Postoperative Pain Management Practices Research Articles

Association Between English Proficiency and Postoperative Pain Management for Adult Patients Undergoing Gynecologic Surgery: A Retrospective Cohort Study

PurposeTo determine if language-based disparities in postoperative pain management exist in women undergoing gynecologic surgery. DesignA retrospective cohort study was performed. MethodsThe electronic medical records were reviewed of individuals, aged 18 to 80, who underwent an abdominal hysterectomy between 2016 and 2021 at the University of Colorado Anschutz Medical Center. A random sample of 100 patients, 50 categorized as English proficient and 50 categorized as having limited English proficiency (LEP), were compared. The primary outcomes were the number of quantitative pain assessments and the total dose of opioid given in oral morphine milligram equivalents. The secondary outcomes were the average pain scores, the number of qualitative pain assessments, postanesthesia care unit length of stay, regional block use, patient-controlled analgesia, or opioid use after the first 24 hours. Linear and generalized linear modeling was used to assess the relationship between English proficiency and the outcomes of interest. FindingsAll patients received at least 1 pain assessment while in the postanesthesia care unit (range 2 to 25). There was no significant difference in the number of objective pain assessments or the total dose of opioid given between the groups. There were no significant differences in any of the secondary outcomes between the groups. On subgroup analysis, the presence of a documented bedside interpreter did not result in a significant difference in endpoints. Fewer LEP patients received patient-controlled analgesia (34% LEP vs 58% English proficient), though the difference did not reach statistical significance. ConclusionsLanguage barriers may complicate care and impact postoperative recovery. In our population of women in a high-volume, urban, level I, trauma center, there were no observed differences in postoperative pain management practices in patients with LEP compared with English-proficient patients. Standardized nursing protocols may contribute to more equitable care. Ongoing investigations in the identification and prevention of language-related disparities in perioperative care are warranted.

Expression of concern: “Practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia, 2019” [Int. J. Africa Nurs. Sci. 20 (2024) 100642]

Expression of concern: “Practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia, 2019” [Int. J. Africa Nurs. Sci. 20 (2024) 100642]

Correction to “A cross‐sectional study of factors associated with nurses’ postoperative pain management practices for older patients”[Youngcharoen, P., & Aree‐Ue, S. (2023). A cross‐sectional study of factors associated with nurses' postoperative pain management practices for older patients. Nursing Open, 10(1), 90–98. https://doi.org/10.1002/nop2.1281

Correction to “A cross‐sectional study of factors associated with nurses’ postoperative pain management practices for older patients”[Youngcharoen, P., & Aree‐Ue, S. (2023). A cross‐sectional study of factors associated with nurses' postoperative pain management practices for older patients. Nursing Open, 10(1), 90–98. https://doi.org/10.1002/nop2.1281

Acute postoperative pain prevalence and intensity in the first 72 hour in Dessie Comprehensive Specialized Hospital, Ethiopia: a prospective single center observational study.

Postoperative pain is poorly studied in developing countries. Severe pain after surgery remains a major problem, occurring in 50-70% of the patients. Differences exist across countries. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain-treatment and develop procedure-specific, optimized pain-treatment protocols, the prevalence and severity of postoperative pain must first be identified. This study aimed to determine the prevalence and intensity of acute postoperative pain and the practice of postoperative pain management. A total of 180 patients were enrolled in the study, with 160 calculated using a single population proportion formula and a 10% attrition rate added, with proportionate stratification according to the size of each ward to obtain the number of participants from each specialty ward. A multistage sampling with stratified proportionate at the initial stages and a simple random sampling technique at the final stage was used. The patients completed a numerical pain rating scale for pain immediately after surgery for the first 72h after surgery. The prevalence of mild, moderate, or severe pain was calculated. The evaluation was performed at eight time points including immediately after surgery: T2, T4, T8, T12, T24, T48, and T72. The prevalence of severe pain in patients who underwent elective surgery in the study period measured by numeric rating scale was 21.6, 43.9, 45.6, 28.9, 39.4, 10.5, and 13.4% at 2nd, 4th, 8th, 12th, 24th, 48th and 72h, respectively. The prevalence of moderate-to-severe pain within 72h postoperatively was slightly lower than that other studies conducted in Ethiopia reported. This was still high, indicating better pain management in the postoperative period. Involvement of the anesthetist in pain management is crucial for better patient management.

Practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia, 2019

BackgroundPostoperative pain is a combined effect of several unpleasant sensory, emotional and mental experiences. Patient’s previous experiences, nature and duration of surgery, site and size of the incision and the extent of surgical trauma are some of the factors affecting the degree of post-operative pain. ObjectivesTo assess practice of non-pharmacological post-operative pain management and associated factors among nurses working in public referral hospitals of Amhara regional state, Ethiopia. MethodInstitutional based cross-sectional study was conducted among nurses working in public referral hospitals of Amhara regional state, Ethiopia from March to April 2019. Census method was employed to select study participants. Data were entered into Epi info version 7.2.0.1 and exported to SPSS window version 20 for analysis. Binary and multivariable logistic regression was used to see the association between dependent and independent variables. The odds ratio with a 95 % confidence interval was computed. P-value < 0.05 was used to declare association. ResultsThree hundred nurses working in post-operative units of selected referral hospitals of Amhara regional state were involved in the study. The respondents’ ages (Mean ± SD.) were (29.8 ± 7.3) years and their experience (Mean ± SD) post-operative unit was (3.8 ± 3.3) years. Majority (59.7 %) of the respondents were females. This study revealed that about 50.2 % of nurses were not applied non-pharmacological post-operative pain management techniques for their patients. Nurse’s educational status, attendance of training, attitude of nurses, willingness of patients, experience in nursing, marital status and working unit were associated with practice of non-pharmacological post-operative pain management with p-value of < 0.05. ConclusionIn this study, nearly half of nurses didn’t apply non-pharmacologic pain management techniques for patients when they had pain. In-service training and educational development are recommended for nurses about non-pharmacologic pain management.

Parental Postoperative Pain Management Perceptions, Attitudes, and Practices in Pediatric Limb Fractures

BackgroundPost-surgical pain in children is common, severe, and inadequately controlled. An effective model should involve the participation of parents. AimsTo investigate parental perceptions, attitudes, and practices in postoperative pain management in children with limb fractures and analyze the factors affecting parental practices. DesignThis was a descriptive cross-sectional study. SettingsResearch was conducted at a tertiary Children's Hospital Affiliated with Soochow University. ParticipantsParents whose children (age, 6–18 years) underwent orthopedic fracture surgery between January 1, 2020, and August 31, 2020, were recruited using purposive sampling. MethodsThe parents were asked to complete self-report questionnaires: “Pain Management Knowledge and Attitudes Questionnaire” and “Parents’ Use of Pain Relief Strategies Questionnaire.” The Wong–Baker Faces Scale was used to measure pain intensity in children. The Mann–Whitney U test, Kruskal–Wallis H test, and correlation and regression analyses were used for statistical analyses. ResultsData of 180 parents were collected. Of the participants, 80.6%, 78.3%, and 71.7% had low-to-moderate scores for knowledge, general attitudes, and use of pain relief strategies, respectively. Moreover, 93.9% of parents had moderate-to-high scores for negative attitudes toward medication, despite 89.5% of them reporting moderate-to-high pain intensities in their children (median proxy-report of pain intensity, 7.0 [3.00]). Multivariate linear stepwise regression showed that parents’ use of pain-relief strategies was related to their general attitudes, knowledge, and sex. ConclusionsMost parents had low-to-moderate scores for perceptions and general attitudes toward children’s postoperative pain management, and use of pain relief strategies. Moreover, they lacked knowledge of and had negative attitudes toward pain assessment and analgesics, which significantly impacted their practices. Clinical ImplicationsClinical pediatric nurses should provide appropriate support for the entire family of the child. Moreover, to enhance parental practices, they should develop targeted parental education programs for pain management, particularly regarding pain assessment tools and pain medications.

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study.

