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. 2018 Oct-Dec;34(4):478-484.
doi: 10.4103/joacp.JOACP_387_17.

Postoperative pain management practices and their effectiveness after major gynecological surgery: An observational study in a tertiary care hospital

Samina Ismail  1 , Ali S Siddiqui  1 , Azhar Rehman  1
Affiliations

Postoperative pain management practices and their effectiveness after major gynecological surgery: An observational study in a tertiary care hospital

Samina Ismail et al. J Anaesthesiol Clin Pharmacol. 2018 Oct-Dec.

Abstract

Background and aims: Despite advances in postoperative pain management, patients continue to experience moderate to severe pain. This study was designed to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing major gynecological surgery.

Material and methods: This observational study included postoperative patients having major gynecological surgery from February 2016 to July 2016. Data collected on a predesigned data collection sheet included patient's demographics, postoperative analgesia modality, patient satisfaction, acute pain service assessment of numeric rating scale (NRS), number of breakthrough pains, number of rescue boluses, time required for the pain relief after rescue analgesia, and any complication for 48 h.

Results: Among 154 patients reviewed, postoperative analgesia was provided with patient-controlled intravenous analgesia in 91 (59.1%) patients, intravenous opioid infusion in 42 (27%), and epidural analgesia in 21 (13.6%) patients with no statistically significant difference in NRS between different analgesic modalities. On analysis of breakthrough pain, 103 (66.8%) patients experienced moderate pain at one time and 53 (51.4%) at two or more times postoperatively. There were 2 (0.6%) patients experiencing severe breakthrough pain due to gaps in service provision and inadequate patient's knowledge. Moderate-to-severe pain perception was irrespective of type of incision and surgery. Vomiting was significantly higher (P = 0.049) in patients receiving opioids.

Conclusion: Adequacy of postoperative pain is not solely dependent on drugs and techniques but on the overall organization of pain services. However, incidence of nausea and vomiting was significantly higher in patients receiving opioids.

Keywords: Acute pain service; gynecological surgery; pain scores; postoperative pain management; practices.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Analgesic modalities used in different surgeries
Figure 2
Figure 2
Comparison of static pain score among different analgesic modalities with respect to follow-up time
Figure 3
Figure 3
Comparison of dynamic pain score among different analgesic modalities with respect to follow-up time
See this image and copyright information in PMC

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