The efficiency of different adjunct techniques for regional anesthesia.

In the present prospective, randomized controlled trial, 110 unpremedicated patients undergoing orthopedic surgery under regional anesthesia were randomly divided into 5 groups, with 22 patients in each. During the operation, group 1 listened to a pre-recorded explanation and music, group 2 listened to a subliminal sound, group 3 received propofol by patient-controlled sedation (PCS), group 4 received intravenous midazolam, and group 5 was the control group. Patients in the midazolam group were significantly more sedated than the control group at 1 hr into the operation. The group that listened to an explanation and music were significantly less satisfied than the propofol group at the end of the operation and 30 min. postoperatively. An incremental cost-effectiveness ratio showed that if explanation and music are used instead of propofol it would save 299.53 baht per patient, but the patient satisfaction score will be 17.26 points lower than if the more expensive drug is used.

The cost-effectiveness of mini peak expiratory flow as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

This study aims to explore the cost-effectiveness of Mini Peak Expiratory Flow (miniPEF) as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities around Siriraj Hospital, using the gold standard of diagnosis based on the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated and completed all the tests. The results showed that the cut-off miniPEF percentage of predicted value of highest average accuracy was 62 per cent. The sensitivity was 72.7 per cent (95% CI 67.0-78.6) and the specificity was 81.1 per cent (95% CI 79.7-82.5) The cost of screening 19 elderly to detect one case of COPD is 923 baht, with a false negative rate of 1.9 per cent (95% CI 1.3-2.5%) and a false positive rate of 17.5 per cent (95% CI 15.4-19.6%). It is suggested that measuring a miniPEF is regarded as one of the cost-effective screening tests for COPD in the elderly.

The most cost-effective screening method for chronic obstructive pulmonary disease among the Bangkok elderly.

Our previous studies demonstrated the high prevalence and incidence of Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly, as well as the cost-effectiveness of a questionnaire, chest radiography, and mini peak expiratory flow rate (miniPEF) as screening tools. This final study aimed to identify the most cost-effective screening method among individual, serial and parallel combinations of the above tools, based on the guidelines for diagnosing COPD of the Thoracic Society of Thailand. There were 3,094 elderly aged 60 years and over in 124 urban communities around Siriraj Hospital who participated and completed all the tests. The results showed that the most cost-effective screening method was the miniPEF at cut-off percentage of 62 per cent of predicted value. This needed to screen 19 elderly people at a cost of 923 baht to detect one case of COPD, with a false negative rate of 1.9 per cent (95%CI 1.3-2.5), a false positive rate of 17.5 per cent (95%CI 15.4-19.6). The questionnaire is the alternative choice of screening tool.

The cost-effectiveness of a questionnaire as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

This study aimed to explore the cost-effectiveness of using a questionnaire as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly residing around Siriraj Hospital. The gold standard used for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. The questionnaire consisted of 10 questions on smoking status, respiratory symptoms and previous history of pulmonary tuberculosis. There were 3,094 elderly who participated, completed the questionnaire, and underwent spirometry as well as chest radiography in the community. The results showed that elderly individuals who are smokers (> 0.5 pack-year) or have ever experienced sudden cough with chest oppression or dyspnea when the weather changes or who have expectorated more than two tablespoons of sputum would be suspected of having COPD with a sensitiviy of 81.4 per cent (95% CI 79.4-83.4), specificity of 62.2 per cent (95% CI 60.4-64.0) false negative rate 1.2 per cent (95% CI 0.7-1.7) and false positive rate 38 per cent (95% CI 35.3-40.7) and subsequently required spirometry and chest X-ray for definitive diagnosis. The test needed to screen 17 elderly individuals to detect one COPD case at a cost of 1,538 baht. This questionnaire is also a self-assessment tool for COPD screening among the elderly in order to encourage them to seek for early medical attention and it is recommended that this should be publicized via the mass media.

