Nursing interventions for acute pain management in the post-anesthesia care unit: scoping review

Dias, Giulia Moreira; Santiago, Elizabete Cristina de Lira; Funez, Mani Indiana

doi:10.63231/2595-0118.20250043-pt

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REVIEW ARTICLE • BrJP 8 • 2025 • https://doi.org/10.63231/2595-0118.20250043-en linkcopy

Nursing interventions for acute pain management in the post-anesthesia care unit: scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES Pain management by the nursing team in the Post-Anesthesia Care Unit (PACU) demands resoluteness in order to complete patient recovery. The aim of this study was to map nursing interventions for acute pain management in the PACU.

CONTENTS This is a scoping review, according to the Joan Briggs Institute methodology, registered in the Open Science Framework (10.17605/OSF.IO/56TS7). The search was conducted via Pubmed, Biblioteca Virtual em Saúde (BVS - Virtual Health Library), Science Direct, Cochrane, CINAHL and the gray literature and updated on March 26, 2025, in addition to the exploratory search. Fourteen articles that met the eligibility criteria were included in the sample. The nursing interventions found were a) pharmacological - supervision of opioid infusion through patient-controlled analgesia or patient-controlled epidural analgesia; opioids through nurse-controlled analgesia; intravenous, oral or intramuscular opioid; oral analgesic; intravenous non-steroidal anti-inflammatory drug; and b) non-pharmacological - specially aromatherapy and music therapy, but also reiki, foot reflexology, therapeutic touch, guided imagination and comfort measures. In addition, the use of standardized pain assessment scales such as the Visual Analogue Scale, numerical pain scales and the verbal rating scale was discussed. The main limitation identified was the lack of recent studies.

CONCLUSION Pharmacological and non-pharmacological interventions were mapped, used in combination, associated with the recommendation for a systematized pain assessment, thus demonstrating the autonomy and importance of nursing action in the treatment of acute pain in the PACU.

Keywords:
Acute pain; Analgesia; Nursing care; Post-anesthesia nursing

HIGHLIGHTS

The study recommends systematically assess pain using standardized instruments

As a pharmacological measure for pain control, the study highlights the supervision of opioid use through patient-controlled analgesia and nurse-controlled analgesia

Aromatherapy stands out among the non-pharmacological measures

	Questions	Terms
Population	Adults in the immediate postoperative period	Adult
Concept	Nursing interventions for acute pain management	Nursing, pain
Context	Post-anesthesia care unit	Perioperative period

Databases	Mapping of terms
Medline via Pubmed	(((adult OR adults) AND (nursing OR nursing care)) AND (pain OR pain management)) AND (perioperative period OR postoperative period OR operative time OR intraoperative time)
BVS	((adulto) OR (adults)) AND ((enfermagem)) AND ((dor)) AND ((períodoperioperatório) OR (período pós-operatório) OR (período pré-operatório) OR (período intraoperatório))
*Science Direct*	(nursing) AND (pain) AND (perioperative period OR postoperative period OR operative time OR intraoperative time)
Cochrane	Nursing AND pain AND “perioperative period” OR "postoperative period" OR "operative time" OR "intraoperative time" AND adult OR adults
CINAHL	nursing AND pain AND "post operative care unit" OR PACU AND adult

Authors/Location	*Type of study and sample**	Objective	Surgical intervention	Intervention in the PACU for pain management	Outcomes of interest
Heiser et al.¹²	Experimental, controlled, prospective study	To investigate the effects of a non-pharmacological and non-invasive intervention (music) in combination with a pharmacological agent (IV morphine) on the levels of pain, anxiety, satisfaction and physiological parameters of patients in the post-operative period.	Lumbar microdiscectomy.	One hour of uninterrupted music, in the musical style previously chosen by the patient or without music therapy + intravenous PCA (morphine).	There was no significant difference between the two groups in terms of pain levels and consumption analgesic drugs.

USA

	n= 34			Pain assessment after 1 hour in the PACU using the VAS*.

