Nonpharmacological interventions for the reduction of post-operative pain after ambulatory surgery: A systematic review of randomised controlled trials

Abstract

Aims: To examine the effectiveness of nonpharmacological interventions for the reduction of post-operative pain in patients undergoing ambulatory surgery (also known as day surgery).

Background: Post-surgical pain remains prevalent, especially in day surgery cases. When poorly managed, this acute pain can lead to chronic pain and delayed recovery. Nowadays, several nonpharmacological regimens are available for reducing pain after ambulatory surgery. Further investigation is required to assess the quality of these alternatives.

Design: Systematic review

Methods: An electronic search of PubMed, CINAHL (via EBSCOhost), Embase, and Cochrane library was undertaken to screen and assess the studies of nonpharmacological intervention in reducing post-operative pain in ambulatory surgery. Inclusion criteria covered randomised controlled trials (RCTs) on patients undergoing day surgery in which the patients received nonpharmacological intervention for post-operative pain management. This review excluded studies published more than 25 years ago, studies using languages other than English and Bahasa Indonesia, and case reports, conference abstracts and review articles.

Results: Four eligible studies provided drug-free interventions for reducing pain after day surgery; the interventions included foot massage, acupuncture, audio–visual relaxation tools delivered by mobile technology and digital video discs (DVDs). There were varying respondents and tool assessment characteristics, especially in pain level instruments and pain outcome indicators across the studies. The risk of bias found in the studies was mainly associated with incomplete data and selective reporting. Although some studies showed less significant statistical results, the mean difference in the intervention arms showed meaningful effectiveness.

Conclusion: The appropriate application of nonpharmacological interventions might reduce patient pain levels after day surgery. High-quality RCTs and specific follow-up studies are needed to investigate the effectiveness of each intervention for post-operative pain reduction.