Clinicians don’t know the best way to support patients with post-operative pain, study finds

Every year, more than 12,000 Australians undergo open heart surgery—an hours-long medical procedure during which surgeons go inside the chest cavity and repair faulty heart valves or bypass blocked cardiac arteries.

There’s no doubt these surgeries save lives.

But new research sheds light on a gap in improving patient recovery. The analysis suggests we don’t know the best combination of medications to support pain management after heart surgery—which can have serious consequences.

The study is published in the Journal of Advanced Nursing with co-authors from the Cardiac Surgery International Nursing and Allied Health Professional Research Network (known as CONNECT).

“Almost 30% of adults continue to experience ongoing pain up to a year after cardiac surgery,” says Professor Rochelle Wynne, Center for Quality and Patient Safety in the Institute for Health Transformation, Deakin University.

“This can slow recovery, lead to serious health complications and increase the rate of readmission to hospital.”

“Our new research shows we’re using guidelines for analgesics after cardiac surgery without having any compelling evidence of effectiveness,” Professor Wynne says.

Analgesics are pain medications, and include opioids (such as morphine), non-opioids (such as acetaminophen) and anti-inflammatories (such as ibuprofen). After cardiac surgery, multimodal pain management plans should involve a regimen of these medications—but which ones, and in what combination?

In their study, Professor Wynne and colleagues performed a systematic review of previously published trials (the gold standard for generating evidence for practice) that tested the effect of different medications for pain management.

“Our results reveal gross under-investigation of measurement and management of pain and how it impacts patient recovery from cardiac surgery,” says Professor Wynne.

“This new knowledge is a starting point, a premise to move forward and carry out patient-centered, robust trials focused on best-practice approaches to treating, assessing and measuring acute pain during postoperative recovery after cardiac surgery and beyond.”

The researchers also propose a need for investment in cardiothoracic nursing to enhance specialist pain assessment and management, and to ensure evidence is translated into effective pain treatments for these patients.