Optimizing post-operative pain management in Latin America (original) (raw)
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Management of postoperative pain in Spain: a nationwide survey of practice
Acta Anaesthesiologica Scandinavica
Background: Although the need for structured assessment and management of acute postoperative pain has been recognized, practices and responsibilities vary between and within hospitals and countries. We sought to determine current pain management practices in Spanish hospitals with and without acute pain services (APSs) or acute pain management programmes (APMPs) and compare them to practices reported for 1997-1998. Methods: Members of the Spanish Pain Society and APS/APMP heads were asked to respond to a survey. Responses were stratified by hospital size (<200 or ≥200 beds) and APS/APMP presence or not. Categorical variables were described by percentages and the 95% confidence interval and continuous ones by the median and interquartile range. Results: Responses were received from 42.4% of hospitals with ≥200 beds (vs. 9.6% of the smaller ones). We fully analysed only data for the larger hospitals, 57.7% of which had an APS or APMP. Full-time pain physicians were on staff in 28.6% of large hospitals; 25% had full-time nurses. Patients received written information about postoperative pain in 34.8% of APS/APMP hospitals, and 72% of them recorded pain assessments routinely. Protocols reflected interdepartmental consensus in 80.8%; training in postoperative pain was organised in 54%. Respondents thought pain was well or very well managed in 46.4%. In APS/APMP hospitals the following results had improved: provision of written information for patients (58.5% vs. 0%), the recording of pain
Pain is a detestable emotional, sensory experience that usually occurs in varying degrees of intensity, identifying itself as multidimensional, as high in quality as in intensity, being able to result from nerve stimulation as a result of injury, emotional disturbance or disease. In this way it makes possible the certification in which pain is a singular and particular experience. The present study aims to evaluate the intensity of pain and analgesia used in patients in the postoperative period in a hospital in the interior of Bahia. This is a quantitative, descriptive and cross-sectional study conducted in a public hospital in the interior of Bahia through a structured questionnaire and the analysis of medical prescriptions. The research involved 50 participants who underwent surgical procedures. NVS was used to assess pain intensity. The data were analyzed in the statistical program SPSS 22.0. The predominance of the male gender (78%) and the age groups of 62-72 years (32%) were observed. In addition, 64% of the participants presented prescription of some type of opioid. 86% presented some type of pain and 76% had mild pain. The results of this research indicate the need for systematic evaluation of pain in postoperative patients, aiming at its control, contributing to the recovery of these patients.
Postsurgical Chronic Pain: Incidence and Associated Factors in a Latin American Population
Introduction: It is important to know the incidence of Chronic Post- Surgical Pain (CPSP), to describe the distribution of risk and protective factors associated with its presentation and to measure its impact on the quality of life. Due to the diversity of factors that have been implicated as potentially associated with chronic post-surgical pain, it is important to look for differential characteristics including emotional features to establish whether there are differences in the incidence of this type of pain. Methods: A prospective analytical observational study was conducted in surgical patients at a University hospital from January 1 2014. Patients were asked to score their pain in the preoperative and immediate postoperative setting, and 3 months after surgery; preoperative, intraoperative, and postoperative risk factors were assessed, and quality of life was assessed in the preoperative setting and 3 months after surgery. Results: We included 108 patients for a preliminary analysis, the study continued until the target sample size had been reached. The global incidence of CPSP was 16.67% (95%CI 9.63-23.69). Risk factors were the presence of pain prior to surgery and the duration of the surgical procedure. The presence of pain prior to surgery is a risk factor for the transition to CPSP.
Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study
British Journal of Clinical Pharmacology, 2001
Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal surgery, admitted between October 1994 and January 1995. For each patient, information about the surgical procedure and the use of analgesics was prospectively collected. The severity of postoperative pain was assessed during the first day after surgery by means of a six-category (none, mild, moderate, severe, very severe, and unbearable) rating scale and a visual analogue scale (VAS). Results Nine hundred and ninety-three patients (547 men) were included. The most common surgical procedures were inguinal hernia repair (315, 32%), cholecystectomy (268, 27%), appendectomy (140, 14%), bowel resection (137, 14%), and gastric surgery (58, 6%). Fifty-nine percent of patients (587) received nonopioid analgesics only, 9% (89) received opioid analgesics only, and 27% (263) received both opioid and nonopioid analgesics. The most frequently administered drugs were metamizole (667 patients) and pethidine (213 patients). Although in the majority of medical orders the administration of analgesics was scheduled at regular time intervals, the majority of actual doses were given 'as-needed'. The average administered daily doses of all analgesics were lower than those prescribed. Thirtyeight percent (371/967) of patients rated their maximum pain on the first day as severe to unbearable. Wide interhospital variability was recorded in the surgical procedures which had been performed, in the analgesics used, and also in the pain scores referred by patients. The percentage of patients in each centre who suffered severe to unbearable pain varied from 22 to 67%.
