Problems in self-management of analgesics after outpatient shoulder surgery

Surgical outpatients are instructed in the use of analgesics post-operatively, but many fail to obtain adequate pain control at home. This study describes how the medication taken related to the prescribed medication and to pain intensity to improve recommendations of drug choice and scheduling. Also, we describe which errors occurred to suggest improvements in patient education and adherence.

Data were extracted from a study of dexamethasone in day-case arthroscopic shoulder surgery. Patients were recommended paracetamol 1 g four times daily and as needed: ibuprofen 600 mg up to 1,800 mg daily and morphine 10 mg up to 60 mg daily. Patients reported pain intensity and analgesic use until the third post-operative day.

A total of 75 patients were available for analysis, and 33 patients (44%) reported an average pain intensity less-than 3 (by numerical rating scale 0-10) during the first three days. Paracetamol was taken as recommended by less-than 50%, and adherence was poorer in patients with higher average pain scores. The maximal daily dose was exceeded for paracetamol (n = 7) and ibuprofen (n = 14) due to too many daily doses or medication of other brand names or strengths than the patients were used to. In total, 32 patients had rescue doses between midnight and 6 a.m. Intolerance was seen for paracetamol (n = 1), ibuprofen (n = 7) and opioid (n = 2).

Problems in analgesic use after outpatient surgery include undertreatment, poor compliance, overdosage, nightly breakthrough pain and poor tolerance due to side effects. Interventional studies should target these areas.

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not relevant.