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Patient education after inguinal hernia surgery did not differ from routine information for pain at rest at 7 days

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J Glindvad

Correspondence to: J Glindvad, Bispebjerg Hospital, Telefon, Denmark; jg02{at}bbh.regionh.dk

QUESTION

In patients having surgery for inguinal hernia, does postoperative patient education at discharge and a follow-up telephone call reduce pain up to 1 week after surgery?

METHODS

Design:

randomised controlled trial.

Allocation:

{concealed}.*

Blinding:

blinded (data entry operators and data analysts).

Follow-up period:

1, 3, and 7 days after surgery.

Setting:

a hospital in Denmark.

Patients:

234 patients >18 years of age having elective, unilateral inguinal hernia surgery. Exclusion criteria were planned laparoscopic or bilateral surgery and inability to complete a pain diary or communicate in Danish.

Intervention:

103 patients were allocated to postoperative patient education (30–60 min), which was delivered by a project nurse at discharge and addressed previous pain experiences, analgesic use, movement and lifting, wound care, complications, relaxation, prevention of constipation, and return to work. Key points were summarised in a 78-point guide. Patients also received a follow-up telephone call 2 days after surgery. 131 patients were allocated to routine information (5–10 min), which was provided by the ward nurse before discharge and addressed pain, analgesic use, lifting, showering/bathing, suture removal, and laxative use.

Outcomes:

included change in patient-reported pain from the day before surgery, assessed at rest (morning, noon, and night) and with movement (noon) (100 mm visual analogue scale [VAS], 0  =  no pain and 100  =  worst possible pain), and return to work <7 days after surgery. A sample size of 100 patients per group was calculated to detect a 15% difference in proportion of patients with pain at rest >3 on a Numeric Rating Scale (80% power, α = 0.025).

Patient follow-up:

92% were included in the intention-to-treat analysis (mean age 54 y, 93% men).

MAIN RESULTS

The education and routine information groups did not differ for change in pain at rest on days 1, 3, and 7 (data reported only in figures). The education group had greater reductions in pain with movement on day 7 (mean difference in VAS 7 mm, 95% CI 0.7 to 13.1). The groups did not differ for number of patients with pain at rest or with movement on day 7 or return to work before day 7 (table).

Postoperative education v routine information for patients having inguinal hernia surgery*

CONCLUSION

In patients having surgery for an inguinal hernia, postoperative education did not differ from provision of routine information for pain up to 1 week after surgery.

*Information provided by author.

ABSTRACTED FROM

Glindvad J, Jorgensen M. Postoperative education and pain in patients with inguinal hernia. J Adv Nurs 2007;57:649–57.

Clinical impact ratings: General surgery 6/7; Patient education 3/7

Commentary

In Glindvad and Jorgensen’s randomised controlled trial of the effects of postoperative education on pain in patients having inguinal hernia repair, both groups received preoperative and discharge information on prospective pain and analgesia. The intervention group also received 30–60 minutes of individual information at discharge and a follow-up telephone call from a project nurse 2 days after surgery. There were no significant differences between the groups in mean VAS scores for pain at rest or with movement (except for 7 d after surgery, although this difference was not clinically significant); however, it should be noted that overall, patients in both groups had fairly low pain intensity scores by day 7 after surgery. This is an important consideration for clinical practice as current thinking on pain management favours a “level-of-comfort goal”:1 that is, the level of pain at which a person can actively function and participate in their care (comfort and function) rather than absence of pain as the determinant of good practice. On this basis, it is reasonable to say that the additional effort required for this intervention was not justified and the standard care provided was adequate. This, however, raises the issue of whether standard practice in the study by Glindvad and Jorgensen is representative of practice in other surgical units. Surveys such as that performed by Krenzischek et al2 and articles by Moline1 and Carr3 suggest that standard practice described in this study might be exemplary when compared with practices in other countries or centres.

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Footnotes

  • Source of funding: Copenhagen Hospital Cooperation Research Council.

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