Assessment of the conformity of analgesics prescribed in postoperative patients: a cross-sectional audit
DOI:
https://doi.org/10.31636/pmjua.v7i4.3Keywords:
analgetics, pain, non-steroidal anti-inflammatory drugs, patientsAbstract
Introduction: Post-operative pain management is crucial and patients can experience moderate to severe pain after surgery. The aims of this study were to assess the conformity to guidelines of analgesic prescription after major surgeries and evaluate the different predictors of non-conformity.
Methods: A cross-sectional study was conducted on 497 hospitalized patients undergoing major surgeries between November 2018 and June 2019 using the data from their medical charts.
Results: In total, 227 patients had a previous medical history. A significant relationship was noted between conformity, age, and length of stay where patients older than 65 had a higher degree of non-conformity compared to younger patients. Almost 90% of the analgesic were conforming in terms of dosage, treatment duration, choice and contraindication.
Conclusion: This study highlights the importance of adequate pain management and its influence on the quality of life of patients, as well as the importance of age, comorbidities and pain intensity as predictors to reach a higher level of conformity.
Downloads
References
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain [Internet]. 2020 Sep;161(9):1976–82. Available from: https://doi.org/10.1097/j.pain.0000000000001939 DOI: https://doi.org/10.1097/j.pain.0000000000001939
Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia [Internet]. 2019 Aug;123(2):e273–83. Available from: https://doi.org/10.1016/j.bja.2019.03.023 DOI: https://doi.org/10.1016/j.bja.2019.03.023
Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Advances in Clinical and Experimental Medicine [Internet]. 2020 Mar 4;29(3):365–74. Available from: https://doi.org/10.17219/acem/112600 DOI: https://doi.org/10.17219/acem/112600
Olsen BF, Valeberg BT, Jacobsen M, Småstuen MC, Puntillo K, Rustøen T. Pain in intensive care unit patients—A longitudinal study. Nursing Open [Internet]. 2020 Sep 12;8(1):224–31. Available from: https://doi.org/10.1002/nop2.621 DOI: https://doi.org/10.1002/nop2.621
van Dijk JFM, Vervoort SCJM, van Wijck AJM, Kalkman CJ, Schuurmans MJ. Postoperative patients’ perspectives on rat-ing pain: A qualitative study. International Journal of Nursing Studies [Internet]. 2016 Jan;53:260–9. Available from: https://doi.org/10.1016/j.ijnurstu.2015.08.007 DOI: https://doi.org/10.1016/j.ijnurstu.2015.08.007
Zamenjani MN, Farahani MF, Amirmohseni L, Pourandish Y, Shamsikhani S, Heydari A. Harorani M. The Effects of Inhalation Aromatherapy on Postoperative Abdominal Pain: A Three-Arm Randomized Controlled Clinical Trial. Journal of PeriAnesthesia Nursing [Internet]. 2021 Apr;36(2):147–52. Available from: https://doi.org/10.1016/j.jopan.2020.07.001 DOI: https://doi.org/10.1016/j.jopan.2020.07.001
Pak DJ, Yong RJ, Kaye AD, Urman RD. Chronification of pain: mechanisms, current understanding, and clinical implications. Current pain and headache reports [Internet]. 2018 Feb;22(2). Available from: https://doi.org/10.1007/s11916-018-0666-8 DOI: https://doi.org/10.1007/s11916-018-0666-8
Kumagai G, Wada K, Kudo H, Tanaka S, Asari T, Chiba D, et al. The effect of low back pain and neck-shoulder stiffness on health-related quality of life: a cross-sectional population-based study. BMC Musculoskeletal Disorders [Internet]. 2021 Jan 5;22(1):1–9. Available from: https://doi.org/10.1186/s12891-020-03871-5 DOI: https://doi.org/10.1186/s12891-020-03871-5
Orhurhu V, Olusunmade M, Akinola Y, Urits I. Depression trends in patients with chronic pain: an analysis of the nationwide inpatient sample. Pain Phys [Internet]. 2019;22(5):E487-94. Available from: https://pubmed.ncbi.nlm.nih.gov/31561661 DOI: https://doi.org/10.36076/ppj/2019.22.E487
