Introduction: Early post-operative pain after laparoscopy can be even more severe compared to open surgery1. The insufflation of carbon dioxide into the abdomen can cause cramping, bloating, and shoulder tip pain2. Repeated opioid dosing leads to adverse effects, including sedation, respiratory depression, ileus, opioid-induced hyperalgesia, and nausea or vomiting3, whereas non-pharmacological interventions are non-invasive and associated with minimal risk. Patients prefer to avoid medications if possible4, and opioids should be avoided in older adults whenever possible to avoid side effects and falls.

Methods: A quality improvement project with a pre-/post-design was utilized to implement an evidence-based bundle of non-pharmacological pain management interventions for an abdominal laparoscopic short-stay surgery population at a comprehensive cancer center. The bundle included integrative medicine videos, music, early and frequent in-bed exercises and ambulation, hot packs, and mint or ginger tea. The nurses were educated on the bundle, and it was added to the order set.

Results: Exercise, tea, and hot packs were reportedly the most utilized and beneficial, according to both patients and nurses. Preliminary analysis shows the post-bundle implementation group had a 34% decrease in post-operative opioid use, a 5.35% decrease in pain scores at discharge, and the average number of documented non-pharmacological, pain-relieving interventions increased from 1.04 to 2.23.

Conclusion: Comprehensive postoperative pain management for abdominal laparoscopic surgery patients must include non-pharmacological strategies. Preliminary data analysis shows that adding a bundle of non-pharmacological strategies to the nursing orders can improve pain outcomes.

References
1. Sjovall, S., Kokki, M., & Kokki, H. (2015). Laparoscopic surgery: A narrative review of pharmacotherapy in pain management. Drugs, 75, 1867-1889. doi: 10.1007/s40265-015-0482-y.
2. Blencowe, N.S, Waldon, R., & Vipond, M.N. (2018). Management of patients after laparoscopic procedures. British Medical Journal, 360. doi: 10.1136/bmj.k120.
3. Hah, J.M., Bateman, B.T., Ratliff, J., Curtin, C., & Sun, E. (2017). Chronic opioid use after surgery: Implications for perioperative management in the face of the opioid epidemic. Anesthesia & Analgesia, 125(5), 1733-1740. doi: 10.1213/ANE.0000000000002458.
4. D’Arcy, Y. (2011). New thinking about postoperative pain management. OR Nurse, 5(6), 29-36. doi: 10.1097/01.ORN.0000406638.19178.07

Leigh Ehinger MS, AGPCNP-BC, OCN

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