	23 to 59 years old

Choiniere et al.¹⁶	Prospective study	To evaluate the efficacy, clinical and economic benefits when comparing PCA with regular IM opioid administration after hysterectomy.	Abdominal hysterectomy.	IV morphine (3mg) until reaching relief or maximum dose of 15mg + PCA morphine or IM morphine.	Pain levels were low and similar between the groups, but patients in the IM group received more morphine than those in the PCA group.

Canada

	n=126			Pain assessment every 10 minutes until relief and then at a fixed schedule using the VAS*.

	37 to 49 years old
Puntillo and Weitz¹⁷	Observational study	To study the relationship between the pain reported by PACU patients and the amount of opioids administered, as well as the general effect of the patients' analgesics.	Abdominal surgery, orthopedic surgery, thoracic decompression and cervical sympathectomy.	IV opioid (morphine, fentanyl, combination of morphine, fentanyl and meperidine).	The decrease in pain level did not go beyond moderate pain, suggesting that the intervention was not effective, which may be related to the drugs dosages.

USA

	n=39			Pain assessment every 5 minutes for 90 minutes or until discharge using the NPS*.

	48 to 53 years old
Taylor et al.¹⁸	Semi-experimental study	To examine the effect of the use of music on patients' perception of pain in the PACU.	Abdominal hysterectomy.	Relaxing music chosen in advance by the patient or solely the use of a silent headset + nursing care and administration of IV and IM opioids (morphine, meperidine and fentanyl) and IV NSAIDs (ketorolac).	There was no significant difference between the two groups in terms of pain levels.
				Pain assessment every 15 minutes in the PACU using VRS; Pain assessment using the NGPIS before discharge from the PACU.
USA

	n=61

	24 to 62 years old
Scales¹⁹	Case report	To show the effectiveness of different holistic healing techniques in the perianesthesia to reduce pain and stress.	Arthroscopic repair of the anterior cruciate ligament, arthroscopic lateral meniscectomy and open repair of the collateral ligament in the left knee.	Oral opioid (hydrocodone) + oral analgesic (paracetamol) + IV NSAID (tromethamine).	The use of holistic techniques improved pain control when combined with the drugs.

USA

	n=1			Oral opioid (oxycodone) + oral analgesic (paracetamol).

	37 years old

				Reiki + foot reflexology + therapeutic touch.



				Pain assessment using the NPS*.
Laurion and Fetzer²⁰	Experimental, pilot study	To determine the effect of guided imagination and music therapy on pain, nausea and vomiting and length of stay in the PACU of patients undergoing laparoscopic gynecological surgery.	Bilateral laparoscopic tubal cauterization/banding and diagnostic/operative laparoscopies with or without hysteroscopy.	Audio-guided imagination	The groups that received guided imagination or music had lower levels of pain (p=0.002).
				Or
USA				Music
				Or
	n=84			Conventional care
				+
	20 to 55 years old			Paracetamol and ibuprofen (route of administration not specified).

				Pain assessment using the NPS*.
Elstraete et al.²¹	Prospective, randomized, double-blind, placebo-controlled study	To evaluate the effect of continuous low doses of IV ketamine, supplemented with remifentanil-based anesthesia and started immediately after anesthetic induction, on postoperative morphine consumption and pain scores.	Tonsillectomy by electrodissection.	IV morphine 3mg every 5 minutes until reaching VAS* <30mm on swallowing.	The addition of ketamine to the anesthesia did not reduce postoperative pain levels.

France				Assessment of pain at rest and when swallowing by VAS* at 15, 30, 45, 60 and 90 minutes.

	n=40

	22 to 49 years old
Ikonomidou et al.²²	Experimental, controlled, prospective study	To test the hypothesis that listening to relaxing music in the pre- and post-operative period could affect the experience of pain, nausea or well-being and that this may have an effect on the vital signs of women undergoing laparoscopic gynecological surgery.	Laparoscopic sterilization or laparoscopic tubal dyeing as part of an infertility program.	Using headphones without music	There was no difference in pain levels when comparing the groups. However, opioid consumption was lower in the group that received music (p=0.04).
				Or
Sweden				Peaceful Pan Flute music 15 minutes after admission to the PACU
				+
	n=60			IV opioid (ketobemidone 2.5mg) if pain > 3 or at nursing discretion.