Postoperative pain management practices in breast surgery are variable, with recent evidence that approaches for minimizing or sparing opioids can be successfully implemented. We describe opioid filling and predictors of higher doses in patients undergoing same-day breast surgery in Ontario, Canada. In this retrospective population-based cohort study, we used linked administrative health data to identify patients aged 18 years or older who underwent same-day breast surgery from 2012 to 2020. We categorized procedure types by increasing invasiveness of surgery: partial, with or without axillary intervention (P ± axilla); total, with or without axillary intervention (T ± axilla); radical, with or without axillary intervention (R ± axilla); and bilateral. The primary outcome was filling an opioid prescription within 7 or fewer days after surgery. Secondary outcomes were total oral morphine equivalents (OMEs) filled (mg, median and interquartile range [IQR]) and filling more than 1 prescription within 7 or fewer days after surgery. We estimated associations (adjusted risk ratios [RRs] and 95% confidence intervals [CIs]) between study variables and outcomes in multivariable models. We used a random intercept for each unique prescriber to account for provider-level clustering. Of the 84 369 patients who underwent same-day breast surgery, 72% (n = 60 620) filled an opioid prescription. Median OMEs filled increased with invasiveness (P ± axilla = 135 [IQR 90-180] mg; T ± axilla = 135 [IQR 100-200] mg; R ± axilla = 150 [IQR 113-225] mg, bilateral surgery = 150 [IQR 113-225] mg; p < 0.0001). Factors associated with filling more than 1 opioid prescription were age 30-59 years (v. age 18-29 yr), increased invasiveness (RR 1.98, 95% CI 1.70-2.30 bilateral v. P ± axilla), Charlson Comorbidity Index ≥ 2 versus 0-1 (RR 1.50, 95% CI 1.34-1.69) and malignancy (RR 1.39, 95% CI 1.26-1.53). Most patients undergoing same-day breast surgery fill an opioid prescription within 7 days. Efforts are needed to identify patient groups where opioids may be successfully minimized or eliminated.

The First Comprehensive Survey of the Practice of Postoperative Pain Management in Hungarian Hospitals: A Descriptive Study

BackgroundPain management is a key issue in health care. Providers adopt promising technological developments, like Acute Pain Service, at differing speeds, with countries, such as the USA and Germany taking the lead. Where Hungary stands is unknown, as the practice of pain management has not yet been comprehensively reviewed in that country. AimTo explore the practice of postoperative pain management in Hungarian hospitals by addressing the questions of who is responsible for it, who measures pain and how, what kind of pain relief technologies are used, and who takes care of patients during duty hours. MethodsWe carried out a survey covering Hungarian hospitals with operational license for surgery, traumatology, orthopedics and anesthesiology between December 2019 and March 2020. The response rate was 72%, and we analyzed 135 questionnaires. ResultsWe identified only 2 hospitals with an Acute Pain Service. In the majority of hospitals, the attending physician orders pain relief therapy. During duty hours the surgeon on duty takes care of pain management in 52.1% of the cases. Among pain relief therapies, intravenous infusions (74.1%) and oral medication (67.4%) are the most frequent. Ward nurses measure postoperative pain (77.8%) with unidimensional scales. According to 59.7% of the respondents, pain is not measured and documented at rest. Written protocols are available in 34.4% of the departments. ConclusionsCompared with other countries, pain management in Hungary lags behind with significant room for improvement. Development and implementation of pain management protocols with appropriate education is the key intervention point.

Practice of Postoperative Pain Management in Under-Five Children in A Tertiary Hospital: A Prospective Crossectional Study.

Despite advancements in pain management, children have remained undertreated for postoperative pain. Data regarding the practice of post-operative pain management in paediatric patients remains less available in the developing world. This study was aimed at evaluating practice of postoperative pain management in under five children. A prospective cross sectional one-year study was conducted on all paediatric patients who underwent major paediatric surgical procedures from February 1, 2020 to January31, 2021, at a tertiary hospital in Addis Ababa, Ethiopia. A single type of analgesic medication was used in 67.1% patients. Analgesic medications were administered on standing base only in 64.4% of patients. Patients' charts had no documentation of pain assessment both in the neonatal intensive care units and wards.32.89 % of assessed patients had moderate to severe pain record. Significant number of patients suffer from postoperative pain because of absence of proper pain assessment and inadequate administration of analgesic medication.