British Journal of Clinical Pharmacology, 2001
Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal surgery, admitted between October 1994 and January 1995. For each patient, information about the surgical procedure and the use of analgesics was prospectively collected. The severity of postoperative pain was assessed during the first day after surgery by means of a six-category (none, mild, moderate, severe, very severe, and unbearable) rating scale and a visual analogue scale (VAS). Results Nine hundred and ninety-three patients (547 men) were included. The most common surgical procedures were inguinal hernia repair (315, 32%), cholecystectomy (268, 27%), appendectomy (140, 14%), bowel resection (137, 14%), and gastric surgery (58, 6%). Fifty-nine percent of patients (587) received nonopioid analgesics only, 9% (89) received opioid analgesics only, and 27% (263) received both opioid and nonopioid analgesics. The most frequently administered drugs were metamizole (667 patients) and pethidine (213 patients). Although in the majority of medical orders the administration of analgesics was scheduled at regular time intervals, the majority of actual doses were given 'as-needed'. The average administered daily doses of all analgesics were lower than those prescribed. Thirtyeight percent (371/967) of patients rated their maximum pain on the first day as severe to unbearable. Wide interhospital variability was recorded in the surgical procedures which had been performed, in the analgesics used, and also in the pain scores referred by patients. The percentage of patients in each centre who suffered severe to unbearable pain varied from 22 to 67%. © 1999 Blackwell Science Ltd Br J Clin Pharmacol, 47, 667-673 667 A. Vallano et al.
Current concepts and practice in postoperative pain management: need for a change?
Eur Surg Res. 1999;31(2):97-107., 1999
Despite a growing trend in acute pain management, many deficiencies still account for the high incidence of moderate to severe postoperative pain to date. Patients nowadays continue to receive inadequate doses of analgesics, but additionally the identification and treatment of those patients with pain still remains a significant health care problem. Advanced techniques are available including epidural or intrathecal administration of local anaesthetics and opioids, various opioid administration techniques such as patient-controlled analgesia and infusions via sublingual, oral-transmucosal, nasal, intra-articular and rectal routes. Nonopioid analgesics such as nonsteroidal anti-inflammatory drugs and newer nonopioid drugs such as alpha2-adrenergic agonists, calcium channel antagonists and various combinations of the above are possible. However, the solution to the problem of inadequate pain relief lies not so much in the development of new drugs and new techniques, but in the effective strategy of delivering these to patients through the introduction of acute pain management services on surgical wards.
Efficacy and Safety of an Acute Pain Service among 10,760 Postoperative Patients
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2016
Introduction. Post-operative pain control improves surgical outcome and many hospitals created multidisciplinary teams, called "Acute Pain Services" (APS). We collected APS data on 10,760 adult patients over a five year period, including complications, side effects and patient satisfaction. Methods. Data on patients managed by APS in a high surgical-volume university hospital over a 5-year period were collected and analyzed. Data included demographic characteristics, primary analgesic modality, adjuvant analgesic treatment, type of surgical procedure, Visual Analogue Scale, and analgesia-related sideeffects and complications. Conclusions. An APS, with daily postoperative visits, permits adequate post-operative pain control without serious adverse events. Epidural analgesia was associated with less postoperative nausea and vomiting and had at least similar pain control than morphine patient controlled analgesia.
Are we controlling postoperative pain?
Colombian Journal of Anesthesiology, 2013
Introduction: Immediate postoperative pain has been underestimated and managed inadequately. Objectives: To assess perceived pain 4 h after surgery in patients at the San Jorge University Hospital in the city of Pereira. Materials and methods: Cross-sectional study in patients over 18 years of age was conducted between September 2nd and October 28th, 2011. Postoperative pain intensity was assessed using the Visual Analog Scale, 4 h after completing the procedure. Social, demographic, clinical and pharmacological variables were considered. The analysis was done using the SPSS 20.0 for Windows. Results: Of the 213 postoperative patients studied, 114 (53.6%) were women and 99 (46.4%) were men, with a mean age of 47.1 ± 20.0 years. At 4 h, 51.4% of patients did not have pain control. There was a statistically significant association between lack of control and age, living in the urban area, type of surgery, non-adherence to the dose, and monotherapy analgesia. Discussion: Inadequate pain control requires revisiting its management, ideally on the basis of clinical practice guidelines and using analgesic drugs at adequate doses and intervals.