SAFETY AND EFFECTIVENESS OF ACUTE PAIN MANAGEMENT
R Halliwell, S Pagett, K Quill
Westmead Hospital, Sydney, NSW
Purpose of Study
There is continuing uncertainty about the selection of acute pain management techniques. This study aims to analyse the effectiveness and safety of acute pain management from a large prospective database.
Method
From January 1991 to December 2005 patients managed by the Acute Pain Service at Westmead Hospital where formally assessed during a daily ward round and data was recorded on a form. This information was entered into a computerised database and was analysed using statistical software. Information collected included demographics, anatomical site of surgery, surgical speciality, analgesic technique, pain score, and adverse events (predefined list).
Result
Patient details: total number 27752, ages ranged from 1 to 103 years (median 46.3), male 38%, female 64%. Site of surgery: lower abdominal 32%, upper and lower abdominal 30%, peripheral 11%, thoracic 6%, spine 3.8%, upper abdominal 2.9%, joint replacement 2.5%. Analgesic technique (n): epidural 5958, PCA morphine 12463, PCA fentanyl 2518, morphine infusion 1739, PCEA pethidine 1358, intrathecal morphine 1034, epidural morphine 458, nerve sheath catheter 255. Pain scores on day one were 2 or less for 79% of patients. Variables associated with increased pain score included: young age, site of surgery, and analgesic technique. Adverse events: respiratory rate < 8/min 0.78%, naloxone given 0.65%, hypotension due analgesia 0.6%. Factors associated with respiratory depression were: analgesic technique (systemic opioid), type of surgery, increased age, male sex, and high pain scores. Factors associated with PONV (treated) were: young age, female sex, type of analgesia, type of surgery, high pain score.
Conclusion
Analgesic effectiveness and adverse events are related to patient factors, nature of surgery and choice of analgesic technique.
Time of Presentation
Saturday 13 May 2006 - 1530-1700
