A pre-emptive pain management protocol to support self-care following vitreo-retinal day surgery

Aims and objectives: To describe the development and evaluation of a pre-emptive and multimodal pain management protocol that aims to improve patient experiences following vitreo-retinal day surgery. Background: Vitreo-retinal surgery has been increasingly performed as day surgery that requires patients to undertake postoperative self-care, including the management of pain. While vitreo-retinal surgery is known to be painful in the convalescent period, pain management following day surgery has been described as problematic across many surgical specialties. Design: One hundred patient audit and in-depth qualitative interviews with nine participants. Methods: A pain management protocol was developed from research evidence, established knowledge and expert opinion, then implemented and evaluated. Results: The pre-emptive and multimodal protocol used intravenous Parecoxib in conjunction with regional ocular anaesthesia and oral paracetamol. Parecoxib 40 mg was administered prior to discharge, and participants were instructed to take the paracetamol six hours post-regional anaesthesia. Rescue analgesia was also provided. Following implementation of the protocol in a single clinical site, low levels of pain were reported in the audited patient cohort and confirmed in the qualitatively explored experiences of nine participants. Conclusions: The results of this study were encouraging, in that post vitreo-retinal day surgery pain appeared to have been successfully self-managed with a multimodal and pre-emptive protocol. The protocol was flexible and sensitive to patient comorbidities, surgical complexity, previous experiences and medical preferences. Further research is required to consolidate the success of this protocol to effectively support patients' self-care pain management and provide capacity to generalise the findings. Relevance to clinical practice: Knowledge developed through this clinically based research has the potential for informing future patient care across many sites where day surgery is an integral component of treatment for people with vitreo-retinal disease.