	25 to 45 years old			Pain assessment using the VAS*.




Pasero and McCaffery ²³	Narrative review	To promote an overview of the primary methods used to manage orthopedic pain and describe the role of perianesthesia nurses when administering them.	Orthopedic surgeries.	Multimodal analgesia, NSAIDs (oral, rectal or IV), paracetamol (oral or rectal), IV opioids, PCA (IV, oral and transdermal).	There are numerous ways of treating orthopedic postoperative pain and no consensus on which is best, but there is consensus that the multimodal approach is the most effective.

USA












Charuluxananan et al. ²⁴	Retrospective qualitative study	To study the status of post-anesthetic pain management in order to determine factors for increasing the quality of anesthetic services in Thailand.	Not reported.	IV and IM opioids (morphine, meperidine, fentanyl and tramadol).	The study revealed inadequate pain management in the PACU in Thailand.

Thailand				Pain assessment protocol or no assessment.

	n=261

	28 to 58 years old
Tan et al. ²⁵	Randomized clinical trial	To determine the effectiveness of a nurse-controlled analgesia protocol in reducing the time to reach a satisfactory postoperative pain score.	General and orthopedic surgery.	Protocol of analgesia administered by doctors (control group)	The nurse-controlled analgesia protocol was effective in reducing pain in less time (p=0.037).

Singapore				Or

	n=120			Nurse-controlled analgesia protocol (IV morphine bolus 1-2mg) (intervention group).

	32 to 60 years old

				Pain assessment using the NPS*.
Aydogan et al. ²⁶	Prospective, randomized, double-blind study	To examine the difference in acute postoperative pain intensity, morphine consumption, and adverse effects between patients who received IV PCA and PCEA for pain control in liver donors.	Right hepatectomy for liver donation.	Morphine infusion through the PCA device and epidural anesthesia + morphine infusion through the PCEA device.	The use of PCEA showed a greater reduction in the intensity of acute postoperative pain and morphine consumption than the use of the IV PCA device (p>0.05).

Turkey

	n= 42			Pain assessment using the VAS*.

	18 to 38 years old
Costalino ²⁷	Qualitative research	To ascertain nursing professionals' perceptions of patients' post-operative pain and the ways in which they deal with the patient's complaint.	Does not apply.	Comfort-related measures (warmth, decubitus changes, bladder distension management) + Measures by consulting a doctor (drugs).	For patient care in the PACU to be effective, all team members must be involved in the whole process.

Brazil

	n=8 professionals			Assessment of pain by verbal communication, without the use of an instrument.


Biachi et al. ⁶	Systematic literature review	To analyze the evidence available in the literature on the effect of aromatherapy for the management of postoperative pain in the PACU.	Abdominal surgery, lower limb fracture surgery and urological surgery.	Aromatherapy with essential oils: lavender, lemon, sweet orange, clary sage and damask rose	Aromatherapy was effective in relieving pain.

Brazil				+ usual care

	n=6 studies			Or

	18 to 65 years old			Placebo + usual care.



				Pain assessment using the VAS* or the NPS*.

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Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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[TFN1] ^*
PCA – Patient-controlled analgesia; PCA – Patient-controlled epidural analgesia; NSAIDs – Nonsteroidal anti-inflammatory drugs; NPS – Numerical Pain Scale; VAS – Visual Analog Scale; VCS – Verbal Rating Scale; GNPIS – Graphic Numeric Pain Intensity Scale; PACU – Post-anesthesia care unit; IV – intravenous; IM – intramuscular. Source: Prepared by the author.