The cost-effectiveness of chest radiography as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities of Bangkok around Siriraj Hospital. The gold standard for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated, completed spirometry and a CXR. The selected nine indices from PA and lateral CXR for diagnosing COPD were based on the presence of hyperinflation. The positive criteria of each index were reported. The cut-off point of best average accuracy ie, Z score of the CXR was 0.07 with a sensitivity of 75.9 per cent (95% CI 70.2-81.6%), specificity of 72.4 per cent (95% CI 70.8-74.0%) and the best average accuracy of 74.1 per cent (95% CI 72.5-75.7%) whereas the cost-effective cut-off point of a Z score of CXR as a screening test for COPD was 0.04 at the lowest grand total cost. The cost to detect one case of COPD was 2,008 baht and needed to screen 17 elderly. It is suggested that CXR is probably not a suitable screening test for COPD in the elderly due to the complicated derivation of the CXR indices. However, its efficacy may be of some value in in-office diagnosis of COPD.

Economic evaluation of influenza vaccination in Thai chronic obstructive pulmonary disease patients.

To determine the cost-effectiveness and cost-benefit of influenza vaccination in chronic obstructive pulmonary disease (COPD) patients the authors conducted a stratified randomized, double-blind, placebo-controlled trial from June 1997 to November 1998 at a university hospital in Thailand. A total of 125 COPD patients were stratified based on their FEV1 as mild COPD (FEV1 > or = 70% predicted), moderate COPD (FEV1 50-69% predicted) and severe COPD (FEV1 < 50% predicted) and in each severity stratum they were randomized to the vaccine group (received intramuscular injection with purified trivalent split-virus vaccine containing A/Texas/36/91 (H1N1), A/Nanchang 1933/95 (H3N2) and B/Harbin 107/94) or the placebo group (received intramuscular injection with vit B1). Number of episodes of acute respiratory illness (ARI) related to influenza (clinical ARI + a serum hemagglutination inhibition antibody titre of 38 or greater and a four fold titre increase in convalescent serum compared to acute serum) as well as severity of each ARI (outpatient treatment, hospitalization or required mechanical ventilation) and costs of treatment (direct medical costs comprised real drug costs from the hospital dispensary in outpatient cases and real charges in hospitalization cases) were collected and analyzed for the cost-effectiveness and cost-benefit of influenza vaccination. The incidence of influenza-related ARI in the study year was 27 per cent in the placebo group and 6.4 per cent in the vaccine group (relative risk [RR] 0.24, vaccine effectiveness 76%). The incidence was 27.3 per cent, 23.5 per cent and 29.2 per cent in mild, moderate and severe COPD respectively in the placebo group and 4.3 per cent, 12.5 per cent, and 4.3 per cent in the mild, moderate and severe COPD respectively in the vaccine group (RR 0.16, 0.53 and 0.15; vaccine effectiveness 84%, 47%, and 85% respectively). The incremental cost-effectiveness ratios demonstrated that for every 100 patients with mild COPD whom the authors decided to vaccinate, the cost would be 24,840 baht more and would prevent 18.2 outpatients, 4.8 hospitalizations and 0 patient from mechanical ventilation due to ARI related to influenza. Likewise, the authors would have prevented 5.1 outpatients, 5.9 hospitalizations, 5.9 mechanical ventilation and 20.8 outpatients, 3.9 hospitalizations, 8.3 mechanical ventilation for every 100 moderate COPD and every 100 severe COPD patients vaccinated respectively. More than 90 per cent of the costs of treatment of influenza-related ARI were costs of hospitalization and for patients with moderate and severe airflow obstruction, more than 90 per cent of these costs were attributed to the costs of treating the patients who required mechanical ventilation. Predicted cost savings for every 100 mild COPD, 100 moderate COPD and 100 severe COPD patients vaccinated were 125,629 baht, 538,184.3 baht, and 680,647.1 baht respectively. In conclusion: Influenza vaccination is highly effective in the prevention of acute respiratory illness related to influenza virus infection in COPD, regardless of severity of airflow obstruction. Vaccination is more cost-effective in preventing mechanical ventilation episodes and more cost-benefit in patients with more severe airflow obstruction. Influenza vaccination should be recommended to all patients with COPD with the higher priority provided to patients with more severe airflow obstruction.

