Article

Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients

Acute Pain 01/2005; 7(2):75-83. DOI: 10.1016/j.acpain.2005.05.001

ABSTRACT A total number of 1071 patients was investigated using a modified questionnaire of the American Pain Society to evaluate the pain profile and satisfaction/dissatisfaction on the second post-operative day after different types of surgery (abdominal, traumatic, orthopaedic, urologic, gynaecologic, ENT). Patients were either treated with non-standardized pain management (no measurement of pain intensities, no regular administration of analgesics) (non-APS; n = 575) under responsibility of surgical specialties or with standardized pain management (regular assessment of pain and dose adaptation with i.v. PCA or epidurals) (APS; n = 496) by an anaesthesiology-based acute pain service.
Patients with a non-standardized pain management gave answers expressing higher pain intensities and breakthrough pain compared with APS-patients as a sign of their analgesic undertreatment (p ≤ 0.05). The differences between the non-APS and APS groups were also significant after major surgery (abdominal, urologic, traumatic, orthopaedic), showing the benefit of using i.v. PCA or epidurals. Furthermore, it could be demonstrated that patients in the APS treatment group were satisfied with their pain management to a significantly higher degree than patients in the non-APS group. 27.3% of non-APS versus 1.1% of APS-patients (p ≤ 0.05) were dissatisfied with their pain management. The majority of these patients did not want to experience the same management again.
The stepwise multivariate regression to estimate influencing variables on dissatisfaction (e.g. pain intensity, breakthrough pain, pain service, age, type of surgery) had yielded the surprising result that the most important factor for dissatisfaction was the patient's feeling that a complaint about pain had been taken seriously.
Our data has shown the necessity to improve pain management after surgery under the responsibility of surgical specialties, in order to avoid undertreatment and to increase patient's satisfaction. As a consequence of this prospective study, an interdisciplinary standardized pain management was introduced at the University Hospital. A repetition of this audit is planned.

0 Bookmarks
 · 
32 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this discussion paper, it is suggested that uni‐professional clinical audits could be used for reflective dialogue centred inter‐professional education opportunities. Using an analysis of two medical audits that illustrate how uni‐professional audit might reinforce mistaken assumptions about inter‐professional situations, it is argued that there is a need to challenge the current audit culture, emphasizing enhancement of practice rather than compliance‐based assurance. To realize the refocusing of the audit process from one of quality assurance to one of quality enhancement, this paper suggests that there needs to be a shift in the balance of audit process outcomes which are essentially pragmatic and compliance oriented to more dialogic formative outcomes that require the auditors to have an interactive relationship with both trainee healthcare providers (i.e. pre‐registration medics, nurses and allied healthcare providers) as well as a discursive one with other post‐registration professionals.
    Reflective Practice 01/2010; 11(1):95-106.
  • [Show abstract] [Hide abstract]
    ABSTRACT: as effective as intravenous patient-controlled analgesia or regional methods of pain manage- ment after very stressful and painful major sur- gery. Especially regional analgesia with catheter techniques lead to earlier and more intensive mobilization and rehabilitation. Epidural anal- gesia can reduce cardiopulmonary complica- tions, postoperative ileus, and the hospitaliza- tion period. This may lead to considerable eco- nomic advantages. However, the benefits of an appropriate pain management become only evident when performed as an integrated part of a multimodal perioperative approach based on clinical pathways. This requires interdiscipli- nary management programs, as well as closer cooperation with those involved in outpatient treatment during the postoperative follow-up.
    01/2005;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Adequate pain management after major surgery is important to improve patients' quality of life and to support the healing process. Since the cost for pain management is included in the DRG system for hospital reimbursement, hospitals should aim to provide adequate postoperative pain management at the lowest possible cost. In this study we compare two multimodal pain management schemes for postoperative pain management in a cost-minimisation analysis. In a decision analytic model two treatment regimes for postoperative pain management are compared in a cost-minimisation analysis: diclofenac + morphine vs paracetamol vs morphine. The study is performed from the perspective of a public hospital. Due to the short time horizon costs are not discounted. Assuming comparable effectiveness for adequate postoperative pain management, the expected value in the decision tree model for the combination diclofenac + morphine is 13.37 EUR and for the combination paracetamol + morphine 32.23 EUR, respectively. The results are robust under various one- and two-way sensitivity analyses. With no contraindications given the combination diclofenac + morphine is more cost-effective for postoperative pain management after major surgery compared to paracetamol + morphine.
    Der Schmerz 01/2010; 24(4):373-379. · 1.02 Impact Factor