors predictive of post‐operative pain and opioid requirement in multimodal analgesia following knee replacement. Eur J Pain. 2016;20(5):822-832. doi:10.1002/ejp.808
19. 19. Akarca, FK, Karcıoğlu Ö, Korkmaz T, Erbil B, Demir ÖF. Analgesic treatment in patients with acute extremity trauma and effect of training. Tr-J Emerg Med 2012;12(2):69-76 doi: 10.5505/1304.7361.2012.50480
20. 20. Viglino D, Masson N, Verdetti A, Champel F, Falcon C, Mouthon A, Maignan M. Multimodal oral analgesia for non-severe trauma patients: evaluation of a triage-nurse directed protocol combining methoxyflurane, paracetamol and oxycodone Intern Emerg Med. 2019;14(7):1139-1145. doi:10.1007/s11739-019-02147-8
21. 21. Aslan FE, Aygin D, Sarıyıldız D. The satısfactıon level of patıents wıth trauma on paın management. Turkiye Klinikleri Journal of Medical Sciences, 2007;27(5), 687-694. https://www.turkiyeklinikleri.com/article/tr-travma-geciren-hastalarin-agri-yonetimine-iliskin-memnuniyet-duzeyi-48547.html
22. 22. Karadaş Z and Yılmaz E. Retrospective Examination of Pain Relief Approaches According to Trauma Severity in Emergency Trauma Units. JAREN. 2020;6(1):44-52. doi:10.5222/jaren.2020.50470 https://jag.journalagent.com/jaren/pdfs/JAREN-50470-ORIGINAL_RESEARCH-YILMAZ.pdf
23. 23. Sullivan, D, Lyon M, Montgomery R, Quinlan-Colwell A. Exploring opioid-sparing multimodal analgesia options in trauma: a nursing perspective. Journal of Trauma Nursing, 2016; 23(6), 361. DOI: 10.1097/JTN.0000000000000250
24. 24. Newton-Brown E, Fitzgerald L, Mitra B. Audit improves emergency department triage, assessment, multi-modal analgesia and nerve block use in the management of pain in older people with neck of femur fracture. Australas Emerg Nurs J. 2014;17(4):176-183. doi:10.1016/j.aenj.2014.06.001
25. 25. Berben SA., Schoonhoven L, Meijs, TH, Van Vugt AB, Van Grunsven PM. Prevalence and relief of pain in trauma patients in emergency medical services. Clin J Pain. 2013;29(1):64-69. doi:10.1097/AJP.0b013e3182454a9e
26. 26. Hatton GE, Kregel HR, Pedroza C, Puzio TJ, Adams SD, et al. Age-related Opioid Exposure in Trauma: A Secondary Analysis of the Multimodal Analgesia Strategies for Trauma (MAST) Randomized Trial. Ann Surg. 2021;274(4):565-571. doi:10.1097/SLA.0000000000005065
27. 27. Yang J, Bauer BA, Wahner-Roedler DL, Chon TY, Xiao L. The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain? J Pain Res. 2020;13:411-417. Published 2020 Feb 17. doi:10.2147/JPR.S244173
28. 28. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anest 2012;116:248-73. doi:10.1097/ALN.0b013e31823c1030
29. 29. Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan M, Shaefer G, Tet al. Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81(5):936-951. doi:10.1097/TA.0000000000001209
30. 30. Manley NR, Maish GO. Blunt Chest Wall Trauma. Clinical Algorithms in General Surgery 2019; (pp. 633-635). Springer, Cham. https://doi.org/10.1007/978-3-319-98497-1_155
31. 31. Bardakçı O, Akdur O, Karatağ O, Akdur G, Alar T, Beggi H. Should computed tomography be the first choice in blunt chest trauma? Health. 2018; 22, 30. https://www.nobelmedicus.com/en/Article.aspx?m=636
32. 32. Burton SW, Riojas C, Gesin G, et al. Multimodal Analgesia Reduces Opioid Requirements in Trauma Patients with Rib Fractures [published online ahead of print, 2021 Nov 29]. J Trauma Acute Care Surg. 2021;10.1097/TA.0000000000003486. doi:10.1097/TA.0000000000003486
33. 33. Hamrick KL, Beyer C, Lee JA, Cocanour C, Duby JJ. Multimodal analgesia and opioid use in critically ill trauma patients. Journal of the American College of Surgeons, 2019;228(5), 769-775. e1. doi:10.1016/j.jamcollsurg.2019.01.020
34. 34. Hatton GE, Bell C, Wei S, Wade CE, Kao LS, Harvin JA. Do early non-steroidal anti-inflammatory drugs for analgesia worsen acute kidney injury in critically ill trauma patients? An inverse probability of treatment weighted analysis. J Trauma Acute Care Surg. 2020;89(4):673-678. doi:10.1097/TA.0000000000002875
35. 35. Li AS, Philip JF. Traumatic macular hole closure and visual improvement after topical nonsteroidal antiinflammatory drug treatment. Retinal Cases and Brief Reports 2020: 14:324–327. DOI: 10.1097/ICB.0000000000000705
36. 36. Baldemır R, Akçaboy EY, Çelık Ş, Noyan Ö, Akçaboy ZN, Baydar M. An assessment of physicians attitudes toward opioid usage and opiophobia: Results of a survey from a training and research hospital. Ağrı. 2019; 31(1): 23-31 | DOI: 10.5505/agri.2018.03411
37. 37. Özel F, Bağlama SS. The effect of pain management barriers in emergency deparment. Kocaeli Med J ,2018; 7; 3:14-20 https://jag.journalagent.com/kocaelitip/pdfs/KTD-17136-ORIGINAL_ARTICLE-OZEL.pdf
38. 38. Stone RH, Griffin B, Fusco R, Vest K, Tran T, Gross S. Factors affecting contraception access and use in patients with opioid use disorder. The Journal of Clinical Pharmacology, 2020;60, S63-S73. doi:10.1002/jcph.1772
39. 39. Oddo M, Crippa IA, Mehta S, Menon D, Payen J, Taccone F, et al. Optimizing sedation in patients with acute brain injury. Crit Care. 2016;20(1):128. Published 2016 May 5. doi:10.1186/s13054-016-1294-5
40. 40. Aminiahidashti H, Shafiee S, Hosseininejad SM, et al. Propofol-fentanyl versus propofol-ketamine for procedural sedation and analgesia in patients with trauma. Am J Emerg Med. 2018;36(10):1766-1770. doi:10.1016/j.ajem.2018.01.080
41. 41. Algın A, Hökenek NM, Yıldırım Ç. The Use of Ketamine in Trauma Patients. Ankara Medical Journal, 2019, 19.4: 776-783. https://doi.org/10.17098/amj.652006
42. 42. Samarkandi OA. Knowledge and attitudes of nurses toward pain management. Saudi J Anaesth. 2018;12(2):220-226. doi:10.4103/sja.SJA_587_17
43. 43. Rafati F, Soltaninejad M, Aflatoonian MR, Mashayekhi F. Postoperatıve paın: management and documentatıon by ıranıan nurses. Mater Sociomed. 2016;28(1):36-40. doi:10.5455/msm.2016.28.36-40
44. 44. Varlık M, Eroğlu ES, Özdemir S, Kahraman HA, Yıldız NM, Bozan Ö. Evaluation of Paiıents who Applied to the Emergency Department by Intra-Vehicle Traffic Accident. Firat Med J. 2019;24.4. http://www.firattipdergisi.com/pdf/pdf_FTD_1176.pdf