Treatment of postoperative pain in anaesthesiological units in Croatia

Abstract

Abstract The treatment of postoperative pain is a problem that has too often been neglected. The aim of this survey was to examine the current situation in postoperative pain treatment in anaesthesiological units in Croatia. The knowledge of practice, habits and standpoints of our anaesthesiologists could serve as the basis for the formulation of unique guidelines for the treatment of postoperative pain. A questionnaire and a letter explaining the purpose of the study were used in the survey. Twenty-eight out of 49 mailed questionnaires were returned (57%). The results of the survey show that there is no formal organisation within the anaesthesiological units to provide postoperative pain treatment. Intermittent parenteral application of analgesics is instituted in the majority of responses (81%) and infusion analgesia in 23.7% of responses. Of the regional methods, only epidural analgesia — used ‘predominantly’ in 8% of responses and ‘occasionally’ in 43% of responses — can compete with parenteral application of analgesics. Tramadol (24% of responses) and pethidine (21% of responses) are mild opioids frequently used for systemic drug therapy. Of the strong opioids, fentanyl (17% of responses), morphine (11% of responses) and methadone (5% of responses) are used most often. This reflects clearly the lack of other strong opioids on the Croatian market (piritramide, buprenorphine). Patients are poorly informed about possible postoperative pain (they are informed in only 25.9% of responses). The intensity of postoperative pain is infrequently measured and rarely documented (14.3% occasionally), yet such data is the very prerequisite for the successful treatment of postoperative pain. Lack of time is the most frequently quoted cause of inadequate analgesia (50% of responses). Improved organisation, better environmental conditions, better trained personnel and more equipment would contribute to superior postoperative pain management. Better patient information is also expected to make an improvement, whilst only a small improvement is expected from advanced methods and analgesics. Better protocols for the evaluation of pain management ranked lowest of the suggestions (6.1% of responses). The fact that pain is neither measured nor recorded and that the treatment of pain is not organised results in inadequate postoperative analgesia.