The risk and effectiveness of transurethral resection of prostate.

BACKGROUND: To advise a patient to have transurethral resection of prostate (TURP) needs information on the benefit and complications of the procedure. Quality assurance also needs present results to be compared with future ones. OBJECTIVES: The authors wanted to know: 1. Whether TURP can decrease theInternational prostate symptom score (IPSS) and improve the Quality of Life (QOL) scores concerning urination at 1.5 months post-operatively for at least 25 per cent of the pre-operative scores?; 2. What are the common medical diseases in this type of patient?; and 3. What are the mortality and immediate complications of TURPF? METHOD: This was a prospective, before-after design trial. All patients who came to have TURP at a tertiary care hospital were studied. IPSS and QOL scores were recorded before surgery and again when the patients came back to follow up at 1.5 months after discharge. Patients were evaluated for cardiopulmonary reserve and congestive heart failure. Anesthetic technique of choice was spinal anesthesia with 0.5 per cent bupivacaine. Anesthetic and surgical complications were recorded if the definitions were met. ANALYSIS: Pre-operative and 1.5 months post-operative scores were compared using paired t-test and 95 per cent confidence interval. RESULTS: During the 13 months there were 269 consecutive males who received TURP. The mean +/- SD age was 70.4 +/- 8.8 years (range 35-97). The mean difference between pre- and post-operative IPSS was 6.7 +/- 9.1 (95% CI 5.2-7.8). Quality of Life also improved, the mean difference between pre- and post-operative QOL was 3.2 +/- 1.6 (95% CI 2.9-3.5). Most patients had ASA class 2. Common pre-operative existing diseases were hypertension (31.6%), ischemic heart disease (18.2%), diabetes (15.6%), and COPD (7.1%). Anesthetic techniques were spinal block (77.3%), epidural block (5.9%), continuous epidural (11.2%), and general anesthesia (5.6%). Intra-operative complications were reported and T URsyndrome occurred in 1 patient (0.37%). There was one surgical death 3 days post-operation, due to septic shock probably from bowel perforation. CONCLUSION: The patients' symptoms and quality of life significantly improved, but there was 1 surgical death and 1 TUR syndrome among 269.

The prevalence and incidence of COPD among urban older persons of Bangkok Metropolis.

COPD substantially affects the national healthcare resource and healthcare cost especially among the older persons. Identifying the accurate prevalence and incidence reflects the scale of problem posed by COPD. This epidemiological study using the criteria for diagnosing COPD based on ratio of FEV1.0/FVC less than 70 per cent and the reversibility of less than 15 per cent increase of post bronchodilator FEV1.0 in the absence of parenchymal lesions and cardiomegaly in CXR (PA and lateral view) revealed the prevalence (1998) of COPD among the 3094 older persons aged 60 years and over in the communities of Bangkok Metropolis 10 km around Siriraj Hospital was 7.11 per cent (95% CI: 6.21-8.01), whereas the incidence (1999) of COPD was 3.63 per cent (95% CI: 2.83-4.43). Both the prevalence and the incidence were increased with increasing age.The disease occurred predominantly among male smokers. The distribution of mild : moderate : severe COPD in the prevalence study was 5.6:2.2:1. The current findings also suggest that tobacco smoking is the prime important cause of COPD and the indoor pollution especially cooking smoke is not significant. In particular, the unexpectedly high incidence compared with prevalence in this population probably represents the warning message to the national policy maker for prompt and effective health promotion and disease prevention to prevent further social and economic loss.

Perioperative cardiac arrest at Siriraj Hospital between 1999-2001.