Management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Northeast Ethiopia. Prospective cross sectional study

IntroductionPain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components. Inadequate postoperative pain management leads to negative clinical outcomes such as extended hospitalization, poor recovery, diminished and decreases the quality of life, increased healthcare costs and utilization, higher morbidity and mortality, and the development of chronic pain. The study was used for the hospitals administrations, health professionals, committee that develop the pain management guideline, researcher, and governmental health institutions regarding the practice of postoperative pain management. The aim of this study was to assess the management of postoperative pain among health professionals working in governmental hospitals in South Wollo Zone, Ethiopia. Methods and materialsA hospital-based prospective cross-sectional study was conducted from February 20, 2022 to March 25, 2022. The study population was selected from South Wollo Zone governmental hospitals and 386 samples were collected using a self-administered questionnaire and verified, coded and entered into Epidata software version 3.1 and it exported to SPSS version 23 for analyze. To summarize descriptive statistics frequencies, percentages, and mean were used and presented with tables, charts, and figures. Result386 participants were involved and making up 95.8% of the response rate. Among the respondents, 97.9% of the respondents had used pharmacological management. 51.3% applied non-pharmacological and 66.1% applied multimodality management of postoperative pain. Among pharmacological management, 48.7% of systemic analgesics technique, 26.3% of regional analgesics technique, and 25.0% of patient-controlled epidural analgesics, whereas in non-pharmacological management 40.4% of cold and heat application followed by 32.3% of immobilization was applied to the management of postoperative pain. Conclusion and recommendationThe overall level of pharmacological, non-pharmacological and multimodality approach of post-operative pain management among health professionals in the study area was more than ninety, half and more than half of the participants, respectively. Postoperative pain management found in many key areas of postoperative pain management has an impact on the provision of effective pain management and optimal care given to surgical patients. This study provided an opportunity for health professionals working in hospitals, to evaluate themselves in the area of postoperative related to pain management.

A cross-sectional study of factors associated with nurses' postoperative pain management practices for older patients.

The aim of the study was to identify factors associated with nurses' pain management practices in older patients undergoing surgery. A cross-sectional study. The study sample was 85 Registered nurses working in inpatient surgical units in a tertiary care hospital, Thailand. Data were analysed using descriptive statistics, Pearson's and point biserial correlation coefficients, and stepwise multiple regression analysis. A positive correlation was found between practices and (a) pain management training and (b) perceptions related to collaboration with physicians. However, practices were negatively related to (a) the nurses' perception of their workload and (b) the number of years of nursing experience. The recent pain management training, the nurses' perceptions of both collaboration with physicians and their workload explained 24.40% of the variance in practices. Appropriate nursing workloads, regular pain management training and promoting collaboration among the healthcare team could all improve the quality of nurses' postoperative pain management.

Practice of Postoperative Pain Management in Neurosurgery

Practice of Postoperative Pain Management in Neurosurgery

Postoperative Pain Management Practice and Associated Factors Among Health Professionals Working in Governmental Hospitals in South Wollo Zone, Ethiopia

