PAIN STUDY Surgical unit RNs conducted a study to find out how a non-opioid IV analgesic given pre-operatively compared to morphine and fentanyl.

PAIN CONTROL Should We Switch to Non-Opioid IV Pain Meds?

One of our general surgeons wanted to know if giving her laparoscopic hernia and cholecystectomy patients a non-opioid, non-NSAID, intravenous analgesic pre-operatively would reduce the use of opioids, reduce pain and improve discharge times. To find out, we performed an evidence-based study in our unit at the Surgery Center at Virginia Baptist Hospital in Lynchburg, Va.

First, we added a standing order to the surgeon's order set that included 1 gram IV of the analgesic given pre-operatively in the holding room. For 6 months, from February to July 2013, we gave this medication to all the surgeon's laparoscopic hernia and cholecystectomy patients who were between the ages of 18 and 50.

We completed data collection sheets on each patient who fell into the category for this study. The data we collected included:

• medical record and account number;
• pre-operative pain;
• IV analgesic (yes or no);
• rescue medications (morphine, dilaudid, fentanyl or pain pill);
• arrival time at surgery center to post-op (minutes);
• discharge pain (rated on a numeric scale of 0 to 10); and
• discharge time from surgery center (minutes).

The retrospective data collection was much harder. The time period for this data was before the use of IV analgesic, from January to June 2010. The data analyst at our hospital created a list of 54 random patients with the specific criteria we were looking for, as noted above in the data collection list. We had to dig through our computer system to look up this information. It was a very time-consuming process.

Just as every study has its barriers, ours did as well. We wanted to collect data on at least 54 patients who had not received the IV analgesic as well as at least 54 who had received the analgesic, but unfortunately 16 were admitted to the hospital instead of being outpatient. At the end of the study, we had reviewed 36 patients who had received IV analgesic and 38 who did not receive IV analgesic. Given all that, here are the answers from our study.

• Does IV analgesic reduce the number of rescue medications? Yes. The mean number of medications per patient who received IV analgesic was 1.7, while the mean number for patients not receiving IV analgesic was 1.9.
• Does IV analgesic improve post-operative pain scores? It's hard to say. Our study found that the mean discharge pain for patients who received the IV analgesic was 3.1, the same as the mean discharge pain for those who did not receive the IV analgesic. It was amazing to us that this result was exactly the same.
• Does IV analgesic shorten length of stay for the surgical patient? Yes. The mean length of post-operative stay for patients who received the IV analgesic was 152.1 minutes, while the mean length of post-op stay for those who didn't receive the IV analgesic was 171.1 minutes.

We're passing on making the change for now. The improvements in use of rescue medications and length of stay correlate with our literature review, but we need to further investigate the pain control aspect. Our study really didn't give us a clear answer to whether IV analgesic improves pain control. Perhaps we can look at medicating the patient post-operatively with IV analgesic, or review more patients who would be discharged instead of admitted to the hospital. We could collect data for a year instead of for 6 months. Also, maybe adding different surgical procedures could yield more definitive results.

There's also the cost of implementing IV analgesic to consider. We pay $8.21 per vial of morphine and $2.23 per vial of fentanyl. The IV analgesic costs $106.34 ($58.45 per vial of IV analgesic, $28.75 for secondary IV tubing and $19.14 for 50 ml of NS flush.)

— Carrie White, RN, BSN