Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries were included. Post-operative analgesic strategy, co-analgesics used, pain and sedation scores, motor block, nausea and vomiting were recorded and patient satisfaction was determined. Results: Data was collected on 100 patients. Epidural analgesia was used in 61, patient controlled intravenous analgesia (PCIA) in 25 and opioid infusion in 14 patients. Multimodal analgesia was employed in 98 patients. The level of epidural was between L1-L3 in 31, T10-L1 in 20 and T8-T10 in 10 patients. Pethidine was used in 80% of patients receiving PCIA. Patients with epidurals at T8-T10 had lower pain scores. Fifteen patients had motor block, 73% of which were with epidural at L1-L3. Fourteen patients complained of nausea. Ninety nine out of 100 patients were satisfied with their analgesia. Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS) and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

[1]  Amy M. Pick,et al.  The management of acute postoperative pain , 2010 .

[2]  H. Kehlet,et al.  Improving postoperative pain management: what are the unresolved issues? , 2010, Anesthesiology.

[3]  J. Kroin,et al.  Multimodal analgesia for controlling acute postoperative pain , 2009, Current opinion in anaesthesiology.

[4]  M. Paech,et al.  Analgesia after Caesarean Delivery , 2009, Anaesthesia and intensive care.

[5]  R. Vonthein,et al.  Audit of motor weakness and premature catheter dislodgement after epidural analgesia in major abdominal surgery , 2009, Anaesthesia.

[6]  P. White.  Pain management after ambulatory surgery — Where is the disconnect? , 2008, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[7]  D. Carr,et al.  Pain Management: A Fundamental Human Right , 2007, Anesthesia and analgesia.

[8]  P. White,et al.  Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery , 2007, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[9]  H. Kehlet,et al.  PROSPECT: evidence-based, procedure-specific postoperative pain management. , 2007, Best practice & research. Clinical anaesthesiology.

[10]  A. Date,et al.  Acute Pain Management , 2009, The Perioperative Medicine Consult Handbook.

[11]  H. Kehlet.  Effect of postoperative pain treatment on outcome—current status and future strategies , 2004, Langenbeck's Archives of Surgery.

[12]  S. Mehta,et al.  Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged , 2003, Anesthesia and analgesia.

[13]  Jon S Thompson,et al.  Effect of Epidural Anesthesia and Analgesia on Perioperative Outcome: A Randomized, Controlled Veterans Affairs Cooperative Study , 2001, Annals of surgery.

[14]  N. Rawal.  Acute Pain Services Revisited—Good From Far, Far From Good? , 2001, Regional Anesthesia & Pain Medicine.

[15]  N. Rawal.  Analgesia for day-case surgery. , 2001, British journal of anaesthesia.

[16]  H. Kehlet,et al.  Effect of postoperative analgesia on surgical outcome. , 2001, British journal of anaesthesia.

[17]  M. Cousins,et al.  1996 Labat Lecture: Pain—A Persistent Problem , 1999, Regional Anesthesia & Pain Medicine.

[18]  K. A. George,et al.  Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery A comparison of thoracic and lumbar routes , 1995, Anaesthesia.

[19]  P. Bromage.  A Comparison of the Hydrochloride and Carbon Dioxide Salts of Lidocaine and Prilocaine in Epidural Analgesia , 1965, Acta anaesthesiologica Scandinavica. Supplementum.