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. 2023 Oct 1;39(10):537-545.
doi: 10.1097/AJP.0000000000001153.

The Perioperative Pain Management Bundle is Feasible: Findings From the PAIN OUT Registry

Dusica Stamenkovic  1   2 , Philipp Baumbach  3 , Dragana Radovanovic  4   5 , Milos Novovic  6 , Nebojsa Ladjevic  7   8 , Emilija Dubljanin Raspopovic  9   8 , Ivan Palibrk  10   8 , Dragana Unic-Stojanovic  8   11 , Aleksandra Jukic  12 , Radmilo Jankovic  13 , Suzana Bojic  8   14 , Jasna Gacic  8   15 , Ulrike M Stamer  16 , Winfried Meissner  3 , Ruth Zaslansky  3
Affiliations
Free article

The Perioperative Pain Management Bundle is Feasible: Findings From the PAIN OUT Registry

Dusica Stamenkovic et al. Clin J Pain. .
Free article

Abstract

Objectives: The quality of postoperative pain management is often poor. A "bundle," a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a "Perioperative Pain Management Bundle" and whether this would be associated with improved multidimensional pain-related patient-reported outcomes (PROs).

Methods: "PAIN OUT," a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the "Perioperative Pain Management Bundle" into the clinical routine and collected another round of data. The bundle consists of 4 treatment elements: (1) a full daily dose of 1 to 2 nonopioid analgesics (eg, paracetamol and/or nonsteroidal anti-inflammatory drugs), (2) at least 1 type of local/regional anesthesia, (3) pain assessment by staff, and (4) offering patients information about pain management. The primary endpoint was a multidimensional pain composite score (PCS), evaluating pain intensity, interference, and side effects that was compared between patients who received the full bundle versus not.

Results: Implementation of the complete bundle was associated with a significant reduction in the PCS ( P < 0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, nonopioid analgesics were associated with a higher PCS (ie, poorer outcome, and negligible ES), and the other elements were associated with a lower PCS (all negligible small ES). Individual PROs were consistently better in patients receiving the full bundle compared with 0 to 3 elements. The PCS was not associated with the surgical discipline.

Discussion: We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect.

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Conflict of interest statement

This work was supported by (1) PAIN OUT was developed with funding from the European Community’s Seventh Framework Program FP7/2007-2013, Brussels, Belgium under Grant Agreement No. 223590. (2) The European Pain Federation (EFIC), Brussels, Belgium provided funding to the Serbian Pain Society to cover the costs of the project in Serbia. Funding included: (1) the annual subscription to PAIN OUT for 10 hospitals over a 2-year period, (2) two half-day face-to-face meetings so that the principal investigator and one research surveyor from each participating hospital could review the findings collected, and (3) partial remuneration to hospitals for data sets collected. The funds were transferred to the Serbian Pain Association, which then contacted each of the participating hospitals. W.M. received grants (paid to the institution) and personal fees from Grünenthal, grants (paid to the institution) from Pfizer and Mundipharma. Personal fees from TAD, BioQPharm, Bionorica, Kyowa, Northern Swan, and Tilray. U.M.S. received fees (paid to the institution) and reimbursement for travel costs from Sintetica and Sanofi-Aventis Swiss. The remaining authors declare no conflict of interest.

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