A Decision Tree Model for Postoperative Pain Management

Cynthia W. Ward, DNP, RN-BC, CMSRN, ACNS-BC


Urol Nurs. 2015;35(5):251-256. 

In This Article

Abstract and Introduction


Postoperative pain management involves many factors. Current information regarding assessment and treatment of postoperative pain is discussed. A decision tree model flowchart was developed based on patient characteristics, comorbidities, and the type of pain.


Many factors should be considered in treatment of postoperative pain. In addition to the characteristics of the analgesic, the individual receiving treatment must be considered in terms of co-morbidities affecting the metabolism and safety of the medication (Ahmed, 2011; Pasero, Quinn, Portenoy, McCaffery, & Rizos, 2011).

A review of the literature assessed the current evidence related to individual co-morbidities affecting analgesia usage. An electronic search of the CINAHL and Google Scholar databases was conducted using the following search terms: postoperative pain, postoperative pain management, effects of pain on the body, ad verse effects of pain, how pain affects the body, physiologic consequences of pain, physiologic response to pain, consequences of unrelieved pain, effects of unrelieved pain, pain medication recommendations for postoperative pain, medication recommendation for postoperative pain based on pain scale, medication guidelines for postoperative pain based on pain scale, opioid guidelines for postoperative pain based on pain scale, barriers to postoperative pain management, obstructive sleep apnea, opioid use in obstructive sleep apnea, use of opioid analgesics in patients with OSA, PROcedure-SPECific postoperative pain management (PROSPECT), PROSPECT studies, and Joint Commission guidelines for pain management. Limits were set to include full text, date range since 2008, English language, and adult patients. Other appropriate sources contained in the reference lists of the searched literature were considered, leading to identification of 45 articles and 14 guidelines/protocols. Three were not useful and were excluded. Seven relevant reference books on the topic of pain management were consulted and information from these books was included. A decision tree model flowchart then was developed to offer analgesia options based on the type of pain as well as individual patient characteristics or co-morbidities.