Acute pain service, Kandang Kerbau Hospital, 1995--a first year's experience

To determine the efficacy and safety of the different modes of post-operative analgesia in the first 24 hours for both caesarean section and major gynaecological procedures.

Being a purely descriptive study, the patients were not randomised to the post-operative analgesic mode. The choice was made both by the patient and the anaesthetist. The modes employed were continuous intravenous morphine, continuous intravenous pethidine, epidural morphine/bupivacaine, epidural bupivacaine/fentanyl and spinal morphine. During the first 24 hours, the patients' maximum pain scores, ability to sleep well, presence of nausea and/or vomiting, pruritus, respiratory depression and drowsiness and/or giddiness were elicited. Backache and inflammation at the site of insertion of the epidural catheter were also elicited in patients on regional analgesia. They were also asked if they were satisfied with the Pain Service.

Out of 2,024 patients, 60% had undergone caesarean section and 40% had undergone major gynaecological procedures. Continuous intravenous morphine, the most common mode, was used in 83% of obstetric patients and 47.9% of gynaecological patients. Only one obstetric patients and one gynaecological patient complained of severe pain at rest while 12 obstetric patients and 3 gynaecological patients had severe pain on movement or coughing. Side-effects, most commonly nausea and/or vomiting and drowsiness and/or giddiness, were present in 8.8% of obstetric patients and 32.5% of gynaecological patients. 99.3% of obstetric patients and 99.6% of gynaecological patients were overall satisfied with their analgesia.

Our post-operative analgesic modes were found to be effective and safe.