Cohort study to evaluate the pattern of analgesic prescription in adult patients undergoing ambulatory surgery

Abstract

Introduction

Postoperative pain in ambulatory surgery (AS) continues to be a recurrent problem despite anesthetic and surgical advances. Analgesic prescription and follow-up by patients at home may be a determining factor. Our objective was to evaluate analgesic prescription and its impact on the intensity of postoperative pain at 24 h and 7 days in an AS unit.

Methods

Retrospective cohort study of patients undergoing AS. Anthropometric data, ASA classification, surgery, anesthesia, analgesic prescription and postoperative pain. A telephone call was made by nurses to evaluate the DAP at 24 h and one week after surgery.

Results

A total of 875 patients, 62% women, aged 50 ± 17 years, were studied. Orthopedic (45.4%); head and neck (19.5%); general (10.6%); vascular (11.9%); plastic (2.4%) and gynecological (10.2%) surgery was performed. Multimodal analgesia was prescribed: 83.7%, combination of nonsteroidal anti-inflammatory drug (NSAID) + paracetamol + metamizole: 70.79%; opioid + paracetamol or NSAID or in monotherapy:13.1%; monotherapy with paracetamol (15%) or NSAID (1.15%). Some 62.45% were prescribed “if pain” and 61.87% had rescue analgesia. At 24 h the median (IQR) of pain on the self-assessing verbal scale was 3 (2–5) and at one week 2 (0–4). The presence of moderate-severe pain was 46% at 24 h and 31% at one week after surgery.

Conclusions

Our results show great variability in analgesic prescription with insufficient control of postoperative pain in ambulatory surgery. Although the multimodal analgesic strategy has been widely used, opioid prescription has been insufficient in surgeries associated with moderate to severe pain.