A clinical audit for postoperative pain control on 1443 surgical patients.

Abstract

BACKGROUND: Moderate to severe pain occurs in 75 to 100% of patients after major operations. Pain control techniques, for examples the patient controlled analgesia (PCA) and epidural analgesia, are effective in relieving postoperative pain. Routine delivery of these pain control techniques to patients undergoing operations can be provided by an anaesthesiologists-based acute pain service (APS). METHODS: This manuscript audited postoperative pain management service to 1369 ethnic Chinese patients and 74 patients of other races, over a 30 mon period in a teaching hospital in Hong Kong. The APS was prioritized to elderly patient (36.1%, aged 65 or higher), patients of poor physical condition (27.0% ASA III or IV) and those undertaken major operations. Most patients (1348, 93.4%) received either one of the four standardized analgesic regimens including PCA or epidural analgesia. RESULTS: The median verbal quantitative scale of pain (VQS) at rest/movement were 2.0/4.3 on operative day and 0/0.6 on 4th postoperative day. The morphine consumption in 665 Chinese patients (PCA intravenous morphine) was 26.1 +/- 14.3 mg/kg/h (mean +/- SD) during the first 20 postoperative hours. This decreased to 18.1 +/- 15.1 at 21th to 44th and 18.5 +/- 14.9 at 45th to 68th hours postoperatively. There was no difference in morphine consumption between Chinese patients and other races. The incidence for nausea and vomiting were 26.5% and 13.3%, respectively. Respiratory derangement occurred in 23 patients (1.9%) and almost always accompanied by somnolence. Most patients (1176, 81.5%) rated their postoperative analgesia on discharge from the care of APS. CONCLUSIONS: Effective and safe postoperative analgesia in Chinese patients can be achieved with currently available pain control techniques such as epidural and PCA. APS is a practicable approach to deliver these techniques to postoperative patients on a routine basis.