Analgesic Efficacy of Postoperative Pain Management Following Upper Abdominal Surgery in Srinagarind Hospital

Abstract

Background  and objective: Upper abdominal surgery causes severe pain. Effective postoperative pain management  achieveds quality of life in patients and reduces complications from surgery. This study aims to study of the efficacy of postoperative pain management, complications and satisfaction to Acute Pain Service (APS) for upper abdominal surgery in Srinagarind hospital.

Methods: We studied from the APS records of upper abdominal surgery in patients aged more than 10 years old and received postoperative pain management by APS. We studied about pain management techniques, maximum and minimum pain score during at rest and on movement, side effects and satisfaction.

Results: Totally, there were 417 patients, most in hepato-biliary surgery (79.38%) and mostly received epidural analgesia technique (57.79%). Effective pain management after 24 hours of surgery revealed most of patients (50.50%) decreased pain symptom. Epidural analgesia technique revealed free of pain in 20.54%. (p= 0.002) Between postoperative pain techniques, we found maximum pain scores at rest in IV PCA of 36.64% while minimal pain score in IV PCA combined with spinal morphine (MO) of 25.71% and in epidural analgesia of 26.27%. When compared in free of pain at rest, we found that the most in epidural analgesia technique (75.86%), the second in IV PCA combined with spinal MO (72.33%) and the third in IV PCA technique (57.48%). (p= 0.001)

          The maximal pain on motion in epidural analgesia technique, patients revealed 50.85% while the minimal pain at rest in this technique revealed 75.86%.

          During postoperative 48 hours, efficacy of pain management in IV PCA combined with spinal MO revealed equal to epidural analgesia, however epidural analgesia reduced pain score better than IV PCA combined with spinal MO in 72 hours of postoperative period.

The common side effects are nausea/vomiting (11.51%), pruritus (10.07%), over sedation (1.44%) and absent severe complications. The satisfaction on APS was mostly satisfied (98.16%).

Conclusion: Efficacy in postoperative pain management in upper abdominal surgery revealed mostly effective and the most effective analgesic technique is epidural analgesia and IV PCA combined with spinal MO, subsequently.