[Periodic evaluation of practices in postoperative pain management]

Periodical assessment of practices as part of a quality assurance program: impact on postoperative pain.

All patients evaluated from the first postoperative day during a week.

Two surveys performed at a six month interval after establishment of some corrective measures. Different items were evaluated: pre-anaesthesia information for patients, pain severity and satisfaction with pain treatment. Medical data were consulted concerning postoperative analgesic prescriptions, their realization, pain assessment by nurses. Between the two surveys, first survey results were presented to anaesthesiologists. Then guidelines for prescriptions were suggested and new monitoring guidelines were proposed to nurses in surgical ward.

94 patients were evaluated during each survey. Patients had undergone orthopaedic, visceral, urology, ophthalmology and vascular surgery. Half of the patients did not receive information about pain before surgery. 43% of patients had a pain scores = 30/100 during movements; no difference was found between the two evaluations. Satisfaction graded as "moderate or insufficient" decreased from 22% (1rst survey) to 10 (2nd survey) (p < 0.05). Non steroidal anti-inflammatory drugs and nefopam prescriptions increased between the two surveys (p < 0.05). Association of three or four analgesics increased between the two surveys and monotherapies decreased (p < 0.05). Concordance of prescriptions with guidelines was 55% during first survey and 62% during the second (NS). Pain severity was not recorded for 36% of patients at first survey and in 18% at the second (p < 0.05).

Although anaesthesiologists and nurses changed their practice due to a quality insurance program concerning postoperative pain, its consequence on the severity of postoperative pain was not significant.