Management of Procedural Pain

Medical procedures are frequently associated with psychological distress and/or pain that must be anticipated and managed proactively. Painful and distressing procedures include, but are not limited to, moving the patient, changing dressings, venipuncture and venous catheterisation, arterial puncture, lumbar puncture, urinary and suprapubic catheterisation, heel pricks (in paediatric patients), chest drains, bone marrow aspiration and trephines, tissue biopsy and endotracheal intubation. 

Certain patient populations, such as children and patients with HIV/AIDS may be especially vulnerable to procedure-related anxiety and pain.

Recommendations for management of procedural pain include:

• Anticipate, prevent and manage pain proactively
• Keep procedures to a minimum, performing them only if they are really necessary
• Patients should be reassured with discussion about the procedure and expectations before intervention.
• Where it is possible, patient discomfort may be reduced by consolidating patient interactions rather than spreading out interventional procedures during the day (e.g., washing the patient and changing dressings at the same time; taking all blood samples together with one venipuncture port).
• Maintenance analgesia should be optimised
• Appropriate analgesia should be administered at an appropriate time before predictable incident pain (e.g., immediate-release oral morphine 20-30 minutes prior to the procedure).

For more information about acute pain management during interventional procedures, refer to the South African Acute Pain Guidelines, available at: www.sasaweb.com