110 Implementation of a standardized multimodal postoperative pain protocol reduces postoperative pain among neurosurgical patients.

INTRODUCTION: It is well established that postoperative pain has far reaching effects on patient physiology and length of stay. However, recent CMS initiatives such as the HCAHP survey have forced hospitals and neurosurgery departments to improve postoperative pain control.

METHODS: A prospective quality improvement trial with a time series design was performed among postoperative neurosurgical patients at a large tertiary academic center. The Multimodal Pain Initiative (MMPI) consisted of improved preoperative documentation of risk factors for postoperative pain, standardization of intraoperative analgesia, improved recognition of postoperative pain by floor nurses, and development of a standardized pain management protocol. The intervention was refined through multiple PDSA improvement cycles.

RESULTS: Detailed analysis was performed on a systematic random sample of pre- (n = 48) and post-intervention (n = 48) subjects. After implementation of the MMPI, significant improvements were made in preoperative documentation of pain (P < .0001), postoperative use of nonsteroidal antiinflammatory drugs (P < .005) and gabapentin (P < .05), and overall compliance with the pain protocol (P < .0001). More importantly, post-intervention patients reported significantly less pain as assessed by the visual analog pain scores on the first postoperative day (P = .05), with most improvement being seen among spine patients. Further regression analysis showed that the greatest predictors of postoperative pain were the type of surgery (P < .0001), patient age (P < .05), and inclusion prior to the intervention (P < .05). Adverse events were tracked with no increase in naloxone use or patient length of stay.

CONCLUSION: A multimodal pain control protocol can be developed and implemented among neurosurgery patients. Furthermore, its implementation correlated with improved postoperative pain scores among neurosurgery patients.