Clinical study on post operative analgesia and pain management of patients undergoing elective surgeries

Authors

  • Siva Rama Krishna Rao Mukiri Associate Professor, Department of General Surgery, Malla Reddy Medical College for Women, Suraram, Hyderabad, Telangana

DOI:

https://doi.org/10.18203/2349-2902.isj20150781

Keywords:

Clinical study, Pain management, Surgery

Abstract

Background: Adequate control of the postoperative pain plays an important role in postoperative management, taking into account the fact that, beyond the fear for the outcome of surgery, the main concern of patients is related to postoperative pain, which is often perceived as the most unpleasant event and unwanted side effect of the surgical act. The objective was to assess post-operative pain, to compare various modalities of pain management in respects of analgesic efficacy, level of sedation.

Methods: This is a prospective, descriptive study. All the patients were explained about the study, an informed consent was taken. They were explained and educated about the Visual Analogue Scale (VAS) and the usage of it preoperatively. The degree of pain perceived by the patients was evaluated at 1, 3, 6, 12, 24, 48, and 72 hours following surgery, using VAS in mm. The level of sedation was determined using Ramsay’s Sedation score. 4 analgesic modalities were used.

Results: Patients in group IV experienced lowest VAS scores compared to all remaining group patients at all intervals of time except at 6 hours when the average VAS score was more. Level of sedation for patients in group IV was negligible compared to other groups and also few complications. Conclusions: Multi modal analgesia with wound infiltration win LA + IV tramadol + IM diclofenac achieved the best level of analgesia in this study with least consumption of opioids, lowest level of sedation and with best patient satisfaction. 

References

Brennan F, Carr BD, Cousins MJ. Pain management as a fundamental human right. Anaesthesia and analgesia. 2007;105:205-21. [DOI via Crossref] [Pubmed]

Watt-Watson J, Stevens B, Garfinkel P, Streiner D, Gallop R. Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients. Journal of Advanced Nursing. 2001;36(4):535-45. [DOI via Crossref] [Pubmed]

Ferguson J, Gilroy D, Puntillo K. Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit. Journal of Advanced Nursing. 1997;26(6):1065-72. [DOI via Crossref] [Pubmed]

Gust R, Pecher S, Gust A, Hoffman V, Bohrer H, Martin E. Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Critical Care Medicine. 1999;27(10):2218-23. [DOI via Crossref] [Pubmed]

Apfelbaum. Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to be undermanaged. Anesth Analg. 2003;97:534–40. [DOI via Crossref] [Pubmed]

Nesher N, Ekstein MP, Paz Y. Morphine with adjuvant ketamine vs. higher dose of morphine alone for immediate post thoracotomy analgesia. Chest. 2009;136:245-52. [DOI via Crossref] [Pubmed]

Melzack R, Coderre T, Katz J, Vaccarino AL. Central neuroplasticity and pathological pain. Annals of the New York Academy of Sciences. 2001;933:157-74. [DOI via Crossref] [Pubmed]

Pan PH, Coghill R, Houle TT, Seid MH, Lindel WM, Parker RL et al. Multifactorial preoperative predictors for post caesarean section pain and analgesic requirement. Anaesthesiology. 2006;104:417-25. [DOI via Crossref]

Ozalp. Postoperative pain management: predictors, barriers and outcome by Kerstin WIckstrom ENE, Goteborg, 2008.

Ramsey sedation scale. Available from: http://www.londonccn.nhs.uk/_store/documents/ramseysedationscale.pdf.

Kilbride et al Intramuscular vs. PCA vs. Epidural analgesia. Surg Gynecol Obstet. 1992;174(2):137-40. [Pubmed]

Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008;95(11):1331-8. [DOI via Crossref] [Pubmed]

Downloads

Published

2016-12-14

Issue

Section

Original Research Articles