Cardiac arrest during the perioperative period is a good indicator of the quality of anesthetic management. The incidence of perioperative cardiac arrest in Siriraj Hospital hasn't been reported before. Our objectives were to determine the incidence of perioperative anesthesia-related cardiac arrest and the results of cardiopulmonary resuscitation in these cases in order to find out how to improve our anesthetic care. This prospective study was undertaken between 1999-2001 by sending a questionnaire to those witnessing a cardiac arrest. The incidence of perioperative cardiac arrest was 8.2:10,000 instances of anesthesia with a mortality of 5.6:10,000 within 48 hours of the arrest. The incidence of perioperative cardiac arrest that was related to anesthesia was 0.7:10,000 instances of anesthesia and the anesthesia related mortality was 0.19: 10,000 within 48 hours of arrest. Failed cardiopulmonary resuscitation occurred in of occasions 41.7 per cent. There was no difference between intraoperative and postoperative cardiopulmonary resuscitation. Twenty-one per cent of patients experiencing a cardiac arrest were discharged from hospital. Seventy-three per cent of events occurred in patients with an ASA rating 3-5 and most often the cause of arrest was massive or uncontrolled bleeding. In those patients with an ASA rating 1-2 there were no outstanding cause of arrest.

A survey of the anesthesia scavenging systems in a teaching hospital.

Pollution by anesthetic gases can be a problem in operating theaters. More than 90 per cent of this pollution can be reduced by using a scavenging system. Such systems increase the complexity, and thus the hazards of administering anesthesia. A case of pneumothorax prompted an investigation of the active scavenging systems currently used in a teaching hospital by using a pre-use check up protocol. Thirty-eight closed-reservoir active scavenging systems were included. Ten systems (26.3%) were assembled incorrectly. All systems passed a negative pressure relief valve test. Seventeen systems (44.7%) failed to pass a positive pressure relief valve test because high pressure (over 10 cmH2O) developed during an O2 flush, but direct measurement of the pressure at the scavenging interface revealed that these defects were caused by a problem with the adjustable pressure limiting (APL) valves, not with the positive pressure relief valves of the system. We suggest that routine pre-use check up together with regular maintenance of equipment should be emphasized and all personnel should be encouraged to learn more about safety precautions.

Mental state change after general and regional anesthesia in adults and elderly patients, a randomized clinical trial.

BACKGROUND: Mental state changes after anesthesia seemed to be more frequent in older patients, but the results were still unclear. OBJECTIVE: To compare the mental scores between adults and elderly patients after general and regional anesthesia. METHODS: This was a stratified randomized trial with factorial design. Sixty patients > or = 60 years old and sixty patients < 60 years old were randomly assigned to receive general or regional anesthesia. Their mental states were assessed blind by investigators, using the Thai Mental State Examination score. RESULTS: The two anesthetic groups showed no difference in the mental scores, but the two age groups showed significantly different scores. The components of mental states that were significantly different were orientation and recall. There were no significant differences in registration, attention, calculation and language. The model for predicting the score included age, education level and narcotics given within six hours before assessment. Sex, weight, intraoperative hypotension, blood loss and duration of anesthesia could not explain the change in the scores. CONCLUSION: Age, but not anesthetic technique, affected the mental scores after anesthesia.

Anesthesiologist training, home or abroad?

Anesthesiology training in various countries vary a lot in structure, manpower, duration, budget, material, and equipment. Training at home results in better understanding of local problems. Anesthesiologists in developing countries have to adapt and endure the challenge of training abroad. The results are knowledges in anesthesia, new techniques and equipment, new contacts and understanding of other way of life. But many countries have lost their anesthesiologists from emigration. Training abroad is useful only when the trainees bring the knowledge back home and help their countrymen.

Anesthesia for cystectomy.

Objectives : To determine the common pre-existing medical condition, the anesthetic technique used, monitoring, complication, the duration of stay in postoperative ICU, and mortality of cystectomy. Methods: Between February 1998 and July 1999, 61 patients underwent cystectomy for bladder carcinoma. Their medical conditions, anesthetic technique, monitoring, complication, and perioperative mortality were recorded. Result: The common associated diseases were hypertension (18%), renal insufficiency (16.4%), and diabetes (13.1%). Combined general and epidural anesthesia was chosen in 80.3% of cases. Besides standard monitoring, 80.3% of patients had central venous pressure monitoring. Complications that occurred were hypotension, hypothermia and massive transfusion. There was one intraoperative death from massive bleeding. Postoperatively, 82.0% of patients were admitted in the ICU and the mean duration of admission in ICU was 1.1 (S.D. 0.63) days. Conclusion: Anesthesia for cystectomy needs vigilance and combined general and regional anesthesia is the technique of choice. Because of the long operative time and invasive surgery, patients often experienced intraoperative hypotension and hypothermia. Central venous pressure monitoring was useful and commonly used. Postoperatively, most patients were admitted to the ICU but mostly for only 1 day, therefore ICU admission may not always be necessary.

