Indian abdominal surgery postoperative pain control: A multi-center drug use study
Author(s): Dr. N. Murali Krishna and Sreedhar Ganga
Abstract:Aims: Postoperative pain is frequent among hospitalized patients. Different therapeutic traditions and the attitudes of each hospital's medical staff impact its treatment. This study Aim to find out how analgesic drugs were prescribed and used to treat pain after abdominal surgery in Indian hospitals. It also Aim to find out how common and bad postoperative pain was, as well as how much the way pain was treated differed between the centers that took part.
Methods: The study involved a descriptive cross-sectional examination of drug use in 12 Indian hospitals. The subjects were a non-selected sample of consecutive abdominal surgery patients who were hospitalized between October 2020 and January 2022. Information about the surgical technique and the use of analgesics was prospectively obtained for each patient. On the first day after surgery, a visual analogue scale (VAS) and a six-point scale (none, mild, moderate, severe, very severe, and intolerable) were used to rate the level of pain.
Results: There were 993 patients (547 men) involved in the study. Inguinal hernia repair (315, 32%), cholecystectomy (268, 27%), appendectomy (140, 14%), bowel resection (137, 14%), and gastric surgery (58, 6%) were the most prevalent surgical procedures. 59% (587) of patients received only nonopioid analgesics, 9% (89) received only opioid analgesics, and 27% (263) received both opioid and nonopioid analgesics. Metamizole (667 patients) and pethidine were the medications provided most frequently (213 patients). Although the administration of analgesics was scheduled in the majority of physician orders, the majority of actual doses were administered "as needed." The average daily doses of all analgesics delivered were less than those indicated. 38 percent (371/967) of patients reported severe to terrible first-day maximum pain. The surgical procedures that had been conducted, the analgesics that had been administered, and the pain scores that had been reported by patients exhibited substantial interhospital variation. Between 22% and 67% of patients in each facility had pain that was severe or intolerable.
Conclusions: It appears that poor usage of analgesics is to blame for the fact that many patients in India continue to experience significant pain after undergoing abdominal surgery. It was found that there were big differences between hospitals in how pain after surgery was treated and how often it happened.