Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain.

Objectives  The primary objective of this systematic review was to assess the effectiveness of nursing interventions for the relief/reduction of post-operative pain when compared with either standard care or other nursing interventions. Inclusion criteria  Types of studies This review included randomised controlled trials (RCTs) and other quasi-randomised experimental research designs. Types of participants Adults treated for post-operative pain in an acute care hospital. Types of interventions Interventions included in the review were only those directly administered by nursing staff such as: (i) administration of analgesia: including oral, intramuscular injection, patient controlled analgesia, epidural; (ii) pre-operative patient education; (iii) assessment and documentation of intensity of pain at regular intervals; (iv) protocols, clinical pathways or flow-sheets used in the management of pain; and (v) non-pharmacological interventions such as massage and relaxation. Types of outcome measures The primary outcome was the relief or reduction of post-operative pain. Other measures included analgesia consumption, patient satisfaction and length of hospital stay. Search strategy  Search terms were chosen after reviewing text words and MeSH terms in relevant articles and databases. A search for published and unpublished research covering the period 1985-2004 (inclusive) was conducted, using 11 major electronic databases. Reference lists of retrieved articles were hand searched. The search was restricted to reports published in English. Assessment of quality  The methodological quality of eligible studies was appraised by two independent reviewers, using a standardised critical appraisal tool. Differences in opinion were decided by consensus after discussion with a third investigator. Data extraction and analysis  Data were extracted from the studies that met the criteria for methodological quality. Two reviewers independently extracted data for each study, using a standardised extraction tool. Results from homogeneous RCTs where possible were pooled in meta-analysis using RevMan4.2 software program. If the studies were clinically or statistically heterogeneous, the results are discussed in a narrative form. Non-randomised studies are also discussed in narrative form. Results  Overall, there is no strong evidence to support the use of any intervention even though a few interventions showed some benefits. However, evidence for these benefits was often based on single studies. Most of the included studies showed that there was no difference between the interventions and the usual care with both being found equally effective. Implications for practice  There was no strong evidence to support a particular practice. No intervention was found to be harmful; however, this does not presume to be evidence of safety. When there are two similarly effective interventions nurses need to weigh the possible positive and negative of the intervention including side effects, risk of adverse events, cost and patient preference. Other considerations include variations in patients' past pain experiences, type of surgery, many different analgesics. Although there were no controlled trials to support assessment and documentation, professionally and legally, documentation is required.