Management of postoperative pain. An intervention study

In 1989 a study had shown that the quality of postoperative pain treatment (PPT) in a district general hospital was not satisfactory. Therefore, new instructions for PPT were issued, intra-venous medication with morphine was introduced on the wards, and the staff was educated in PPT. The purpose of this study was to investigate the quality of PPT in 1992 compared to the quality in 1989.

Using identical questionnaires, 191 patients in 1989 and 126 patients in 1992 were interviewed before and 2-5 days after surgery regarding postoperative pain. At the postoperative interview patients in pain also filled out the McGill Pain Questionnaire. A questionnaire was also answered by the nurses regarding PPT in 1989 and in 1992.

1992 compared to 1989 (1992/1989): all patients were now medicated (100%/93%), most of them regularly (79%/ 4%) and the majority (94%/15%) also received non-opioid analgesic. Fewer patients (65%/80%) experienced postoperative pain lasting more than one day following surgery. Analgesic prescription was more standardized. In 1992 the nurses were more satisfied than in 1989 with the PPT and the physicians' prescribing patterns. All the above-mentioned parameters were significantly improved from 1989 to 1992. All the different pain-scores showed a reduction (8-30%) but did not reach statistical significance (P = 0.2).

Our two investigations show that it is possible to improve the quality of pain management with rather simple reforms.