DEPARTMENT OF PHARM
ACY
UNIVERSI
TY OF MA
LTA
Pharmacist Intervention in Pain Management following Heart Surgery
1
1
2
1
Danika Agius Decelis , Maurice Zarb Adami , Joseph Galea , Anthony Serracino Inglott , Lilian M. Azzopardi
1
1
Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
2
Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
Department of Pharmacy
University of Malta
email: danika.agius-decelis.08@um.edu.mt
INTRODUCTION
I
Postoperative pain is the commonest complaint by cardiac surgical
1,2
Pain leads to various mechanisms reacting and effecting the patient
patients . According to Gottschalk and Smith, in the US pain is
negatively, such as cardiovascular response (tachycardia, increased
often inadequately treated and accompanies the more than 23
possibilities
million surgical procedures performed each year3. Unfortunately
vomiting).5 Increased risk of morbidity and mortality are also
pain may persist long after tissue heals.
possible implications.1
Pain is a warning symptom that helps the individual to take
AIMS
protective measurements in order to prevent further damage. Pain
and fear give rise to the release of adrenaline and noradrenaline
4
via the adrenergic nervous system .
of
infarction),
gastrointestinal
system
(nausea,
To develop and evaluate pharmacist intervention in pain prevention
and relief, in patients undergoing heart surgery.
METHOD
 115 patients recruited from Cardiac Surgical Ward Mater
Dei Hospital, Malta
 Patients divided into two groups, intervention and control
group depending on last digit of ID number being odd or
even (Fig.1)
 Fig.2. demonstrates material given to patients
 Intervention group contacted at weeks 2,4,6 post discharge
while control group contacted at week 4,6.
 Data Analysed using SPSS v.20
Fig. 1 : Material given out to the two groups of patients
Figure 2 (left): Diary given to patients; (right) Pain score to be filled in weekly
Figure 3: Pain score analysis (n=50 in each group)
RESULTS
Both groups consisted of 50 patients each (mean age: 62.3 and 62.2 years in
intervention and control group respectively) who completed all steps of the study.
Patients in the intervention group had pain scores (mean range: 0.58 – 4.56)
significantly lower than the patients in control group (mean range: 1.86 - 4.64) (p ≈ 0).
(Fig.3) Mean pain scores decreased significantly throughout the weeks for both groups
but this decrease was more rapid in the intervention group (p ≈ 0) (mean pain in group
A - week 1: 4.56, week 6: 0.58).
Diary analysis (Fig.4) using Chi-Squared test indicated that from the first week there
was a significant difference in painkiller ingestion between the two groups. It was also
noted that the intervention group followed written advice given.
CONCLUSION
Figure 4: Diary Analysis
Patients in intervention followed the advice given to them with regards to the paracetamol regimen. This can be also reflected in the pain
score charts filled in weekly by these same patients. The pain felt over the weeks was significantly lower than that in the control group
demonstrating that pain decrease was not by chance but because the majority of these patients followed the written regimen and benefitted
from the pharmacist intervention. One can therefore conclude that a pharmacist on the ward is vital for the benefit of these cohort of
patients.
Acknowledgement(s) Thanks to all patients participating, and Cardiac Surgeons, Dr A. Manche, Dr W. Busuttil
Reference(s)
1
Aslan Fatma Eti , Aysel Badir, Senay Karadag Arli, Hatice Cakmakci. Patients’ experience of pain after cardiac surgery. Contemporary Nurse (2009–10) 34(1): 48–54.
2
Fonseca et al. Pain in the post-operative of myocardial revascularization and its inter-relation with the quality of life. Revista de Pesquisa: Cuidado é Fundamental; Apr-Jun2013, 5(2) p3636-44 [internet].[ Updated on:April 2013 Cited on: 20th July 2013] Abstract Available from:
http://connection.ebscohost.com/c/articles/86989682/pain-post-operative-myocardial-revascularization-inter-relation-quality-life
3
Gottschalk Allan, David S. Smith, New Concepts in Acute Pain Therapy: Pre-emptive Analgesia. Am Fam Physician. 2001; 63(10):1979-1985.
4
Freye Enno, Levy Joseph Victor. Rational for the Use of Opioids in Nociceptive Transmission. In: Opioids in Medicine a Comprehensive Review on the mode of Action and the Use of Analgesics in Different Clinical Pain States. Netherlands: Springer; 2008. p 1-80
5
Oates Barnes Heidi. Non-Pharmacologic Pain Control for the CABG patient. Dimensions of Critical Care Nursing 1993;12(6):296-304