The quality and continuity of systemic postoperative analgesia: a single center two-stage follow-up study

Abstract

The aim of two prospective 1-month follow-up studies was to assess and compare the quality and continuity of postoperative systemic analgesia in Departments of Anaesthesiology and Surgery I and II, as well as adherence to prescribed plan of analgesia with respect to the effect of postoperative analgesia guidelines adopted in 2018. The studies included 94 (2016) and 80 (2018) patients who were operated under general anaesthesia, transferred to post-anaesthetic care unit (PACU), then to surgical wards and received systemic analgesia postoperatively. Comparison was based on adherence to postoperative analgesia plan during patient transfer. Recommendations for multimodal postoperative analgesia were given by the anaesthesiologist in 35.1% (ketoprofen + opioid) and 40.4% (paracetamol + opioid) in 2016 vs. 91.3% of cases in 2018, p < 0.001. Comparing 2016 to 2018, adherence to planned analgesia in PACU, % of cases was 35.1% vs. 92.5% for paracetamol (p < 0.001), 30.9% vs. 80% for ketoprofen (p < 0.001) and 75.5% vs. 72.5% for pethidine (p = 0.649). Adherence to planned analgesia after transfer to Department of Surgery I, % of cases was 3.3% vs. 80% for paracetamol (p < 0.001), 1.7% vs. 22% for ketoprofen (p < 0.001) and 61.7% vs. 20% for pethidine (p < 0.001). Adherence to planned analgesia after transfer to Department of Surgery II, % of cases was 0% vs. 10% for paracetamol (p = 0.059), 61.8% vs. 73.3% for ketoprofen (p = 0.325) and 29.4% vs. 13.3% for pethidine (p = 0.12), respectively. In conclusion, patients receive recommended systemic analgesia in PACU. Implementation of guidelines in Department of Surgery I resulted in 42% reduction of opioid and 76%increase of paracetamol use. Adherence to recommended analgesia in Department of Surgery II remains low.