When should we order preoperative blood glucose, BUN, creatinine, or electrolytes: A systematic review and clinical practice guidelines.

The study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative checking of blood glucose, BUN, creatinine and electrolytes. The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review suggested there were no randomized controlled trials to answer the question and no studies reported health outcomes. From this review and the consensus, we proposed guidelines which consisted of a history questionnaire, physical examination and indications for investigation. For the preoperative checking of blood glucose, the indications were: age > 60 years, obesity, diabetes, hypoglycemia, liver disease, alcoholism, severe infection, alteration of consciousness, hypothalamic, pituitary, pancreatic and adrenal disease, and steroid therapy. The common indications for both BUN/creatinine and electrolytes checking were: age > 60 years, undergoing TURP, TUR-BT and major KUB surgery, obesity, diabetes, hypertension, chronic renal failure, renal disease, liver disease, alcoholism, severe infection, severe vomiting or diarrhea, history of fluid, acid base or electrolyte disturbance, alteration of consciousness, hypothalamic, pituitary, pancreatic and adrenal disease, ADH abnormality and diuretic or digoxin therapy. The additional indications for electrolyte checking were: convulsion or muscle weakness, CNS disease with increased ICP and steroid therapy.

When should we order preoperative electrocardiography: A systematic review and clinical practice guidelines.

Routine preoperative investigation consumes many resources at the time when Thailand is suffering a severe financial crisis. The objectives of the study were to apply a systematic review to answer the question if routine preoperative investigation affects health outcomes; and to construct clinical practice guidelines for preoperative electrocardiography (ECG). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were a Medline search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from systematic review found that there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative investigation yielded few positive results and were not very useful for patient care. From this review and consensus, we proposed the following guidelines: a history questionnaire, physical examination, and indication for investigation. For the preoperative ECG, the indications are: age > 45 years, history of hypertension, heart disease, palpitation or frequent syncope, diabetes, chronic cough for > 3 weeks or pulmonary disease, heavy smoking (> 10 pack /days for> 10 years), radiotherapy or chemotherapy. Preoperative ECG carried out according to these guidelines would be more cost-effective and routine preoperative investigation should be abandoned.

When should we order preoperative complete blood count and urinalysis: A systematic review and clinical practice guidelines.

Routine preoperative investigation is expensive especially at this time when Thailand is suffering a severe financial crisis. Objectives of the study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative complete blood count (CBC) and urinalysis (UA). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review found that there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative CBC and urinalysis yielded few clinically significant positive results and was not very useful for patient care. From this review and the consensus, we proposed a guidelines, which consisted of a history questionnaire, physical examination and indication for investigation. For the pre-operative CBC the indication were: age > 60 years, would have an operation that needed blood transfusion, had acute or chronic blood loss, malnutrition, pregnancy, heart disease, cancer, chronic renal failure, liver disease, severe infection, SLE, connective tissue disease, radiotherapy or chemotherapy. The guidelines for preoperative UA were: pregnancy, diabetes, abnormal urination, chronic renal failure, SLE or connective tissue disease. Preoperative CBC and UA requests according to these guidelines should be more cost-effective and routine preoperative investigation should be abandoned.

Direct medical costs of anaesthesia in Siriraj Hospital.

