Arch Hellen Med, 27(4), July-August 2010, 650-661
Determination of the Greek clinical practice for the management of post-operative pain
J. YFANTOPOULOS,1 V. PAPAGIANNOPOULOU,1 S. PAPANIKOLAOU2
OBJECTIVE Sequential analysis of analgesia techniques for post-operative pain management, according to surgical procedure in Greece.
METHOD In order to analyze the analgesia techniques used for the management of post-operative pain, a multi-center analysis was conducted, including a total of 289 doctors in public and private hospitals in Greece. The data were collected with the use of personal interviews and completion of a predetermined questionnaire on the analgesia techniques used for patients after surgical procedures up to the fifth 48-hour period after the procedure. Data validity was confirmed with the method of Delphi panel in which 40 doctors from 8 public hospitals of Athens participated. The following analgesia techniques were investigated: (a) intravenous (iv) bolus, (b) continuous infusion (set), (c) epidural anesthesia, (d) nerve block, (e) oral, (f ) patient-controlled epidural anesthesia (PCEA), (g) patient-controlled iv (PCA), (h) intramuscular (im), (i) subcutaneous (sc), and (j) combination.
RESULTS The analgesia techniques for the management of post-operative pain in Greece are used for a period of up to 6 days after the surgical procedure. Epidural is the analgesia technique of choice for the first 48 hours after knee (29%) and hip (25%) arthroplasty, operations involving the lower extremities (22%), and upper (16%) and lower (19%) abdominal and gynecological (33%) and renal (18%) procedures. The iv bolus is preferred after upper extremities (28%), spinal (21%) and genitourinary system (20%) procedures. For the second 48 hours, oral administration is the technique of choice for knee (14%) and hip (13%) arthroplasty, upper (25%) and lower (22%) extremities, and gynecological (21%) and genitourinary (24%) procedures, while im adminstration is used following upper (16%) and lower (12%) abdominal surgery. As far as the third 48 hours is concerned the technique of choice is oral, although the majority of the doctors did not refer to any specific technique.
CONCLUSIONS The selection of analgesia techniques for post-operative pain management depends on the category of surgical procedure. The most widely used techniques for the first 48 hours after surgery are epidural and iv bolus, and for the second 48 hours oral, im and iv bolus.
Key words: Analgesia techniques, Post-operative pain, Post-operative pain management, Surgical procedures.