Better Pain Relief in the PACU
Claudia P. Barone RN, APN, LNC, CPC, CCNS-BC, EdD
Bryn Walthall RN, BA
Martha Fenton RN, BSN
Mary Tinsley RN
Brent D. Fikes RN, BSN

OR Nurse 2014
January 2010 
Volume 4  Number 1
Pages 21 - 26
  PDF Version Available!

A primary goal of nursing care in the postanesthesia care unit (PACU) is to gain control of pain. Although patients will, of course, prefer complete and total pain relief, managing the pain and getting the pain under control as reported by either a numeric or visual pain scale is the goal. The treatment of pain may vary depending on how the nursing staff is integrated into the postoperative multidisciplinary team. There are a variety of reasons for undertreatment of pain such as those associated with healthcare provider delivery, patients and families, and society.1 Perceptions of the addictive nature of pain medicine may interfere with adequate administration. These perceptions may be on the part of the healthcare provider, patient, or family.By definition, pain is an unpleasant sensation associated with actual or potential tissue damage and mediated to the brain via specific nerve fibers where its conscious appreciation may be modified by various factors.2 The International Association of the Study of Pain also defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.3There are four factors involved in the transmission of pain. The first is when inflammatory facilitators—such as substance P, serotonin, histamine, and bradykinin—are released at the tissue site of surgery or injury. The facilitators stimulate peripheral sensory afferent nerves. Transmission, the second phase of this stimulus, occurs when ascending nerves from the dorsal horn to the brain are stimulated by the peripheral sensory afferents. Modulation occurs along the descending pathways to the dorsal horn where the activity of the peripheral nerves is affected by the release of enkephalins and endorphins. The brain then perceives the pain (See Nociception system and pain impulse transmission).To appreciate the management of pain, it's necessary to combine an understanding of what pain is with its implications for patients undergoing

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