Utilization and Evaluation of Analgesics in Post Gynecologic Operations: A Cross- Sectional Study
Abstract
Background: This study evaluated the current practices of opioid and non-opioid analgesic administration for postoperative pain management in gynecological surgeries, aiming to optimize pain relief while minimizing side effects.
Methods: A cross-sectional, prospective Drug Utilization Evaluation (DUE) study was conducted at Al-Zahra Hospital, Tabriz, Iran. Medical records of 100 patients undergoing gynecological surgery were reviewed over five months. Data on prescribed analgesics, pain scores, and adherence to APS2016 and ERAS2016 guidelines were collected and analyzed statistically.
Results: Meperidine (pethidine) and diclofenac were the most frequently prescribed analgesics. The average patient pain score was 2.48 units. A combination of meperidine, diclofenac, and acetaminophen was identified as the most effective regimen for pain control. Prescribed regimens demonstrated 41.4±27.3% theoretical and 60.60 ± 28.77% practical compliance with APS2016 and ERAS2016 guidelines. While achieving the primary objective of pain relief with minimal side effects, compliance with established guidelines could be further improved through educational interventions.
Conclusion: Optimizing analgesic regimens for postoperative pain management requires careful consideration of individual patient needs, including the benefits of opioid analgesics in achieving greater pain reduction. Adherence to evidence-based guidelines and ongoing educational programs for healthcare professionals are crucial for ensuring optimal pain relief with minimal side effects.
2. Nascimento MC, Kelley A, Martitsch C, Weidner I, Obermair A. Postoperative analgesic requirements–total laparoscopic hysterectomy versus vaginal hysterectomy. Aust N Z J Obstet Gynaecol. 2005;45(2):140-3.
3. Beaulieu ND, Epstein AM. National Committee on Quality Assurance health-plan accreditation: predictors, correlates of performance, and market impact. Med Care. 2002:325-37.
4. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5S):S5-S22.
5. Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain. 2002;3(3):159-80.
6. Philip BK, Reese PR, Burch SP. The economic impact of opioids on postoperative pain management. J Clin Anesth. 2002;14(5):354-64.
7. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149-60.
8. Garimella V, Cellini C. Postoperative Pain Control. Clin Colon Rectal Surg. 2013;26(3):191-6.
9. Chou R, Gordon DB, de Leon-Casasola O, Rosenberg J, Bickler S, Brennan T. Guidelines on the management of postoperative pain. J Pain. 2016;17(2):131-57.
10. Imani F. Postoperative pain management. Anesth Pain Med. 2011;1(1):6-7.
11. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22(5):588-93.
12. Olofsson CI, Legeby MH, Nygårds E-B, Östman KM. Diclofenac in the treatment of pain after caesarean delivery: An opioid-saving strategy. Eur J Obstet Gynecol Reprod Biol. 2000;88(2):143-6.
13. Vallano A, Aguilera C, Arnau JM, Baños JE, Laporte JR. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study. Br J Clin Pharmacol. 1999;47(6):667-73.
14. Wilder-Smith CH, Schuler L. Postoperative analgesia: pain by choice? The influence of patient attitudes and patient education. Pain. 1992;50(3):257-62.
15. Ip HYV, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. T Anesthesiology. 2009;111(3):657-77.
16. Nelson G, Altman A, Nick A, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations—Part II. Gynecol Oncol. 2016;140(2):323-32.
17. Trowbridge ER, Dreisbach CN, Sarosiek BM, Dunbar CP, Evans SL, Hahn LA, Hullfish KL. Review of enhanced recovery programs in benign gynecologic surgery. Int Urogynecol J. 2011;29(1):3-11.
18. Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract. 2011;2011:748031.
19. Cohen FL. Postsurgical pain relief: patients' status and nurses' medication choices. Pain. 1980;9(2):265-74.
20. Briggs M, Dean KL. A qualitative analysis of the nursing documentation of post‐operative pain management. J Clin Nurs. 1998;7(2):155-63.
21. Lellan KM. A chart audit reviewing the prescription and administration trends of analgesia and the documentation of pain, after surgery. J Adv Nurs. 1997;26(2):345-50.
22. Wettermark B, Elseviers M, Almarsdóttir AB, et al Introduction to drug utilization research. Drug utilization research: methods and applications. 2016:1-2.
23. Shelton PS, Hanlon JT, Landsman PB, et al. Reliability of drug utilization evaluation as an assessment of medication appropriateness. Ann Pharmacother. 1997;31(5):533-42.
24. Dukes M. Development from Crooks to the nineties. Auditing drug therapy approaches towards rationality at reasonable costs Stockholm, Swedish Pharmaceutical Press. 1992.
25. Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD. A comparison of multimodal analgesic approaches in institutional enhanced recovery after surgery protocols for colorectal surgery: pharmacological agents. J Laparoendosc Adv Surg Tech A. 2017;27(9):903-8.
| Files | ||
| Issue | Vol 11, No 4 (Autumn 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v11i4.16019 | |
| Keywords | ||
| Narcotic Analgesics; Pain Management; Gynecological Surgery | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
