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body temperature can diminish their post-opera-
tive pain. Even though the link is not well under-
stood, research has shown that hypothermia can
and does affect patients' experience of post-oper-
ative pain.
You've no doubt seen hypothermic patients.
They're tense, they're shivering and they're
struggling to get their surgical pain under con-
trol. Shivering is remarkably uncomfortable
and upsetting, so much so that some patients
rate post-operative shivering and the feeling of
cold associated with it as worse than surgical
pain. On its own, shivering can aggravate post-
operative pain simply through involuntary
muscle contractions, contributing to surgical
incision pain. Shivering has also been demon-
strated to consume a huge amount of oxygen while increasing myocardial
workload, and it increases intraocular and intracranial pressures.
We know that the primary cause of post-anesthetic shivering is perioperative
hypothermia, largely due to anesthetic-induced inhibition of thermoregulation.
Early initiation of warming measures for surgical patients helps mitigate that
phenomenon, elevating the patient experience. One study found that patients
who use warming gowns needed fewer opioids to manage their postoperative
pain. The study, published in the May 2012 American Journal of Nursing
(osmag.net/ZHgX8j), found that TKA patients who received warming gowns had
higher temperatures in PACU, used fewer opioids after surgery and reported
more satisfaction with their thermal comfort than did patients who received
standard blankets.
PACU nurses will tell you that it's hard to get a cold patient's pain under con-
trol. They require more analgesics, which can cause a longer stay in recovery.
DRUG CONTROL
Warm Patients
Require Fewer
Pharmaceuticals
Active patient warming
helps prevent side effects
of surgery.
• The reduction in pain
realized by warming
more patients could
lower opioid use.
• The reduction in surgical
site infections realized
by warming more
patients could lower
antibiotic use.