The direct medical cost of anaesthesia in 1995 at Siriraj Hospital, which is a government tertiary care and teaching hospital was studied from the hospital’s perspective. The costs of anaesthesia were divided into labour cost, equipment cost, and drug and consumable item cost. For labour cost, different personnel were costed separately. In the care of equipment costs depreciation was applied. The costs of drugs and consumable items were calculated at 1995 prices. Four operative procedures: paediatric inguinal herniorrhaphy, caesarean section, laparoscopic cholecystectomy and correction of scoliosis were used as models to show different costs of an anaesthetist (salary plus fringe benefits) was 136.80 baht per hour. The cost of equipment varied from 4.04 to 38.42 baht per hour. The percentage of the labour cost, equipment cost, and drug and consumable item cost, were 40, 12 and 48 percent respectively in anaesthesia for scoliosis correction and 29, 6 and 65 percent respectively in caesaream section under general anaesthesia. The cost of monitoring equipment was lower than the amount that the hospital previously charged. We did not include non-medical costs and indirect medical costs in this study. The direct medical cost was low because of low personnel salary in the government sector. This study lay the toundations for further economic analysis in anaesthesia.

Outpatients’ satisfaction with social security service of Siriraj Hospital.

We interviewed 872 outpatients who came for Social Security Service of Siriraj Hospital. On average, this was the 1.88th time the patients had come for treatment. Most of them were younger than 40, 55 percent had finished elementary education. Most were workers in factories and the average wage was 4,131 baht/month. Female:male ratio was 6:4 and about half of them were married. Sixty-nine percent of the patients did not know what disease caused their illness. The average cost of traveling from home to the hospital was 129.65 baht. Traveling time was less than 30 minutes in 38.5 percent, 30 minutes to 1 hour in 28.7 percent, 1-2 hours in 25.8 percent. There was no problem in coming for treatment in 87.4 percent of cases; in the group who had a problem, the problem was the long distance from home to the hospital. The average time that the patients spent waiting in front of the registration card room was 10.3 minutes, examination room 43.5 minutes and pharmacy room 19.8 minutes, total waiting time 73.6 minutes. Before examination, 88.3 percent were satisfied that they were insured with Siriraj Hospital. After examination and pharmacy rooms, 78.7 percent were satisfied. Eighty-two percent answered that there was no aspect they wanted Siriraj Hospital to improve in. We investigated the satisfaction of these outpatients by using rating-scale questionnaire, 12 questions for registration card room, 14 questions for examination room and 8 questions for pharmacy. Using step-wise multiple regression, we found that the satisfaction score of each room was 81.1, 78.1 and 74.6 problem in coming for treatment and wages. For the examination room the were sex, work character, education level and traveling expense. Fore pharmacy they were waiting time and age.

Pain management in Siriraj Hospital (Data from doctors and nurses).

A survey was carried out among housestaffs and nurses involved with postoperative patient cares to assess their attitudes toward postoperative analgesic care and their knowledge of analgesics. Only 37 percent of the respondents prescribed analgesics for complete pain relief, The most common prescribed drugs were paracetamol, pethidine, morphine, sosegon, baralgan and aspirin, but morphine would be in the second order in the nurses opinion. Doctors had more knowledge in the routes of pain relief such as intermittent intravenous injection, local infiltration or gases inhalation. The respondents knew many intramuscular routes, but did not know about their dangers and toxicitis.56.8 percent of the respondents were satisfied with their treatments. This study demonstrates the need for better and more comprehensive training of housestaff and nurses in analgesic case.

Pain management in siriraj hospital: Data from patients.

The objectives of the study are to evaluate the significance of pain problem in Siriraj Hospital, success rate and mothods of pain relief being given to the patients. We questioned 440 patients in whom 53.7% had pain as one of the main symptoms that brought them to the hospital and 53.3% had asked for pain relief drugs during their admission, these showed that pain is a common problem and a challenge to all doctors. By using Linear Analogue Scale we found that the success rate of pain relief were excellent 26.6%, good 25.9, bad 34.3% and there was no effect in 13.2% Factors affecting success are sites of pain, sex, age and duration after operation. 71.8% of all patients had received analgesic drug prescription but only 44.1% were recorded to have the drugs. The most commonly used drugs are paracetamol, morphine and pethidine. Oral and intramuscular routes are most common administrative routes.