A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

Abstract

(249 words)We carried out a national survey on postoperative pain (POP) management in a representative sample (public/private, teaching/non teaching, size) of 76 surgical centers in France. Based on medical records and questionnaires, we evaluated adult patients 24 hours after surgery, concerning information, pre and postoperative pain, evaluation, treatment and side effects. A local consultant provided information about POP management. Data were recorded for 1900 adult patients, 69.3% of whom remembered information on POP.Information was mainly delivered orally (90.3%) and rarely noted on the patient's chart (18.2%). Written evaluations of POP were frequent on the ward (93.7%) with appropriate intervals (4.1 (4.0) hours), but not frequently prescribed (32.7%). Pain evaluations were based on visual analog scale (21.1%), numerical scale (41.2%), verbal scale (13.8%) or non numerical tool (24%). Pain was rarely a criterion for recovery room discharge (19.8%).Reported POP was mild at rest (2.7 (1.3), moderate during movement (4.9 (1.9) and intense at its maximal level (6.4 (2.0). Incidence of side effects was similar according to patient (26.4%) or medical chart (25.1%) including mostly nausea and vomiting (83.3%). Analgesia was frequently initiated during anesthesia (63.6%). Patient-controlled analgesia (21.4%) was used less frequently than subcutaneous morphine (35.1%) whose prescription frequently did not follow guidelines. Non-opioid analgesics used included paracetamol (90.3%), ketoprofen (48.5%) and nefopam (21.4%). Epidural (1.5%) and peripheral (4.7%) nerve blocks were underused. Evaluation (63.4%) or treatment (74.1%) protocols were not available for all patients.This national, prospective, patient-based, survey reveals both progress and persistent challenges in POP management.

Acute postoperative pain in 1 231 patients at a developing country referral hospital: incidence and risk factors

“…16 In a large national survey in France subcutaneous morphine was prescribed in 35% of patients of whom 88% received it at an interval of 6 h or less and 8% never received morphine. 7 In a public teaching hospital in Melbourne, Australia, the percentage of fixed analgesic administered was 65% over the first 24 postoperative hours. 17 In our institution, the discrepancy between the dose intervals at which morphine was prescribed and that at which it was administered was substantially worse than what was previously reported.…”

“…This could provide a way to make nursing staff more aware of the problem as patients tend to underreport their pain until it becomes unbearable. 7,15,16 An excessive nursing workload due to low staff numbers in addition to the paperwork needed for scheduled drug administration and the fear of opiate abuse may also have contributed.…”

“…[1][2][3][4][5][6][7] In a resource-limited environment with an expected high incidence of postoperative pain it is necessary to fully utilise basic analgesic modalities and to reserve more costly advanced methods for those who need it most. For this reason the incidence and risk factors associated with a higher incidence of postoperative pain need to be identified.…”

Ibuprofeno intravenoso: experiencia clínica en el tratamiento del dolor postoperatorio

“…Alrededor de 60 millones de cirugías electivas y ambulatorias son realizadas anualmente en hospitales públicos en los Estados Unidos de América (EUA) (2,3) y se considera que poco más del 30 % de los pacientes padecerán dolor postoperatorio de intensidad alta o muy alta (1). En Francia, cerca del 4 % de los pacientes en postoperatorio reportan dolor severo en reposo y el 26,9 % en movimiento (4). En general, los pacientes postquirúrgicos tienen un mayor riesgo de presentar dolor durante su estancia hospitalaria (5), por lo tanto no es sorprendente que la investigación en este campo continúe en pleno desarrollo, buscando brindar nuevas alternativas para el tratamiento del dolor postoperatorio.…”

Controlo de Dor, Infeção Local, Satisfação, Efeitos Adversos e Dor Residual no Pós-Operatório de Cirurgia Abdominal Major: Epidural versus Infusão Contínua da Ferida Cirúrgica (PAMA Trial)

“…A analgesia por via endovenosa tem sido frequentemente associada a atraso na recuperação pós--operatória devido aos efeitos adversos associados de que são exemplos náuseas e vómitos, prolongamento do íleus gástrico e intestinal, sedação e tonturas. 6 A analgesia por via epidural tem vindo a demonstrar muito bons resultados quer na dor estática, quer na dor dinâmica, sendo atualmente a técnica gold standard. 7 No entanto, há algumas limitações à sua utilização como as contraindicações absolutas e relativas, a falência da técnica e os efeitos adversos e complicações com prevalência importante.…”