van Dijk JF, Schuurmans MJ, Alblas EE, Kalkman CJ, van Wijck AJ. Postoperative pain: knowledge and beliefs of patients and nurses. Journal of Clinical Nursing [Internet]. 2017 Mar 27;26(21–22):3500–10. Available from: https://doi.org/10.1111/jocn.13714 DOI: https://doi.org/10.1111/jocn.13714
Chatchumni M, Namvongprom A, Eriksson H, Mazaheri M. Thai Nurses’ experiences of post-operative pain assessment and its’ influence on pain management decisions. BMC Nursing [Internet]. 2016 Feb 29;15(1). Available from: https://doi.org/10.1186/s12912-016-0136-8 DOI: https://doi.org/10.1186/s12912-016-0136-8
Nimmo SM, Foo ITH, Paterson HM. Enhanced recovery after surgery: Pain management. Journal of Surgical Oncology [Internet]. 2017 Sep 5;116(5):583–91. Available from: https://doi.org/10.1002/jso.24814 DOI: https://doi.org/10.1002/jso.24814
Lin L-Y, Hung T-C, Lai Y-H. Pain control and related factors in hospitalized patients. Medicine [Internet]. 2021 Jul 30;100(30):e26768. Available from: https://doi.org/10.1097/md.0000000000026768 DOI: https://doi.org/10.1097/MD.0000000000026768
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: a clinical practice guideline from the American pain society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' committee on regional anesthesia, executive committee, and administrative council. The journal of pain [Internet]. 2016;17(2):131-157. Available from: https://doi.org/10.1016/j.jpain.2015.12.008 DOI: https://doi.org/10.1016/j.jpain.2015.12.008
Anekar AA, Cascella M. WHO Analgesic Ladder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/32119322/
Kdigo A. Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138.
Tawfic Q, Bellingham G. Postoperative pain management in patients with chronic kidney disease. Journal of Anaesthesiology Clinical Pharmacology [Internet]. 2015;31(1):6. Available from: https://doi.org/10.4103/0970-9185.150518 DOI: https://doi.org/10.4103/0970-9185.150518
Ministry of public health. Statistical Bulletin 2019 [Internet]. Beirut: Ministry of Public Health. 2019. Available from: https://www.moph.gov.lb/en/Pages/8/327/statistical-bulletins
Weinberg I, Fernández-Capitán C, Quintana-Díaz M, Demelo-Rodriguez P, García de Casasola G, Fidalgo Á, et al. Systematic testing for venous thromboembolism in hospitalized patients with COVID-19 and raised D-dimer levels. Thrombosis Update [Internet]. 2021;2:100029. Available from: https://doi.org/10.1016/j.tru.2020.100029 DOI: https://doi.org/10.1016/j.tru.2020.100029
Habeeb‐Allah A, Alshraideh JA. Delirium post‐cardiac surgery: Incidence and associated factors. Nursing in Critical Care [Internet]. 2019 Dec 10;26(3):150–5. Available from: https://doi.org/10.1111/nicc.12492 DOI: https://doi.org/10.1111/nicc.12492
Chalak A, Nakkash R, Abu-Rmeileh NME, Khader YS, Jawad M, Mostafa A, et al. Own-price and cross-price elasticities of demand for cigarettes and waterpipe tobacco in three Eastern Mediterranean countries: a volumetric choice experiment. Tobacco Control [Internet]. 2021 Jun 30;32(1):86–92. Available from: https://doi.org/10.1136/tobaccocontrol-2021-056616 DOI: https://doi.org/10.1136/tobaccocontrol-2021-056616
Kim Y, Cortez AR, Wima K, Dhar VK, Athota KP, Schrager JJ, et al. Impact of Preoperative Opioid Use After Emergency General Surgery. Journal of Gastrointestinal Surgery [Internet]. 2018 Jan 16;22(6):1098–103. Available from: https://doi.org/10.1007/s11605-017-3665-x DOI: https://doi.org/10.1007/s11605-017-3665-x
Kang H, Jung HJ, Lee JS, Yang JJ, Shin HY, Song K-S. Early Postoperative Analgesic Effects of a Single Epidural Injection of Ropivacaine Administered Preoperatively in Posterior Lumbar Interbody Spinal Arthrodesis. Journal of Bone and Joint Surgery [Internet]. 2013 Mar 6;95(5):393–9. Available from: https://doi.org/10.2106/jbjs.k.01729 DOI: https://doi.org/10.2106/JBJS.K.01729
El-Masry R, Elhadidy SS, Shams T, Amr M. Do Religiosity and Socio-demographic Factors Affect Adherence of Cancer Patients to Analgesics? An Egyptian Study. Egyptian Journal of Community Medicine. 2018;36(4). DOI: https://doi.org/10.21608/ejcm.2018.22991
