Audit on post-operative analgesia in surgical wards in the General Hospital (Teaching), Peradeniya

Abstract

Satisfactory post-operative pain management to the expectation of patients is a major challenge for clinicians. Unrelieved acute post-operative pain will lead to many acute deleterious effects as well as neural alterations such as central and peripheral sensitization which can evolve into chronic pain syndromes. Despite efforts to improve post-operative pain management, it remains sub-optimal in many countries. The primary objective of this study was to assess the adequacy of post-operative pain management in surgical wards of the Teaching Hospital, Peradeniya. The secondary objectives were to assess the pain scores of patients based on current pain management and to assess the feasibility of using Visual Analog Scales (VAS) to assess the post-operative pain in the future. This observational study was done in surgical wards of the Teaching Hospital, Peradeniya. Eighty two post-operative patients who underwent hernia repair, thyroidectomy, mastectomy or laparotomy were studied. Patients’ demographic data, surgical information, pain assessment information and analgesic utilization on the date of surgery and the following two days were collected on a data sheet. Data were analysed to assess the adequacy of post- operative pain management at the Teaching Hospital, Peradeniya. Approximately 62% of patients had high levels of “pain at rest”, while 77% of patients had high levels of “pain on movement” on the day of surgery. The percentage of patients having high “pain on movement” had been reduced to approximately 49% by the following day. There was no significant difference in pain levels according to the drug doses administered, BMI, gender, or the surgery type. The study found that patients had a high incidence of post-operative pain “at rest” and “on movement”, on the day of surgery and post- operative day one. It highlights the inadequacy of the current pain management and suggests there is much room for improvement. The study also confirmed that VAS is a useful tool in expressing and documenting severity of post-operative pain.