Preoperative analgesic instruction and prescription reduces early home pain after outpatient surgery: a randomized controlled trial

Strategy for the management of acute postoperative pain in day surgery centres in Spain. DUCMA 2.0. project

INTRODUCTION

Adequate treatment of acute postoperative pain is one of the quality requirements in ambulatory surgery and its suboptimal management is associated with delayed discharge, unplanned admissions and late admissions after home discharge. The aim of the present study was to learn about the organizational strategy for the management of postoperative pain in ambulatory surgery units (ASU) in Spain.

METHODS

A cross-sectional, multicenter study was carried out based on an electronic survey on aspects related to the management of acute postoperative pain in different ASUs in our country.

RESULTS

We recruited 133 ASUs of which 85 responded to the questions on the management of postoperative pain. Of the ASUs that responded, 80% had specific protocols for pain management and 37.6% provided preoperative information on the analgesic plan. The assessment of postoperative pain is carried out in 88.2% of the ASUs in the facility and only 56.5% at home. All ASUs use multimodal analgesia protocols; however, 68.2% report the use of opioids for the treatment of moderate to severe pain. Home invasive analgesia strategies are minimally used by the surveyed ASUs.

CONCLUSIONS

The DUCMA study highlights that the practice of pain treatment in day surgery remains a challenge in our country and is not always in agreement with national guidelines. The results suggest the need to establish strategies to improve clinical practice and homogenize pain management in ambulatory surgery.

Incidence of Postoperative Pain at 7 Days After Day Surgery Reported Using a Text Messaging Platform: Retrospective Observational Study

Background

The most frequent complication observed after ambulatory surgery is acute postoperative pain.

Objective

The purpose of this study was to evaluate the late incidence of postoperative pain at 7 days after day surgery.

Methods

We retrospectively included patients who underwent day surgery under general or regional anesthesia and those who underwent local anesthesia in Rouen University Hospital from January 2018 to February 2020. Data collected were moderate-to-severe pain reports defined as numeric rating scale (NRS)>3/10 at 1 day (secondary end point) and 7 days (primary end point) after surgery. These data were collected using a semi-intelligent SMS text messaging platform to follow up with the patient at home after ambulatory surgery. Univariate and multivariate analyses were performed to analyze the risk factors for pain.

Results

We analyzed 6099 patients. On the day after the surgery, 5.2% (318/6099) of the patients presented with moderate-to-severe pain: 5.9% (248/4187) in the general or regional anesthesia group and 3.7% (70/1912) in the local anesthesia group. At 7 days after the surgery, 18.6% (1135/6099) of the patients presented with moderate-to-severe pain, including 21.3% (892/4187) of the patients in the general or regional anesthesia group and 12.7% (243/1912) of the patients in the local anesthesia group. General surgery (odds ratio [OR] 1.54, 95% CI 1.23-1.92; P<.01) and orthopedic surgery (OR 1.66, 95% CI 1.42-1.94; P<.01) were associated with more late postoperative pain risk. Male gender (OR 0.66, 95% CI 0.57-0.76; P<.01), ophthalmology surgery (OR 0.51, 95% CI 0.42-0.62; P<.01), and gynecologic surgery (OR 0.67, 95% CI 0.50-0.88; P=.01) were associated with less late postoperative pain risk. The rate of emergency consultation or rehospitalization at 7 days after the surgery was 11.1% (679/6099). Late postoperative pain (OR 2.54, 95% CI 1.98-3.32; P<.001), general surgery (OR 2.15, 95% CI 1.65-2.81; P<.001), and urology surgery (OR 1.62, 95% CI 1.06-2.43; P=.02) increased the risk of emergency consultation or rehospitalization. Orthopedic surgery (OR 0.79, 95% CI 0.63-0.99; P=.04) and electroconvulsive therapy (OR 0.43, 95% CI 0.27-0.65; P<.001) were associated with less rates of emergency consultation or rehospitalization.

Conclusions

Our study shows that postoperative pain at 7 days after ambulatory surgery was reported in more than 18% of the cases, which was also associated with an increase in the emergency consultation or rehospitalization rates.

The Perception of the Anesthesiologist Among the Medical, Paramedical and Administrative Staff

Introduction

Anesthesia remains a young medical discipline still relatively unknown by the general public and probably by some health professionals. The objective of the study was to evaluate the perception of anesthesiologist by health professionals working with this specialty.

Methods

We distributed a computerized survey to physicians, residents, paramedical, midwives, and administrative staff in different hospitals between April and July 2018 in Normandy, France. The survey included 38 questions on 6 different topics: communicated image, skills and knowledge, communication, place in patient care, workload, and initial anesthesiologist formation. The survey was validated by a semi-directive interview methodology. A Likert scale from ×2 to +2 ("completely disagree" to "completely agree") was used for each item.

Results

Six hundred and twenty five out of 2,000 surveys sent were analyzed. The anesthesiologist conveys an image of serenity (+0.94 ± 0.79), has a high degree of responsibility (+1.72 ± 0.59) with important decision-making power (+1.39 ± 0.82). He guarantees patient safety and comfort (+1.07 ± 0.88) with his/her dual competence in anesthesia and intensive care (+1.36 ± 0.82). Anesthesiology requires teamwork (+1.68 ± 0.58) and good communication skills (+1.48 ± 0.73). The anesthesiologist is not perceived as a service provider (-0.33 ± 1.15) but is the physician responsible for perioperative care (+1.69 ± 1.00). His/her workload is moderately perceived as high (+0.71 ± 1.17) but is confronted with potentially conflictual relationships with colleagues from other specialties (+1.40 ± 0.68) and stressful situations (+1.44 ± 0.80).

Conclusion

The overall perception of the anesthesiologist in our study appears to be good.