Investigation Of Postoperative Analgesia In Guangdong Province

BackgroundPostoperative pain is one of main concerns to the surgery patients. Postoperative pain not only leads to patient afraid of surgery, but also affects the postoperative recovery of patients, lowers the quality of life and satisfaction, and prolongs hospital stay. What's more, the acute postoperative pain may develop to postoperative chronic pain. Clinical epidemiological investigation may profile the current situation of surgical patients postoperative pain, analgesic situation, the incidence of incomplete analgesia and adverse events related to pain management. An investigation of postoperative pain can provide realistic evidence for solving the incomplete analgesia of postoperative patients, and improving patient's satisfaction of postoperative analgesia. In 2003, an American retrospective investigation found that 82% of surgery patients experienced postoperative pain, and the pain could sustain for two weeks . Of these patients, 47% had moderate pain, 39% had severe pain or extreme pain. A prospective investigation report which contains 1490 cases in Netherlands showed that postoperative analgesia, although based on an acute pain protocal, was still not satisfied. The incidence of postoperative moderate pain on the operation day was 41%, in the first to the fourth day after surgery, the incidence of moderate pain were up to 30%, 19%, 16%, 14% respectively. In 2010, a Germany retrospective investigation including 25 hospitals 2252 surgical patients reported that the incidence of postoperative moderate pain at rest was 29.5%. What's more, the incidence of postoperative moderate pain at activity was more than 50%. The epidemiology information of developed countries could not represent the situation in China. However, there was little information on the epidemiology of current status of postoperative pain in China. Therefore, it is necessary to have our own data. For this reason,we conducted this survey in order to provide basis for improving postoperative pain. And we observed the postoperative analgesia effects of Parecoxib pre-administration in thyroid surgery patient with general anesthesia from the first people's hospital of Guangzhou. ObjectiveA survey was made of patients undergone surgery from 12 hospitals of Guangdong province during Aug 28th to Sep 27th, 2010, to obtain the situation of postoperative analgesia, the incidence of incomplete postoperative analgesia and related adverse reactions, then to analyze its possible causes and explore effective measures for solving these problems. We hope this study could provide basis and suggestion for improving patient's satisfaction of postoperative analgesia.MethodsWe collected information about all surgical adult patients in 12 hospitals which participate in this survey in Guangdong province during Aug 28th to Sep 27th, 2010,and recorded their analgesic method, analgesic drugs, analgesic effect and adverse reaction in 48 hours after surgery. Pain was assessed by visual analogue scale (VAS). The questionnaire was self-designed, including anesthesia records and follow-up records. Anesthesia records were recorded by anesthesiologist. Follow-up personnel surveyed patient's postoperative pain in postoperative (24±2) h and (48±2) h. According to the data, we choose proper method to process statistics and analysis. Main data describing methods include ratio and percentage, mean, standard deviation, frequency, median statistical quantities, etc. Statistical analysis methods include anova, t-test, chi-square, etc.Results1. The survey collected a total of 5468 cases, of which 2378 cases were male (43.5%), 3090 cases were female (56.5%), 1146 cases were elderly patients (21.0%), 482 cases were ASA III-class (8.8%), and no cases were ASA IV-class. 2. 3394 cases were performed operation under general anesthesia (62.1%), 2041 cases were under regional block (37.3%), and 121 cases were under general anesthesia combined with regional block (2.3%).3. Based on the expected grade of pain and the surgical site, 2417 cases were classified as minor surgery (45.2%), 2614 cases were classified as intermedium surgery (47.8%), and 437 cases were classified as major surgery (8.0%).4. The radio that anesthesiologists took part in pain management in Guangdong top comprehension hospitals was 36.7%. Of these, 23.3% of surgical patients were accepted patient controlled intravenous analgesia (PCIA), and 13.4% of surgical patients were accepted patient controlled epidural analgesia (PCEA). 63.3% of surgical patients were accepted analgesics injectly or orally given by surgeon.5. The incidence of moderate to severe pain (VAS>4) was different in different kinds of surgical patients. The incidence of moderate to severe pain in the first and the second day at rest were 17.0%(11.4%～42%) and 7.1%(4.6%～7.8%) respectively. The incidence of moderate to severe pain in the first and the second day at activities were 37.4%(34.2～72.3%) and 27.6%(17.4%～50.6%) respectively. Incomplete postoperative pain in China of Guangdong was prevalent. We should pay more attention to the postoperative pain when patients took activities.6. The patients under upper limb surgery had the highest incidence of postoperative moderate to severe pain. The incidence in the first day at rest was 39.6%, at activity was 68.3%. The incidence in the second day at rest was 14.2%, at activity was 54.1%. The incidence of postoperative moderate to severe pain of patients under thoracic surgery (non-cardiac surgery) was also very high, followed by the patients under upper limb surgery. In abdominal surgery patients, the incidence of moderate to severe pain was still as high as 23.1% at rest, and 47.7% at