ABSTRACT
Background: Postoperative pain is very common and develops naturally as a warning. After surgery, its development can be predicted and should be prevented and treated. Besides the disagreeable aspects and physiological repercussions of postoperative pain, it delays ambulation and hospital discharge. Despite the drugs and anesthetic techniques available, the prevalence of postoperative pain is still high. Methods: Pain assessment was done by BP cuff inflation method and Numerical rating scales both pre and postoperatively. Results: Complain of postoperative pain is more in female patient. Over all complain of postoperative pain was observed more in 31-45 year age group. Complain of postoperative pain was more at 18 hour time interval. Postoperative pain complains was more in patients undergoing general surgery. Postoperatively out of 310 patients 298 patients were received diclofenac only and 18 patients were received diclofenac + tramadol combination of these 112 and 13 patients complained of post-operative pain respectively. Conclusions: 112 patients from diclofenac only received group and 13 patients from diclofenac + tramadol received group complain of post operative pain. Post-operative pain control at 12 hours is sufficient but high post-operative pain scores at 18 hour of post-operative time interval suggesting needs of additional pain control. Majority of study patients received single analgesic (Diclofenac sodium).
ABSTRACT
Background: Prophylactic antimicrobials have an important adjuvant role in the prevention of Surgical Site Infection (SSI), which is one of the most preventable causes of post-operative complication. In India, due to lack of adequate information and guidelines for antimicrobial prophylaxis in surgery there is a need to generate baseline data on the pattern of use of prophylactic antimicrobials. Aims & Objective: This study is aimed to analyze the pattern of surgical chemoprophylaxis and surgical site infection (SSI) rate in patients who underwent elective orthopedic surgical procedure. Material and Methods: A prospective, observational study was performed on patients undergoing surgery, in a tertiary care teaching hospital. Data were collected in a pro-forma which included the patients’ details, prescriptions from date of admission to discharge or any other outcome and operative notes. Surgical site infection as defined by Centre for Disease Control criteria was recorded. Results: Total 305 patients were enrolled over a period of one year. In 237 (77.70%) patients antimicrobials prescribed by generic name. In preoperatively and intraoperatively, all the patients received parenteral antimicrobial. Postoperatively, 294 (96.40%) patients received only parenteral antimicrobials while in 11 (3.60%) patients received parenteral antimicrobials followed by oral antimicrobials. Preoperatively antimicrobials started 12 hours prior to surgery. Average duration of antimicrobials given postoperatively was 5.05 ± 1.14 days. Third generation Cephalosporins and Aminoglycosides were prescribed most frequently. Average number of antimicrobials used per patient was 4.40 ± 1.05. In follow up 37 (13.03%) patients developed SSI and most common isolated organism was Staphylococcus aureus. Conclusion: Surgical chemoprophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of administration as well as the total duration of prescription, in majority of the cases, leading to higher SSI. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.