Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
FERNANDEZ, D. L. et al. Postoperative analgesia treatment during the first 24 hours in a second level hospital.. Rev. Soc. Esp. Dolor [online]. 2006, vol.13, n.1, pp.18-23. ISSN 1134-8046.
Objective: We carried out this study in our second level hospital to evaluate the fulfillment and effectiveness of postoperative analgesics administered without appropriate guidelines during the first 24 h after surgical procedures where the intensity of pain is considered moderate-severe. Method: We included 119 patients above 18 years of age, who underwent orthopedic surgery: total knee or hip replacement, vertebral arthrodesis, shoulder surgery and laparotomies. Postoperative analgesics (base and rescue) were prescribed according to criterion of the responsible anesthesiologist through lack of appropriate protocols. The use of morphine, epidural analgesia and PCA (patient controlled analgesia) devices were restricted to recovery room and critical care unit. In hospitalized patients the prescribed opiates were meperidine and tramadol by intramuscular and intravenouse route, respectively. The opiates were always associated to nonsteroidal antiinflammatory drugs (NSAIDs) as metamizol or diclofenac and analgesics as paracetamol. Intensity of pain was measured by VAS 0-100 mm and verbal scale (VS) 1-4, 24 h after surgery (24) and we registered the maxim intensity of pain (Max) perceived during the first postoperative day, in both moments the percentages of patients with non controlled pain (NCP): VAS >30 and VS >2 were considered. Prescribed and administered doses of analgesic drugs (base and rescue) were registered. The proportion between prescribed and administered doses of analgesics was considered as a fulfillment indicator and expressed by percentage (GC).≠ Results: Pain intensity 24: VAS 27.8 ± 22.6, VS 2 (1-4); percentage of patients with NCP measured by VAS/VS: 36.1 and 42.8%, respectively . Max: VAS 58.4 ± 28.9, VS 4 (1-4); NCP by VAS/VS: 79.8 / 82.3 %, respectively. Prescribed opiates (Nº patients, X± SD and GC %): morphine : 28, 11.7 ± 12.6 mg /day, 100%; meperidine: 58, 333.4 ± 108.7 mg/day, 35.2%; tramadol: 13, 218.9 ± 80.2 mg/day, 59.3%. Administered NSAIDs ( Nº patients, X ± SD): diclofenac : 39, 223.1 ± 52.5 mg /day; metamizol : 74, 6.86 ± 1.8 mg /day. Conclusions: We observed medical inframetering prescription of opiates and lack of fulfillment in the administration from the infirmary staff. On the contrary NSAIDs were prescribed and administered at higher doses than the recommended ones. These results suggest that postoperative pain is not well controlled in our hospital. The continuing education and involvement of anesthesiologists, nurses and surgeons are essential factors to improve the quality of pain relief.
Palabras clave : Postoperative pain; Opiates; Nonsteroidal antiinflammatory drugs.