activity.7. The incidence of postoperative moderate to severe pain in patients under minimally invasive surgery and open surgery at rest were 14.7% and 17.8% respectively (P> 0.01), and at activities were 33.8% and 38.9% respectively (P <0.01).8. In the first and second postoperative day, patients with adverse reactions related to pain treatment accounts for 29% and 14% respectively. As for all postoperative adverse reactions, the incidence of nausea was 15.9%, vomiting was 13.8%, pruritus was 17.1%, urinary retention was 3.36%, hypotension was 0.7%, respiratory depression was 1.08%, and lower limbs paralysis was 2.1%.9. Patient's satisfaction on the first and second day after operation was 71.6% and 78.5% respectively.Conclusion1. Only 36.7% of patient's postoperative analgesia was performed by anesthesiologists, other 63.3% was performed by surgeon. This reminds us anesthesiologists should actively participate in the management of postoperative pain and play a dominant role to ensure effective postoperative analgesia.2. The incidence of moderate to severe pain (VAS>4) was different in kinds of surgical patients. The incidence of moderate to severe pain in the first and the second day at rest were 17.0%(11.4%～42%) and 7.1%(4.6%～7.8%) respectively. The incidence of moderate to severe pain in the first and the second day at activities were 37.4%(34.2～72.3%) and 27.6%(17.4%～50.6%) respectively. Incomplete postoperative pain in China of Guangdong was prevalent. We should pay more attention to the postoperative pain when patients took activities.3. In the first and second postoperative day, patients with adverse reactions related to pain treatment accounts for 29% and 14% respectively. Of which, the incidence of nausea, vomiting and pruritus were high, and the incidence of respiratory depression (mild) was 1.1%. We should strengthen the prevention of adverse reactions and drugs intervention to improve patient satisfaction. ObjectiveThe study was made to observe paracoxib sodium pre-administration effects on perioperative hemodynamics, postoperative pain and adverse reactions in patients undergone subtotal thyroidectomy with general anesthesia.Methods60 female patients(ASA I～II) undergoing subtotal thyroidectomy with general anesthesia were randomly assigned to three groups.Group A (n=20) was administrated with paracoxib sodium 40 mg intravenously at 10 min before anesthesia,group B (n=20) was administrated with paracoxib sodium 40 mg intravenously at the end of the surgery, and group C (n=20) was administrated with equivalent volume of saline.We observed patient's SBP, DBP, HR at T0 (before anesthesia), T1 (5min after surgery started), T2 (when stripped superior thyroid) and T3 (end of surgery), intraoperative fentanyl, propofol cumulative consumption were calculated, patient's pain intensity were evaluated with VAS score at 2h, 4h, 8h, 12h during rest and activities. The Ramsay sedation score, patient satisfaction and postoperative pain side effects (nausea, vomiting, dizziness, gastrointestinal discomfort, etc.) were recorded.Results1. SBP, DBP, HR between three groups of patients before anesthesia showed no significant difference. SBP, DBP, HR at T1, T2 point increased in three groups. In group B and C, the SBP, DBP, HR increased significantly compared with those in group A when strop the upper and lower pole of thyroid. SBP in group A, B, C at T2 increased 12%, 17%, 22% respectively compared with SBP at T0. DBP in group A, B, C at T2 increased 17%, 18%, 19% respectively at T2 compared with DBP at T0. HR in group A, B, C at T2 increased 8%, 15%, 9% respectively at T2 increased 8% compared with HR at T0. (P <0.01)2. The operation duration, propofol, isoflurane consumption per minute, fentanyl, propofol, isoflurane total consumption in three groups were similar (P>0.05). But the fentanyl consumption per minute in group A (3.4 ug/min) was less than those of in group B (4.0 ug/min) and C (4.1 ug/min) (P<0.05).3. At 2 hours after surgery, the patient's VAS scores at rest in group A, B, C were 1.5±1.1, 1.7±0.9, and 2.3±0.7 respectively. At 4 hours after surgery, the patient's VAS scores at rest in group A, B, C were 1.1±0.9, 1.4±0.8, and 2.0±0.7 respectively. At 8 hours after surgery, the patient's VAS scores at rest in group A, B, C were 0.6±0.4, 0.9±0.5, and 1.5±0.7 respectively. At 12 hours after surgery, the patient's VAS scores at rest in group A, B, C were 0.5±0.3, 0.5±0.4, and 0.5±0.3 respectively. At 2h, 4h, 8h after surgery, the patient's VAS scores at rest A group, B group of were significantly lower than C group (P <0.05). While during activities, VAS scores among the three groups showed no significant difference at 4h, 8h, 12h after surgery (p>0.05).4. The Ramsay sedation score in the patients of group A at T0, T1, T2, T3were 3.5±0.2, 2.5±0.2, 2.1±0.1, and 2.0±0.0 respectively. The Ramsay sedation score in the patients of group B at T0, T1, T2, T3were 3.5±0.2, 2.8±0.2, 2.2±0.1, and 2.0±0.0 respectively. The Ramsay sedation score in the patients of group C at T0, T1, T2, T3 were 3.5±0.2, 2.5±0.2, 2.1±0.1, and 2.0±0.0 respectively(group comparison P>0.05).5. There was one case with nausea in group A (5%) and group B (5%). In group C, there was one case with postoperative bleeding (5%). There were no cases with vomiting, dizziness, gastrointestinal discomfort, hypotension and respiratory depression in all three groups.ConclusionParacoxib sodium pre-administration in thyroid surgery can reduce the intraoperative cardiovascular response and postoperative pain intensity with low incidence of side effects. But paracoxib sodium pre-administration in thyroid surgery has no obvious advantage on analgesic effect compared with paracoxib sodium post-administration.