Utilization, availability of analgesics and quality of pain control for post-operative pain in surgical patients

Abstract

Effective post-operative pain control can provide patient comfort and satisfaction and also improve quality of life. The study aimed to determine the amount of opioid and non-opioid analgesics used during the 24-h post-operative period, as well as the effectiveness of pain control, in the general surgical wards of Thingangyun Sanpya General Hospital and Yangon General Hospital in Yangon, Myanmar. We conducted this hospital-based, prospective, cross-sectional descriptive study over a period of 5 months (May to September, 2016). World Health Organization (WHO) Anatomical Therapeutic Chemical classification (ATC)/Defined Daily Dose (DDD) methodology and drug utilization (DU) 90% segments were used to determine the amount of opioid and non-opioid analgesics used during the 24-h post-operative period. The effectiveness of pain control was determined using a numerical rating scale (NRS) and the pain Management Index (PMI). Among total 233 post-operative patients, 161 patients (69%) received combined opioids and non-opioid analgesics, 36 patients (15.5%) received opioid analgesics only and 36 patients (15.5%) received non-opioid analgesics only. Total analgesic usage was 11.04 DDD/1000 inhabitants/days. Diclofenac was the most frequently prescribed analgesic (5.9 DDD/1000 inhabitants/days), followed by tramadol (1.9), and ketorolac (1.75); fentanyl was the least frequently prescribed (0.04). Diclofenac, tramadol and ketorolac were included in the DU 90% segment. Six hourly NRS records reveal 7–25% of patients suffered moderate pain and 0.9–2.1% suffered severe pain. By using PMI, 208 patients (89.3%) received adequate pain medication and 25 patients (10.7%) received ineffective pain medication. All analgesics listed in the 2016 Myanmar National List of Essential Medicines were available on these wards. The results of this study can provide information to the prescriber about to what extent analgesics were being used and to policy makers or administrators for planning services on management of post-operative pain.