Introduction: Pain results from real or potential tissue damage that involves a disagreement sensory and emotional experience. Poor practice in post-operative pain management results in negative clinical outcomes, chronic pain, financial burden, and a reduction in patient functionality and productivity. The study was used for the hospitals administrations, health professionals, committee that develop the pain management guideline, researcher, and governmental health institutions regarding the practice of postoperative pain management. Objective: To assess postoperative pain management practices and associated factors towards healthcare professionals working in governmental hospitals in South Wollo Zone, Northeast Ethiopia, 2020. Method and Materials:- Cross-sectional study design was conducted from 20/02/2020 to 25/03/2020. The study population was selected from south Wollo zone governmental hospitals and 386 samples were collected using a self-administered tool and verified, coded, and entered to Epi-data software version 3.1 and exported to SPSS software version 23 for analysis. To summarize descriptive statistics frequencies, percentages, and mean were used and presented with tables, charts, and figures. Result: The response rate of the study participants were 95.8%. Among the participants 57.5%, of the study respondents had good practice and 42.5% had poor practice of postoperative pain management. The variable, working intensive care unit (AOR (95%CI)=14.5 (1.503-139.93)), using assessment tool (AOR (95%CI)=10.622 (4.776-23.621)), using Pain scale (AOR (95%CI)=10.614 (4.803-23.456)), Do documentation (AOR (95%CI)=6.748 (2.977-15.294)), take training (AOR (95%CI)=4.126 (1.707-9.977)), had past pain experience (AOR (95%CI)=4.174 (1.821-9.564)), favorable attitude (AOR (95%CI)=2.592 (1.191-5.643)); such independent variables were significantly association with the postoperative pain management practice. Conclusion: The overall level of poor postoperative pain management practice among health professionals in the study area was low.

Knowledge, attitudes and practices of health professionals towards postoperative pain management at a referral hospital in Ethiopia

BackgroundPostoperative pain (POP) is a form of acute pain following surgery. It results from tissue injury during surgical procedure like skin incision, tissue dissection, manipulation and traction. It is one of the immediate postoperative complications. Despite new standards, guidelines and different strategies the practice of postoperative pain management is found to be inadequate. We aimed to assess knowledge, attitude and practice on postoperative pain management practice among Health professionals working at Debre Tabor Referral Hospital. MethodInstitution based cross-sectional study was conducted to assess Knowledge, Attitudes and Practices of Health professionals regarding to Post-operative pain management at Debre Tabor Referral Hospital 2020 from 118 health professionals. Data was collected using structured self-administered questionnaire and was verified, coded and entered to Epi Info Software version 3.5.4 and then it was exported and analyzed by SPSS version 20 Software. After analysis frequency and percentages was used to summarize the finding. ResultThe overall finding of the study revealed that health professionals had good knowledge (58.4%), unfavorable attitude (44.9%), and poor practice (24.58%) towards post-operative pain management. ConclusionNon physician anesthetists have good knowledge, attitude and practice towards post-operative pain management. But the overall attitude and practice of health professionals’ towards post-operative pain management is poor.

Assessment of postoperative pain management practices in Cameroon, Ivory Coast and Senegal: A multi-national survey.

Inadequately controlled postoperative pain impacts patients' functional recovery and may affect the quality of life after surgery. Our multinational, cross-sectional study conducted online between November 2017 and January 2018 surveyed anaesthetists' conformity with established postoperative pain control guidelines and looked at pain assessment, dissemination of information to patients, staff training and creation and use of treatment protocols. Of the 170 respondents, only six applied postoperative pain management recommendations. The proportion of respondents who reported regular staff training; the regular provision of pre-operative information to patients; the existence and use of written protocols; and the number conducting at least one pain assessment a day was not just suboptimal, but embarrassingly low.

Effects of Intrathecal vs. oral Multimodal analgesia on pain scores following total knee and hip arthroscopy procedures

