Pre-operative analgesia after injury

Much has been written on postoperative analgesia in the surgical patient. However, no work has been published on pre-operative pain relief in acute injury. We have studied 100 consecutive admissions, reviewing the prescribing pattern and administration of analgesia following acute injury in the period prior to operation, or the first 24 h as an in-patient. We found an over-reliance on a narrow range of analgesics to the exclusion of others. The choice and variety of analgesic offered, their frequency and route of administration could all have been improved. Equally, little thought was given to adjuvant forms of analgesic therapy which are well suited to the injured patient. Analgesics were prescribed more often than they were given. No pharmacological analgesia was prescribed in 9 per cent of admissions, and a further 14 per cent were given no analgesia despite its being prescribed, i.e. 23 per cent of acutely injured patients received no analgesia during the pre-operative period, or first 24 h after admission. This audit revealed evidence of inadequate pre-operative analgesic prescribing and administration practices. We conclude that there is no place for complacency when managing the analgesic requirements of injured patients.