Pain assessment and management considerations

Introduction A comprehensive strategy is needed for adequate management of patients through the entire peri-procedure period. Assessments and interventions pre-procedure, peri-procedure, and post-procedure are codependent. For example, failure to recognize an opioid-dependent patient during the initial pre-procedure screening may result in ineffective sedation strategies. Overuse of and/or failure to report long-acting sedative medications used during procedural sedation can result in a delayed and complicated recovery period. This chapter deals with important considerations with regard to pre-procedure, peri-procedure, and post-procedure patient assessment and pain management strategies. For a detailed discussion of patient evaluation and procedure selection, see Chapter 4. Considerations and patient assessment prior to procedural sedation Given the magnitude of adverse outcomes that can accompany sedation, it is paramount that before start of any procedure, practitioners evaluate patient characteristics, patient preferences, appropriateness of sedation given the invasiveness of the procedure, special considerations during the procedure (e.g., risk to the patient with movement during the procedure), and patient safety. The primary goal of giving sedation should be to achieve an acceptable level of patient comfort while considering all of these factors.