NURSING INTERVENTIONS FOR THE MANAGEMENT OF ACUTE PAIN IN THE IMMEDIATE POSTOPERATIVE PERIOD: A SCOPE REVIEW

• INTRODUCTION, JUSTIFICATION, OBJECTIVE AND RESEARCH QUESTION: The immediate postoperative period (IPO) is the time immediately following a surgical intervention, extending up to 24 hours after the end of the procedure. During this period, the patient is subject to various types of complications and is therefore considered critical. At this stage, patients may present physiological alterations such as unconsciousness, cardiorespiratory depression, absence of sensations, and sympathetic tone changes, thus requiring continuous observation and specific care. Pain is a common and biological event and the most frequent complication or discomfort during the IPO period. It is defined as an unpleasant sensory and emotional phenomenon associated with actual or potential tissue damage, perceived subjectively. Tissue injury leads to the release of prostaglandins by damaged cells, which facilitates the transmission of nociceptive stimuli. In the IPO, pain is considered acute as it results from tissue injury caused by surgical skin incision and manipulation of deep somatic structures, bones, viscera, or organs. Nurses providing care to patients in the IPO must possess highly qualified knowledge and skills to assist individuals undergoing surgeries of varying complexities who require specific and individualized care. Ensuring the restoration of consciousness and homeostatic balance through actions aimed at preventing complications is essential. In the IPO, adequate management of acute pain is essential not only for comfort but also for patient stability and recovery, as prolonged and intense exposure to painful stimuli may cause cardiovascular alterations, reduced immune response, and coagulation changes. In this context, nurses are responsible for planning and implementing actions aimed at preventing and treating this complication, analyzing the patient’s organic functions proactively, thereby contributing to recovery and improving the quality of care in the IPO. This care involves therapeutic actions performed before, during, and after surgery to reduce or eliminate pain, since early treatment makes acute pain easier to control than when it is already established. Furthermore, several published studies indicate that acute pain in the IPO remains undertreated, negatively impacting patient recovery. Ineffective pain control increases hospital length of stay and leads to inappropriate use of pharmacological and non-pharmacological techniques, inadequate prescriptions, and lack of systematic assessment and care management in the IPO. This study provides reflection on perioperative nursing care by identifying evidence described in the literature regarding the management of acute pain in patients during the IPO. Nursing care must be systematic, continuous, planned, and integrated in order to promote, prevent, restore, and rehabilitate patient health. Thus, this study aims to map the main nursing interventions described in the literature for managing acute pain in patients during the IPO. The objective is to map and describe nursing interventions used for acute pain management in patients in the immediate postoperative hospital setting. Using the PCC mnemonic (Population, Concept, Context), the following guiding research question was developed for database searches: “What nursing interventions are used to manage acute pain in surgical patients during the immediate postoperative period in the hospital setting?”. • INCLUSION/ELIGIBILITY CRITERIA: Regarding eligibility criteria, the following were considered as sources of evidence: published or unpublished documents reporting analytical observational and descriptive observational studies, as well as experimental and quasi-experimental studies. The types of documents included were scientific articles, book chapters, full books, monographs, dissertations, and theses available in digital format in Latin American, North American, and European databases. Literature reviews were also included as sources of evidence. No time restriction was applied in order to obtain the largest possible number of evidences. Documents were limited to those indexed in English, Spanish, and Portuguese, considering the researchers’ proficiency in these languages. • SEARCH STRATEGIES: Searches were conducted in the following databases: PubMed via MedLine, Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Scopus, Embase, and grey literature through Google Scholar (first five pages of results) and Open Access Theses and Dissertations (OATD). Search terms corresponding to Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) were used and combined using the Boolean operators “AND” and “OR,” as described in the table below. • STUDY SELECTION: After completing the search strategy, the retrieved information was organized and imported into Mendeley® software to remove duplicates. Subsequently, records were imported into Rayyan – Intelligent Systematic Review for study selection and screening. During this stage, titles and abstracts were read according to the established inclusion criteria and the PCC strategy. For studies included in the sample, a thorough full-text reading was conducted. At all stages, reasons for exclusions were recorded and justified. The selection process was carried out through blinded peer review by two independent reviewers, members of the Graduate Nursing Program at a Federal University in the interior of the state of Minas Gerais. Disagreements during the selection process were resolved by a third reviewer, also a faculty member and postdoctoral researcher affiliated with the same Graduate Nursing Program. • DATA EXTRACTION: Extracted data were entered into a specific instrument developed by the researchers using Microsoft Office Excel®, following the recommendations of the JBI for categorization, classification, and analysis of the productions. • PRESENTATION OF RESULTS: Results were presented using tables, charts, and flow diagrams to answer the research question and objectives of this scoping review. Data were analyzed and synthesized through thematic categorization with grouping by similarity, as recommended by JBI guidelines. Since the objective is to map, identify, characterize, and summarize the evidence, findings were presented clearly and descriptively in alignment with the study objective. • ETHICAL ASPECTS: As this is a scoping review using publicly accessible sources of evidence available in scientific databases or institutional repositories, there is no involvement of human subjects, and therefore submission to a Research Ethics Committee (REC) was not required. Nevertheless, the researchers commit to upholding principles of scientific integrity and methodological transparency regarding data collection, processing, storage, and dissemination.