Audit on assessment of adequacy of Postoperative Analgesia in a Tertiary Care Centre: An Observational study

Anity Singh, Dhanyee (2013) Audit on assessment of adequacy of Postoperative Analgesia in a Tertiary Care Centre: An Observational study. Masters thesis, Christian Medical College, Vellore.


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PRIMARY OBJECTIVE: Assessment of adequacy of current analgesic protocols. SECONDARY AIMS: a)Assessing the need of a pain nurse in our setting. b) To establish the necessity of a functioning Acute pain service in Obstetrics-Gynecology department. METHODS: CLINICAL METHODS: This observational study includes all Gynecology inpatients undergoing any open abdominal procedure, with normal mental health and hospitalized for atleast 48hrs postoperatively. Our exclusion criteria includes all patients transferred directly to an intensive care unit,those who had emergency procedure or discharged in less than 48hrs. Our tool is the Comprehensive Pain Assessment and monitoring sheet/Universal Pain Assessment Tool. During the preoperative visit patients will be made familiar with this tool. Postoperatively the first scoring will be done by the nurse,who will be educated beforehand about the study.It will be continued on the Gynecology wards by the nurses every 4 hours for the next 48 hrs. The patient will need to be reassessed 45 min later after any rescue medication also.We will be comparing the scoring done for the patient as against the analgesia been prescribed.Family members will be involved when appropriate. RESULTS: This Audit was done on all female patients from the age group of 16 to 60 years of age.Their categorization into ASA grades was, about 50.5% of ASA grade I, 47% of ASA grade II, and 2.5% were of ASA grade III. About 39% patients underwent Total Abdominal Hysterectony. The type of Anaesthesia mostly used was spinal anaesthesia, in 43% patients. The commonly performed surgeries seemed to be Total Abdominal Hysterectomy, Vaginal Hysterectomy, Lap-assisted Vaginal Hysterectomy, and Staging Laparotomy. Among our patients, Co-morbidities like Diabetes, Hypertension, hypothyroidism, and Obesity seemed more prevalent. After analyzing the pain scores, we found that about 67% patients were in significant pain on the first postoperative Day, and 45% on the second postoperative Day. A review of their prescriptions was done and Tramadol based analgesic protocol was found in 49% doctor order sheets, on first postoperative day and 63% on second postoperative day.These were mostly administered by intramuscular route.Morhine based treatment was received by 42% patients on the first postoperative day and 41% on second postoperarive day. The commonly followed route for Morphine was subcutaneous. Only 15-16% patients had received the benefit of an Epidural. The Epidural infusion was continued for a maximum of 48hrs and discontinued.This infusion was being stopped whenever the patient was ambulant.Any complication like hypotension was supposed to be due to Epidural infusion. Some feedback from the nurses suggested that, they did not get adequate support from our existing personnel involved with pain services. Dosifuser usuage was done in only 2% patients. One such infusion was discontinued due to lack of knowledge about the modality. All the protocols followed were based on a Multimodal approach, but the dosages were inadequate and frequency of administration variable. Several combination of paracetamol, voveran, proxyvon, ketonov with emeset, phenergan, ranitidine ans pantoprazole were noticed.The brand of paracetamol frequently used was Febrinil. The most common side-effect was constipation, followed by nausea. Ambulation was started on Day II. This concludes the results.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Audit on assessment of adequacy of Postoperative Analgesia in a Tertiary Care Centre: An Observational study
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 02:54
Last Modified: 30 Apr 2018 02:54

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