A Prospective Clinical Audit into the Management of Postoperative Pain in the Postanesthesia Care Unit of a Tertiary Care Teaching Hospital in Coastal Karnataka, India.

Introduction: Clinical audit forms part of clinical governance, which aims to ensure that patients receive the best quality of care. Optimizing pain management in recovery involves measuring a range of processes and outcome indicators. Reducing acute pain improves patient outcomes and reduces chronic postsurgical pain incidence.

Aim: The aim of the study was to assess the practice and outcomes of the management of postoperative pain in the postanesthesia care units (PACUs) of our tertiary care teaching hospital.

Methodology: We studied postoperative pain and management in patients posted for elective procedures and monitored in the PACU. The study design was a prospective audit conducted in the PACU of a tertiary teaching hospital. The data collected and analyzed were based on the best practice guidelines and suggested indicators as per the New Zealand College of Anesthetists (ANCZA) postoperative analgesia protocols.

Results: The planned postoperative analgesia was peri- and postoperative intravenous administration of paracetamol or other nonsteroidal anti-inflammatory drugs (NSAIDs) in the majority of patients (83.3%); four patients (6.7%) were treated with epidural infusions, three with intravenous opioid infusions (5%); only one patient (1.7%) received a bolus nerve block for pain relief. Most of the patients audited underwent general anesthesia, and parenteral analgesia with NSAIDs was effectively used in the majority of patients in the PACU. Failure in the management of acute pain in PACU resulted in severe pain (5%). A review of anesthesiologist for change in treatment protocol was required in these patients and delay of discharge from PACU was minimized. Opioids were mostly used for rescue analgesia.

Conclusion: Evidence-based best practice of acute management of pain was implemented with our current treatment protocol, with emphasis on increased utilization of peripheral nerve blocks for optimal postoperative analgesia.