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Acute Pain Management Following Laryngectomy
Richard Orgill, MD;
Greg A. Krempl, MD;
Jesus E. Medina, MD
Arch Otolaryngol Head Neck Surg. 2002;128:829-832.
Objectives To evaluate the adequacy of as-needed (prn) dosing of narcotics during
the acute postoperative period following laryngectomy and to evaluate the
role of nurses' interpretation and implementation of narcotic orders in postoperative
pain management.
Study Design A retrospective review of the medical records of 37 patients who underwent
laryngectomy at the University of Oklahoma. The postoperative care was standardized
through a clinical pathway to provide a uniform level of care.
Methods The parameters reviewed include (1) the type and dose of analgesic prescribed,
(2) the quantity and frequency of analgesic administered to each patient,
and (3) the adequacy of the initial pain-control prescription.
Results All physician orders for narcotics were at or above the minimum dosing
guidelines; 68% met a recommended adequate postoperative prescription for
moderate pain. However, none of the patients actually received the intended
dose during a 24-hour period while hospitalized. Physicians were contacted
about 13 patients (35%) because of inadequate pain relief, but only 8 patients
(22%) had their narcotic dose increased appropriately. Patients were dosed
below the minimum prescribed dose 19 times (2.8%), and in 24 instances (3.6%)
the backup analgesic, designated as "prn breakthrough pain," was given as
the primary analgesic.
Conclusions As-needed dosing of analgesia resulted in suboptimal pain control for
at least 35% of patients undergoing laryngectomy. Inadequate prescription
and variable implementation of prn orders contributed to this.
From the Department of Otorhinolaryngology, University of Oklahoma
Health Sciences Center, Oklahoma City.
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