Background: Acute postoperative pain can develop into chronic pain if not managed well. Nurse anesthetists consider many factors when developing an anesthetic plan to provide optimal postoperative pain management. Multimodal pain management is recommended for managing pain in the perioperative period and this may include administering medications such as intravenous (IV) acetaminophen and IV non-steroidal anti-inflammatory drugs (NSAIDs) to the patients if not contraindicated. Even though these are valuable and daily considerations for nurse anesthetists, there is not a standard of care for addressing postoperative pain management in adult abdominal surgical procedures. Objective: The purpose of the project is to determine the perspectives of nurse anesthetists for developing postoperative pain management in adult patients having abdominal surgical procedures. Design: This is a descriptive study designed to determine if current nurse anesthetist practices are being guided by evidence-based practices and if the findings can be used to develop a standard of care. Participants: Nurse anesthetists from a local Tucson, AZ health care facility Measurements: Nurse anesthetists were interviewed in-person. They were asked six semi-structured questions and the answers were recorded and transcribed into the program NVivo. Each answer was then coded and compared for emerging common themes. Results: Five out of eleven nurse anesthetists participated in this project. Thirty-five themes were discovered and three main categories developed: 1. Nurse anesthetists consider multimodal pain management an integral part of the anesthetic plan. IV acetaminophen and IV NSAIDs are considered for every surgical patient if they are not contraindicated; 2. IV acetaminophen is used more frequently for abdominal procedures compared to IV NSAIDs because of risks for bleeding associated with IV NSAIDs; and 3. Each anesthetic plan is individualized to safely address both the patient and surgical factors. Conclusion: A multi-center study should be considered for a future project to determine if these common themes would be found consistently across health care facilities. Eventually, this information could be used to develop a standard of care for managing postoperative pain in adults having abdominal surgery. Other methods for addressing multimodal pain management such as regional blocks should be considered for future studies as well.

This randomized, double-blind, placebo-controlled study was conducted to compare the effectiveness of intravenous acetaminophen vs. oral acetaminophen or placebo as an adjunct to opioids on lowering post-operative pain scores, discharge time, need for opioids, and opioid-related side effects, as well as assessing for any effects pain treatment has on embryological and pregnancy outcomes. Secondary analysis included identifying risk factors in patients that cause them to have worsening pain or minor relief from traditional pain management. This study was conducted at a single academic fertility center at Massachusetts General Hospital in Boston with a patient population of 159 English-speaking women between 18-43 years old, undergoing oocyte retrieval as a part of In Vitro Fertilization procedure. Participants were randomly placed in one of three treatment groups to receive either 1000mg IV acetaminophen and PO placebo (Group A), IV placebo, and 1000mg PO acetaminophen (Group B), or IV and PO placebo (Group C) as pain control before oocyte retrieval procedure. The primary outcomes measured were patient-reported post-operative visual analogue scale pain scores in the recovery room at 10 minutes, 30 minutes, and discharge time. Using these values to measure the effectiveness of each treatment at improving post-operative pain. To assess the relationship, if any, between demographical or clinical factors and pain, we analyzed what factors were common in those experiencing high or low pain. We used the Visual Analog Scale (VAS) which has patients rank pain from 1-10. For this analysis, low pain is defined as those whose 10-minute post-operative pain score was less than 5 (VAS score <5/10) and high pain as those whose 10-minute postoperative pain score is 5 or greater (VAS score 5+/10). Results showed that mean post-operative pain scores were similar between the study groups at 10 minutes (A:2.3, B: 2.6, C:2.8, p=0.51). Timing of discharge was also similar (A:60.1 mins, B: 58.8 mins, C:57.6mins; p=0.76). Although not statistically significant, the mean post-operative opioid dose for patients in group A was less than half of that in Group B and C (0.24mg vs. 0.59mg vs. 0.58mg; p=0.34) and fewer required rescue pain medication in the recovery room (4% vs. 19% vs. 15% respectively; p=0.24). There was a trend towards decreased side effects of constipation in Group A compared to Groups B and C (15% vs. 31% vs. 33%, respectively; p=0.07). There were no differences in embryological or early pregnancy outcomes between study groups. An analysis of predictors of pain, patients with BMI >/=30kg/m2 (obese) were more likely to report high post-operative pain (p=0.009). Prior abdominal surgeries, including pelvic laparoscopy and laparotomy, were associated with low post-operative pain (p=0.069 and p=0.025, respectively). Those who reported having pre-operative pain greater than zero were more likely to report lower postoperative pain (p=0.002). There was no significant relationship between race/ethnicity, infertility diagnosis, and procedure length and pain. This study's findings showed no significant difference between post-operative pain scores or discharge times in women undergoing oocyte retrieval when given IV acetaminophen, PO acetaminophen, or a placebo. There were severe findings that suggested that IV acetaminophen may reduce the need for post-operative narcotics and lead to fewer opioid-related side effects, however these findings while large were statistically insignificant. The predictors of higher post-operative pain we found, including high BMI, no prior history of abdominal procedures, and lack of pre-operative pain, indicate that further investigation into these predictors could be beneficial. This information may allow physicians and anesthesiologists to optimize their pain control.