Implementation of a bundle of non-pharmacological interventions aimed at stress reduction in the PACU: effects on pain and use of opioids

Surgical stress, pain and anxiety activate a stress response that can negatively influence post-operative outcomes. This stress response can be influenced by pharmacological and non-pharmacological interventions. Opioids are the cornerstone for the treatment of moderate to severe postoperative pain. However, opioids are associated with adverse respiratory events and opioid addiction. In the U.S, 10% of opioid-naïve patients with cancer undergoing curative-intent surgery develop new persistent opioid use. Non-pharmacological interventions that are aimed at reducing stress have been shown to be cheap, low-risk interventions that affect pain perception and patient outcomes positively.
For this study, a bundle of non-pharmacological interventions will be implemented in the post-anesthesia care unit. The bundle consists of:

a) acces to natural elements in the PACU
b) positive distraction through music
c) aromatherapy
d) introduction of communication techniques that enhance placebo effects and reduce nocebo effects of communication

The effect of the bundle on pain, use of opioids, lenght-of-stay, opioid-related side-effects and adverse events, patient satisfaction and staff satisfaction will be compared to the 6 months prior to implementation of the bundle.

The implementation of a bundel of pharamcological interventions aimed at stress reduction leads to lower pain scores and lower use of opioids in the PACU

Before arm: 6 months data gathering
Implementation of the bundle
After arm: 6 months data gathering

1. Acces to nature (full lenght wall coverings and leighted ceiling pannels with nature images)
2. Positive distraction through music
3. Aromatherapy
4. Comfort Talk communication course for nurses