Background Postoperative pain management practices vary widely among anesthetists in hospitals despite evidence-based pain management guidelines. This study explores a specific practice in managing acute post-operative pain by comparing the use of intrathecal bupivacaine (ITB) and morphine (ITBM) combined with oral multi-modal analgesia (MMA) versus ITB and oral MMA in patients who have undergone total knee arthroscopy (TKA) and total hip arthroscopy (THA) and the effect on pain scores. This study seeks to determine whether the practice of using ITBM is beneficial to patients during the post-operative phase. A total of 153 patients undergoing TKA and THA orthopedic surgery were randomly assigned to one of the two pain management techniques: (1) 3.5ml of 0.5% isobaric bupivacaine injected intrathecally and MMA (500mg of acetaminophen, 200mg gabapentin, 200mg of celecoxib, 10mg of controlled release oxycodone, and 5-15mg of immediate release oxycodone) was initiated on postop day 0; and (2) 3.5ml of 0.5% isobaric bupivacaine and 0.1mg of morphine was injected intrathecally and MMA (500mg of acetaminophen, 200mg gabapentin, 200mg of celecoxib, 10mg of controlled release oxycodone, 5-15mg of immediate release oxycodone). Verbal pain scores were monitored for the first 24 hours post-operatively using the Visual Analog Scale (VAS). Side effects of nausea and vomiting were also monitored for each patient for the first 24 hours post operatively. Results The VAS were similar in the ITBM group and the ITB group during the first 24 hours post-operative. The mean VAS 24 hours post-operative for TKA patients who received ITBM was 4.98, and 5.45 for patients who received ITB. Post-operative nausea and vomiting (PONV) in the TKA group varied according to the treatment group, 12.7% of patients in the ITBM group reported nausea or vomiting, compared to 13.2% in the group of patients who received ITB. The significance is set at P value < 0.05, based off this set value, the significance is shown to be P=0.629 (N.S.). There was no significance in VAS when treated with ITB or ITBM. The mean pain score 24-hour post-operative for THA patients who received ITBM was 3.63 and 4.04 for patients who received ITB. In the THA group, 9.1% of patients in the ITBM group reported PONV, whereas no one experienced PONV in the ITB group. The significance is set at P value < 0.05, based off this set value, the significance is shown to be 0.708 (N.S.). There is no significance in pain scores when treated with ITB or ITBM in patients who have undergone a total hip arthroplasty. In Conclusion, the use of ITBM fails to show superior analgesic effect on patients undergoing TKA and THA compared to ITB combined with MMA. Without superior pain control benefits and mild increase risk of causing nausea and vomiting post operatively in the TKA group, intrathecal morphine shows to provide no additional superior benefits to patients in managing their pain or significantly decreasing severity of onset of pain post operatively.

Knowledge, Attitude and Practice and Associated Factors Towards Post-Operative Pain Management Among Nurses Working at St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia, 2019

Background : Patients’ recovery after surgery is one of the most important health processes in hospital healthcare. Effective pain management requires precise knowledge; attitude and competent assessment skills on practice. There is limited evidence on nurses’ knowledge, attitude and practice of post-operative pain management (POPM) in Ethiopia. The present study aimed to assess Knowledge, Attitudes and Practices of Nurses Regarding POPM at St. Paul’s Hospital Addis Ababa, Ethiopia. Objective : To assess factors associated with knowledge, attitude and practice on postoperative pain management practice among nurses at St. Paul Hospital Millennium Medical College. Methodology: Descriptive cross-sectional survey will be used. Study Area: St. Paul referral hospital. Source population: All surgical and operation room (OR) nurses of St. Paul’s hospital. Study Period is from April- July 2019. Result: The result of this study shows that generally nurses are knowledgeable in POPM. The result reveals that 23(14%) of surgical nurses have in adequate knowledge and 146 (86 %) have adequate knowledge regarding POPM. in attitude study nurses showed negative attitude towards the questioners they were given. Nurses tend to have poor practice regarding POPM according to this study. Conclusion: The results also show that the nurses have negative attitudes regarding patients experiencing pain and the use of placebo. The study found that the practices of nurses related to POPM pain are at low level. As the nurses are the most important parts in the multidisciplinary approach in pain management, their knowledge and attitude make a big difference on practice POPM. So, there is a need for regular in-service education on pop management according to the recommendation of standard. Keywords: Knowledge, Attitude, Practice, Post-Operative, Pain Management, Nurses DOI: 10.7176/JMPB/69-03 Publication date: March 31 st 2021

Postoperative Pain Management among Registered Nurses in a Vietnamese Hospital.

This study examined the postoperative pain management practices among registered nurses in an urban hospital in Vietnam. Data of 90 nurses about postoperative pain management practices and pain management at the department were collected. Results indicated that 83.3% of nurses reported that they regularly assessed the degree of pain for postoperative patients. Only 32.2% used assessment tools such as the numeric rating scale to measure pain. Experience in pain management and having guidelines in the department were associated with a higher score in pain management practice. Findings suggested that facilitating the use of pain instruments and developing pain management guidelines should be prioritized.

