Pattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study

Authors

  • Mohna M. Toro Department of Pharmacology, St. John’s Medical College, Bangalore, Karnataka, India
  • Sheetal John Department of Pharmacology, St. John’s Medical College, Bangalore, Karnataka, India
  • Atiya R. Faruqui Department of Pharmacology, St. John’s Medical College, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180372

Keywords:

Analgesics, Laparotomy, Numerical rating scale

Abstract

Background: Previous studies on post-operative pain document that most patients continue to experience pain after surgery. This study was done to record the drug use for post- operative pain in laparotomy and to determine the patient characteristics that affect their pain score.

Methods: A prospective observational study in 250 adult patients undergoing laparotomy surgery from General Surgery and Obstetrics and Gynaecology (OBG) at a tertiary care hospital.

Results: Among patients recruited, 161 (64.4%) were females, 134 (53.6 %) from surgery department, mean age 37.29±14.9 years. Caesarean section 85 (73.27%) followed by meshplasty 46 (34.3%) were most common.

Parenteral tramadol 100mg (40%) was the most common analgesic post-operative, subsequently shifted to oral. Epidural analgesia used in 31 (12.4%) patients, only from surgery department. First analgesic received within 6 hrs in 55.5 % in surgery and 44.5 % in OBG (Pearson χ2 =2.535, p = 0.111) with mean time to first analgesic 2.85±2.33 hrs. Pain score, using Numerical Rating Scale (NRS) recorded for 200 (80%) patients showed 76 (30.4%) had severe pain on day 1 which decreased to 12 (4.8%) on day 3. Speciality (p=0.01) and nature of surgery (p=0.05) were significantly associated with severity of pain. Gender [OR = 0.55 (95% CI = 0.26, 1.19), p=0.13], nature of surgery  [2.32 (1.02, 5.32), p=0.05], speciality [0.35 (0.15, 0.80), p=0.01] and surgical category [0.76 (1.01, 5.32), p=0.05] affected pain score on univariate logistic regression, but were not significant on multivariate analysis.

Conclusions: Despite the use of opioids and combination analgesics, one third of patients reported severe pain on the first day after surgery.

References

Merskey H. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain. 1979;6:249-52.

Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013;109(1):5-12. Available at: https://doi.org/10.1093/shm/10.1.166. Accessed 1 June, 2016.

Hitchcock T. Reviews. Social History of Medicine. 1997;10(1):166-7.

Vallano A, Aguilera C, Arnau JM, Baños JE, Laporte JR. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study. Br J Clin Pharmacol. 1999;47(6):667-73.

Tufano R, Puntillo F, Draisci G, Pasetto A, Pietropaoli P, Pinto G, et al. ITalian Observational Study of the management of mild-to-moderate Post-Operative Pain (ITOSPOP). Minerva Anestesiol. 2012;78(1):15-25.

Bhagat S, Agarwal M, Roy V. Serratiopeptidase: a systematic review of the existing evidence. Int J Surg Lond Engl. 2013;11(3):209-17.

Serratiopeptidase - finding the evidence. Available at: http://www.medicine.ox.ac.uk/bandolier/booth/alternat/serrapep.html. Accessed 31 August 2015.

Stamer UM, Mpasios N, Stüber F, Maier C. A survey of acute pain services in Germany and a discussion of international survey data. Reg Anesth Pain Med. 2002;27(2):125-31.

Phua DSK, Leong WM, Yoong CS. The acute pain service after ten years: experiences of a Singapore public hospital. Singapore Med J. 2008;49(12):1007-11.

Joshi GP, Schug SA, Kehlet H. Procedure-specific pain management and outcome strategies. Best Pract Res Clin Anaesthesiol. 2014;28(2):191-201.

Vallano A, Malouf J, Payrulet P, Baños JE. Catalan Research Group for the Study of Pain in the Hospital. Analgesic use and pain in the hospital settings. Eur J Clin Pharmacol. 2007;63(6):619-26.

Costantini M, Viterbori P, Flego G. Prevalence of pain in Italian hospitals: results of a regional cross-sectional survey. J Pain Symptom Manage. 2002;23(3):221-30.

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Published

2018-01-25

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Original Research Articles