Background Inappropriate pain management during the surgical process could lead to worse surgery outcomes and quality of life. Hospital pharmacists should develop strategies to improve pain management.
Purpose To describe postoperative pain treatment, the proportion of patients who referred moderate-severe pain 24 hours after surgery and 1 month after discharge, and number of visits to the primary care physician, the emergency room (ER) or re-admissions related to postoperative pain during the first month after surgery.
Material and methods An observational, descriptive, prospective study was conducted from February to September 2018. Inclusion criteria: adult patients admitted to surgery departments 24 hours after surgery. Collected variables: demographic, pharmacotherapeutic and clinical. The intensity of the pain was measured by the numerical verbal scale (NVS). The frequency of patients with moderate-severe pain (NVS ≥4) was calculated at 24 hours after intervention and 30 days after discharge.
One–hundred and thirty–three patients (59% males) were recruited (median age 62.7 years, interquartile range 52.0–72.3).
One–hundred and seventeen patients (88.0%, CI 95%: 82.4% to 93.5%) were prescribed an analgesic around–the–clock.
Ninety–eight patients (73.7%, CI 95%: 66.2% to 81.2%) were prescribed acetaminophen, dipyrone or a NSAID around–the–clock. Thirty–eight of them (38.8%,CI 95%:29.1% to 48.4%) were prescribed a potent opioid as a rescue, whereas 28 of them (28.6%, CI 95%: 19.6% to 37.5%) were prescribed a weak opioid and seven (7.1%, CI 95%: 2.0% to 12.2%) were prescribed another non–opioid drug.
Thirty–two patients (24.1%, CI 95%: 16.8% to 31.3%) were not prescribed any drug as a rescue.
Eighty–five patients (63.9% CI 95%: 55.7% to 72.1%) reported moderate–severe pain within 24 hours after surgery. Only 30 of them (35.3%, CI 95%: 25.1% to 45.5%) were administered one or more rescues within the 24 hours after surgery.
At discharge, 34 patients (25.6%, CI 95%: 18.2% to 33.0%) were prescribed one or more analgesics around–the–clock.
Thirty–one patients (23.3%, CI 95%: 16.1% to 30.5%) reported moderate–severe pain within 30 days after discharge.
Eight patients (6.0%, CI 95%: 2.0% to 10.1%) attended the primary care physician consultation due to postoperative pain during the first month after discharge, while two (1.5%, CI 95%: 0.6% to 3,6%) went to the ER and/or were readmitted for this reason.
Conclusion Most patients were prescribed a NSAID, acetaminophen or dipyrone around-the-clock and a strong opioid as a rescue if more pain was experienced.
Rescue medication was under-prescribed and under-administered, which may partially explain the insufficient pain control within the first month after surgery.
References and/or acknowledgements No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.