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· DOS Abstracts
Pitfalls in the self-management of pain after
outpatient surgery: An exploratory analysis
Karen Toftdahl Bjørnholdt, Lone Dragnes Brix, Lone Nikolajsen
Department of Orthopaedic Surgery, Horsens Hospital; Department of
Anaesthesiology, Horsens Hospital; Danish Pain Research Center/Department
of Anaesthesiology, Aarhus University Hospital
Background:
Adequate pain treatment is important for postoperative recovery.
Studies have shown that many outpatients fail to obtain adequate pain control
at home, but knowledge of the extent of the problem and the pitfalls that occur
is limited.
Purpose / Aim of Study:
We aimed to find possible problem areas in analgesic
consumption after discharge, in order to direct future interventions to improve
pain control.
Materials and Methods:
Data were obtained during a randomised clinical trial
of dexamethasone involving outpatients undergoing minor arthroscopic shoul-
der surgery at Horsens Hospital. Patients received preoperative dexamethasone
(40 mg, 8 mg, or placebo) and intraoperative local bupivacaine. In the recovery
room, patients received fentanyl as needed and initiated the post-discharge re-
gime of paracetamol around-the-clock and ibuprofen and morphine as needed.
Patients recorded pain scores and analgesic use until the third postoperative
day.
Findings / Results:
75 patients were available for analysis. The average pain
intensity was successfully kept <4 out of 10 in 27 patients. Undertreatment
occurred, as 16 patients experienced days or nights with average pain inten-
sity >7 out of 10. Moreover, 6 of these refrained from any rescue analgesics.
Overtreatment also occurred, as 18 patients consumed morphine when their
worst pain intensity was <4. Rescue doses between 0:00 and 6:00 a.m. were
consumed by 32 patients. Some patients exceeded the maximal daily dose of
paracetamol (n=7) and ibuprofen (n=14). Overdoses were mostly due to other
brand names or strengths compared to patients’ usual medication.
Conclusions:
Problems in the self-management of pain after discharge include
overdoses, under-/overtreatment, and nightly failures. Attention should be di-
rected toward improving patient education and/or providing further assistance
to patients after discharge.
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