The use of a questionnaire for improvement of postoperative analgesia after transurethral resection of the prostate

Abstract

Abstract Background : Postoperative analgesic studies with methods like i.v. patient controlled analgesia (i.v. PCA) or epidural analgesia have reported effective pain relief after major surgery, also after urologic cancer surgery. In contrast, systematic results after minor urologic surgery are widely unknown, although the pain intensities may be high for a short time. The aim of the study was to evaluate the usefulness of a pain questionnaire as a measurement tool of postoperative analgesic quality after transurethral resection of the prostate (TUR-P). Methods : A questionnaire of the American Pain Society (APS) for quality assurance of postoperative pain therapy was adapted to estimate the pain profile, analgesic demand, satisfaction and side effects of analgesic therapy at the morning of the first postoperative day in two groups after TUR-P. In one group (group 1; n =50) the efficacy of a routinely used (but non-standardized) analgesic regimen with different analgesics administered only on demand was estimated with the questionnaire. These results were compared with a new and standardized analgesic approach (group 2; n =50), designed as a follow-up study. These patients received an intravenous infusion of the weak opioid tramadol (500 mg) in combination with the spasmolytic butylscopolamine (50 mg) immediately after the surgery until the morning of first postoperative day. Also the effectivity of this standardized regimen was estimated with the questionnaire. Results : In group 1, an evident analgesic undersupply with high pain intensities as well as frequent and long lasting breakthrough pain was documented. In contrast, in group 2 with a standardized approach the questionnaire did indicate impressing clinical improvement. In addition, patient satisfaction was significantly higher, despite some typical side effects of tramadol, such as drowsiness and dizziness. Conclusions : The modified questionnaire of the American Pain Society allows important insights into the analgesic quality after defined surgery without special methods of an Acute Pain Service. The questionnaire is easy to handle and takes only a few minutes. The presented data after TUR-P can not substitute randomized controlled trials.