Abdulla A, Adams N, Bone M, et al. Guidance on the man-agement of pain in older people. Age and ageing [Internet]. 2013 Mar 1;42(suppl_1):51–57. Available from: https://doi.org/10.1093/ageing/afs200 DOI: https://doi.org/10.1093/ageing/afs200
Fuzier R, Serres I, Bourrel R, Palmaro A, Montastruc J-L, Lapeyre-Mestre M. Analgesic drug consumption increases after knee arthroplasty: A pharmacoepidemiological study investigating postoperative pain. Pain [Internet]. 2014 Jul;155(7):1339–45. Available from: https://doi.org/10.1016/j.pain.2014.04.010 DOI: https://doi.org/10.1016/j.pain.2014.04.010
Engkawong S, Mattheos N, Pisarnturakit PP, Pimkhaokham A, Subbalekha K. Comparing patient-reported outcomes and experiences among static, dynamic computer‐aided, and conventional freehand dental implant placement: A randomized clinical trial. Clinical Implant Dentistry and Related Research [Internet]. 2021;23(5):660-670. Available from: https://doi.org/10.1111/cid.13030 DOI: https://doi.org/10.1111/cid.13030
Guillou-Landreat M, Quinio B, Le Reste JY, Le Goff D, Fonsecca J, Grall-Bronnec M, et al. Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France. International Journal of Environmental Research and Public Health [Internet]. 2021 Feb 21;18(4):2097. Available from: https://doi.org/10.3390/ijerph18042097 DOI: https://doi.org/10.3390/ijerph18042097
Gerber E. Using Revised Pain Medication Administration Guidelines in Post Anesthesia Care Unit (PACU): A Program Evaluation [Internet]. Doctor of Nursing Practice (DNP) Manuscripts. 9. 2021. Available from: https://dsc.duq.edu/cgi/viewcontent.cgi?article=1015&context=dnp
Stagg K. Intravenous versus oral paracetamol for postoperative analgesia: A systematic review. Journal of Perioperative Practice [Internet]. 2020 Dec 20;31(10):373–8. Available from: https://doi.org/10.1177/1750458920950652 DOI: https://doi.org/10.1177/1750458920950652
Gupta A, Bah M. NSAIDs in the Treatment of Postoperative Pain. Current Pain and Headache Reports [Internet]. 2016 Nov;20(11):1–14. Available from: https://doi.org/10.1007/s11916-016-0591-7 DOI: https://doi.org/10.1007/s11916-016-0591-7
Lee S, Kim Y, Lee JJS, Im G, Cho J-Y, Chung J-Y, et al. A pharmacokinetic drug-drug interaction study between pregabalin and tramadol in healthy volunteers. European Journal of Clinical Pharmacology [Internet]. 2018 Aug 22;74(12):1605–13. Available from: https://doi.org/10.1007/s00228-018-2543-0 DOI: https://doi.org/10.1007/s00228-018-2543-0
Stevens AJ, Woodman RJ, Owen H. The effect of ondansetron on the efficacy of postoperative tramadol: a systematic review and meta-analysis of a drug interaction. Anaesthesia [Internet]. 2014 Dec 10;70(2):209–18. Available from: https://doi.org/10.1111/anae.12948 DOI: https://doi.org/10.1111/anae.12948
Park SH, Wackernah RC, Stimmel GL. Serotonin syndrome: is it a reason to avoid the use of tramadol with antidepressants? Journal of pharmacy practice [Internet]. 2013 Oct 23;27(1):71–8. Available from: https://doi.org/10.1177/0897190013504957 DOI: https://doi.org/10.1177/0897190013504957
Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of Postoperative Pain and Analgesic Consumption. Anesthesiology [Internet]. 2009 Sep 1;111(3):657–77. Available from: https://doi.org/10.1097/aln.0b013e3181aae87a DOI: https://doi.org/10.1097/ALN.0b013e3181aae87a
Peter WF, Dekker J, Tilbury C, Tordoir RL, Verdegaal SHM, Onstenk R, et al. The association between comorbidities and pain, physical function and quality of life following hip and knee arthroplasty. Rheumatology International [Internet]. 2015 Jan 14;35(7):1233–41. Available from: https://doi.org/10.1007/s00296-015-3211-7 DOI: https://doi.org/10.1007/s00296-015-3211-7
Hsu ES. Medication overuse in chronic pain. Current pain and headache reports [Internet]. 2017 Jan;21(1). Available from: https://doi.org/10.1007/s11916-017-0606-z DOI: https://doi.org/10.1007/s11916-017-0606-z

Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Nour Barada, Georges Hatem, Lara Kaaki, Dalia Khachman, Roula Ajrouche, Samar Rachidi, Sanaa Awada

This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License