Comparison of preemptive paracetamol, paracetamol-diclofenac & paracetamol-tramadol combination on postoperative pain after elective abdominal surgery under general anesthesia, Ethiopia: a randomized control trial study, 2018

BackgroundIn the practice of postoperative pain management, pain is still poorly managed in low resource setting where the practice of epidural and opioid free analgesia is impractical. There has been a recent trend of combining different drugs and concept of preemptive analgesia but the therapeutic superiority remains understudied for postoperative pain management. The aim of this study is to assess postoperative analgesic effect of preemptive Paracetamol, Paracetamol-diclofenac and Paracetamol-tramadol combination in patients undergoing laparotomy surgery.MethodsThree-arm, randomized control trial study conducted on 63 patients undergone laparotomy surgery; group-P (paracetamol 1 g), group-PD (1 g + diclofenac 75 mg) and group-PT (paracetamol 1 g + tramadol 100 mg). The Numerical Rating Scale (NRS) pain rating system was used for this study. The primary endpoint of the study was total amount of analgesia consumption. Post-operative analgesic therapy [intravenous tramadol, 50 mg] were provided when patients complain of pain (request medication) or a numeric rating scale ≥4 was recorded. Secondary endpoint of the study were the time of first analgesic request and the intensity of the pain during 24 h post-op follow up period. Parametric data were analyzed using (ANOVA) and nonparametric data analyzed by Kuruska-Wallis H rank test. Chi-square test used for categorical variable. Statistical significance were sated at p value < 0.05 with a power of 80%.ResultsThe mean total tramadol consumption was significant higher in paracetamol group 250 ± 79.06 mg compared to paracetamol-diclofenac (173.81 ± 87.49 mg p = 0. 008) and paracetamol-tramadol (154.76 ± 70.54 mg p = 0. 001) group. Time to first analgesic request was significantly shorter within paracetamol group (87.62 ± 20.95 min) compared to paracetamol-diclofenac (103.01 ± 23.53 min p = 0.029) and paracetamol-tramadol (144.05 ± 14.72 min p < 0.001) group. There was statistically significant difference at 4th, 6th and 8th hour showing lower median pain score in paracetamol-tramadol group compared to paracetamol group.ConclusionPreemptive combination of paracetamol-tramadol and paracetamol-diclofenac reduce total tramadol consumption and prolongs time to first analgesic request compared to paracetamol alone in patients undergoing laparotomy surgery.Trial registrationThe study was retrospectively registered on 07 July 2019 at Pan African Clinical Trial Registry with the identification number of PACTR201908890749145. It was accepted on 14 August 2019.

Nurses’ knowledge, attitude and practice regarding postoperative pain management at selected hospitals, Bharatpur, Nepal

Background: Acute and severe pain after surgery is the major concern of operated patients and health professionals where the vital responsibilities goes to the nurses for managing pain satisfactorily. Hence, the nurses require to have adequate knowledge, attitude and practice (KAP) to carry out such responsibilities.&#x0D; Methods: A descriptive cross-sectional study design was used to find out the nurses’ KAP regarding postoperative pain (POP) management. Total 74 nurses of postoperative wards were selected from four hospitals at Bharatpur with non-probability enumerative sampling technique. Data were collected with the structured self-administered questionnaire for knowledge, five-point Likert scale for attitude and observation checklist for practice. Data were analyzed by using descriptive statistics for levels of KAP; Chi-square for association between levels of KAP with selected variables and spearman rank correlation to determine relationship among KAP regarding POP management.&#x0D; Results: The study showed that 85.1% nurses had low level of knowledge, 55.4% had satisfactory level of attitude and 52.7% had low level of practice. Statistically significant association was found between level of practice and age (p=0.010) of nurses and with professional qualification (p=0.002). There was no statistically significant relationship among KAP scores regarding POP management.&#x0D; Conclusions: Majority of the nurses had low level of knowledge, more than half had satisfactory level of attitude but low level of practice regarding POP management. The age and the professional qualifications of the nurses found to be associated with the practice of POP management.