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Article: An audit of the safety of an acute pain service

TitleAn audit of the safety of an acute pain service
Authors
KeywordsAnaesthesia
auditing
Pain
postoperative
Issue Date1997
PublisherWiley-Blackwell Publishing Ltd.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0003-2409
Citation
Anaesthesia, 1997, v. 52 n. 11, p. 1042-1047 How to Cite?
AbstractWe audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae, Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 μg.ml-1 infusion occurred in four patients (1.2%), all with a sensory block higher than T5. They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.
Persistent Identifierhttp://hdl.handle.net/10722/145516
ISSN
2015 Impact Factor: 3.794
2015 SCImago Journal Rankings: 1.404
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorTsui, SLen_HK
dc.contributor.authorIrwin, MGen_HK
dc.contributor.authorWong, CMLen_HK
dc.contributor.authorFung, SKYen_HK
dc.contributor.authorHui, TWCen_HK
dc.contributor.authorNg, KFJen_HK
dc.contributor.authorChan, WSen_HK
dc.contributor.authorO'Reagan, AMen_HK
dc.date.accessioned2012-02-28T01:53:12Z-
dc.date.available2012-02-28T01:53:12Z-
dc.date.issued1997en_HK
dc.identifier.citationAnaesthesia, 1997, v. 52 n. 11, p. 1042-1047en_HK
dc.identifier.issn0003-2409en_HK
dc.identifier.urihttp://hdl.handle.net/10722/145516-
dc.description.abstractWe audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae, Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 μg.ml-1 infusion occurred in four patients (1.2%), all with a sensory block higher than T5. They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.en_HK
dc.languageengen_US
dc.publisherWiley-Blackwell Publishing Ltd.. The Journal's web site is located at http://www.wiley.com/bw/journal.asp?ref=0003-2409en_HK
dc.relation.ispartofAnaesthesiaen_HK
dc.subjectAnaesthesiaen_HK
dc.subjectauditingen_HK
dc.subjectPainen_HK
dc.subjectpostoperativeen_HK
dc.subject.meshAgeden_HK
dc.subject.meshAnalgesia - adverse effectsen_HK
dc.subject.meshAnalgesics, Opioid - adverse effectsen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHong Kongen_HK
dc.subject.meshHumansen_HK
dc.subject.meshHypotension - etiologyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMedical Auditen_HK
dc.subject.meshMorphine - adverse effectsen_HK
dc.subject.meshNausea - chemically induceden_HK
dc.subject.meshPain Clinics - standardsen_HK
dc.subject.meshPain, Postoperative - drug therapyen_HK
dc.subject.meshPostoperative Complicationsen_HK
dc.subject.meshRespiration Disorders - chemically induceden_HK
dc.subject.meshRisk Factorsen_HK
dc.subject.meshVomiting - chemically induceden_HK
dc.titleAn audit of the safety of an acute pain serviceen_HK
dc.typeArticleen_HK
dc.identifier.emailIrwin, MG: mgirwin@hku.hken_HK
dc.identifier.emailFung, SKY: sfung@hku.hken_HK
dc.identifier.emailNg, KFJ: jkfng@hku.hken_HK
dc.identifier.authorityIrwin, MG=rp00390en_HK
dc.identifier.authorityFung, SKY=rp00695en_HK
dc.identifier.authorityNg, KFJ=rp00544en_HK
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1111/j.1365-2044.1997.232-az0371.xen_HK
dc.identifier.pmid9404164-
dc.identifier.scopuseid_2-s2.0-0030693805en_HK
dc.identifier.hkuros32573en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0030693805&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume52en_HK
dc.identifier.issue11en_HK
dc.identifier.spage1042en_HK
dc.identifier.epage1047en_HK
dc.identifier.isiWOS:A1997YF72600004-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridTsui, SL=7004961361en_HK
dc.identifier.scopusauthoridIrwin, MG=7202411076en_HK
dc.identifier.scopusauthoridWong, CML=7404954463en_HK
dc.identifier.scopusauthoridFung, SKY=7201970040en_HK
dc.identifier.scopusauthoridHui, TWC=7005618934en_HK
dc.identifier.scopusauthoridNg, KFJ=13608809400en_HK
dc.identifier.scopusauthoridChan, WS=17136719700en_HK
dc.identifier.scopusauthoridO'Reagan, AM=6505483624en_HK

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