Analgesic Prescriptions Patern Following Abdominal Surgery in A University Teaching Hospital
Background: Pain is an inevitable occurrence
following surgery and its control is an important component of post-operative care.
Many patients still suffer from poor post-operative pain control which is associated
with a lot of secondary undesirable consequences.
Methods: We conducted a prospective
observational study on 120 patients undergoing abdominal surgery over a 3-year period
in a teaching hospital to determine adequacy and pattern of analgesic prescriptions.
The patients’ case notes were retrieved from the record unit of the hospital following
discharge and relevant data extracted.
Results: The mean age of the patients
was 47.36 (±8.933). Twenty-four (20%) were older than 65 years. The most common
abdominal surgical procedure performed was appendectomy. Non-steroidal anti-inflammatory
drugs only, opiod only, opiod-NSAID combination and NSAID-NSAID combinations were
prescribed for 42.5% ,30.83%, 14.16%) and 7.85% of cases respectively and no prescription
in 3.3% of cases. Pentazocine was the most commonly prescribed opiod. Females tend
to have more opiod prescriptions than males (OR= 3.4, p=0.0052). Other factors that
favoured opiod prescription include; age <65 years (OR=4.8571, p= .0019), patient
in high social class (OR= 3.6364, p=0.4182), and Yoruba ethnicity (OR=3.2406, p=
0.0149). Non-steroidal analgesics were the most commonly prescribed analgesic to
patients that underwent major abdominal surgeries.
Conclusion: We thus recommend use of
analgesic combinations and dose adjustment based on patients’ severity of pain in
post-operative abdominal pain control.
prescription, Abdominal surgery and Postoperative pain.
. Acute pain
services revisited: Good from far, far from good? Reg Anesth Pain Med. 2002;117-121.
. Agency for
Health Care Policy and Research. Acute pain management: operative or medical procedures
and trauma, part 1. Clin Pharm. 1992; 11:309-331.
JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national
survey suggest postoperative pain continues to be under managed. Anesthy Analg.
. Becker DE.
Pain management: Part 1: managing acute and postoperative dental pain. Anesth Prog
. Becker DE,
Phero JC. Drug therapy in dental practice: nonopiod and opiod analgesic. Anesth
Prog. 2005; 52:140-149.
S, Jarman B, Bosanquet N, Weston D, Erens R, Delbanco TL. National survey of hospital
patients. Br Med J. 1994; 309: 1542-1546.
A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr
Opin Anaesthsiol. 2009; 22:588-593.
. Cohen FL.
Post surgical pain relief: patients’ status and nurses’ medication choices. Pain
. Hemmes SN, Gama de Abreu M, Pelosi P, Schultz
MJ, PROVE Network Investigators for the Clinical Trial Network of the European Society
of Anaesthesiology. High versus low positive end-expiratory pressure during general
anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised
controlled trial. Lancet. 2014; 384(9942):495–503.
G. Pain management in elderly hip fracture patient. 2002. Retrieved from the World
Wide Web 02 October 2003 http://www.gerimed.
Narcotics Control Board. Report of the International Narcotics Control Boardon the
availability of international controlled drugs: Ensuring adequate Access for Medical
and Scientific Purpose. New York, NY: International Narcotics Control Board; 2011.
. Jones JS,
Johnson K, McNinch M. Age as a risk factor for inadequate emergency department analgesia.
Am J Emerg Med. 1996; 14:157-160.
. Kehler H,
Wilkison RC, Fischer HB, Camu F. Prospect working group. PROSPECT: Evidence-based,
procedure-specific postoperative pain management, Best Pract Res Clin Anaesthsiol.
. Kehler PF.
Effect of postoperative pain treatment on outcome-current status and future strategies.
Lagenbecks. Arch Surg. 2004; 389:244-249.
. Kuhn S,
Cooker K, Collins M, Mucklow JC. Perc eption of pain rrelief after surgery. Br Med
J. 1990; 300:1687-1690.
PE, Schug SA, acute pain management. 3rd ed. Edinburgh: Saunders Elsevier;
. Mark RM,
Sachar EJ. Undertreament oof medical inpatients with narcotic analgesic. Ann Intern
Med. 1973; 76:173-181.
. McQuay H,
Moore A, Justin D. Treating acute pain in hospital. Br Med J. 1997; 314:1531-1535.
KA, Smith-Coggins R, Chen AH. Gender- associated differences in emergency department
pain management. Ann Emerg Med.1995; 26:414-421.
. Rawal N.
Analgesiafor day case surgery. Br J Anaesth. 2001; 87:73-87.
D. Postoperative pain. Prescriber’s J 1993; 33:237-243.
. Seiler CM, Deckert A, Diener MK, Knaebel HP,
Weigand MA, Victor N, et al. Midline versus transverse incision in major abdominal
surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227).
Ann Surg. 2009; 249(6):913–20.
. Sinan Sermet,
Muserref Asuman Akgun, Sukran Atamer-Simsek. Analgesic prescription pattern in the
management of dental pain among dentist in Istanbul. Marmara Pharmaceutical Journal.
2012; 16:41-47. DOI:10.12991/201216419.
. Todd KH,
Deaton C, D’Adamo AP, et al. Ethnicity and analgesic practice [comments]. Ann Emerg
Med, 2000; 35(1):11-6.
. Todd KH,
Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department
analgesia [comments]. JAMA, 1993. 269(12):1537-9.
. Torda T.
Postoperative analgesia. Aust Prescriber. 1995; 18:88-91.
. White PF
and Kehler H. Improving postoperative pain management: what are the unresolved issues?
Anesthesiology. 2010; 112:220-225.
. White PF.
Pain management after ambulatory surgery- where is the disconnect? Can J Anaesth.
. World Health
Organization. The World Health Report 2003. Geneva: WHO. 2003; Available from: http://www.who.int/whr/2003/en/overview