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Health professionals often underestimate children's pain and do not treat it as a priority. To raise awareness, the International Association for the Study of Pain has launched a campaign [Global Year against Pain in Children] in 2005, but evidence shows that the pain in children still remains undertreated. to determine the prevalence of postoperative pain and the methods for pain treatment in pediatric patients. This survey was done on a one-day period in 7 hospitals in northeastern Thailand. Participants were all in-patient children of the age <15 years old or their parents. Exclusion criteria were newborn and critically ill infants. Interesting data included; pain prevalence [pain score > 1 during the past 24 hrs], patients' perception of receiving pain treatment. Self report pain was measured with the use of either numerical rating scale [0 to 10 scales] or the Faces Pain Scale-Revised [0-5 faces]. For those who were unable to self report pain, the Neonatal Infant Pain scale was used. Types of surgery, days after surgery, prescription for pain relief and non-pharmacological measures used for pain relief were also recorded. One hundred and thirty three of 487 patients [27.3%] were surgical cases. The prevalence of postoperative pain during the past 24 hrs was 69.2%, but those who had moderate to severe pain was 43.6%. Most of children [78.2%] experienced mild or no pain at the time of interview. Almost a half [44.6%] of them perceived they had pain medication upon request and more than half of them [60.1%] used non-pharmacological methods for supplementary pain relief. Two most common prescribed medications were paracetamol [51.9%] and morphine [25.6%]. The proportion of medication administered to patients was less than those found in the prescription such as 24.8% vs 51.9% for paracetamol and 8.3% vs 25.6% for IV morphine. Only three conventional routes, oral, intravenous and intramuscular /subcutaneous routes, were found in the prescription for pain treatment. Postoperative pain remains undertreated in northeastern Thailand. We need to raise awareness level and improve the understanding and the knowledge about Postoperative pain and its management
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Background: Currently, post-operative pain management is considered an integral part of recovering and reducing complications related to pain. Acute pain service (APS) has been established worldwide in order to improve the effectiveness of patient care. The Departments of Anesthesia at Khon Kaen and Chiang Mai Universities (KKU and CMU, respectively) developed an APS system each at approximately the same time. Collaboration of the two institutions to benchmark their APS data will help them move forward vis-à-vis post-operative pain management.Objectives: Comparing the results of the respective APS systems between Khon Kaen and Chiang Mai Universities.Design: Retrospective, descriptive studyMethods: The 2005 calendar year data, from the respective APS databases, were reviewed, allowing a comparison of post-operative pain management at KKU and CMU hospitals. We focused on the percentage of post-operative orthopedic patients care through the APS system compared with (1) APS service, (2) days of service, (3) method of pain management, (4) pain assessment, (5) complications, (6) the APS system and (7) patient satisfaction. The data were analyzed using descriptive statistics.Results: Patients who received APS accounted for 12.3 and 7.2 percent of KKU and CMU patients, respectively. The greatest proportion of patients at KKU receiving APS was for intra-abdominal surgery (60%) while at CMU it was for cardiovascular and thoracic surgery (76%). Both institutions provided an average 2.0+1.0 days of service. Surgery on extremities (orthopedics) ranked second at both institutions (26.8 and 20.7 percent, respectively). KKU used variety techniques for controlling pain among orthopedic patients: viz., IV PCA (59%), IV opioid infusion (30%), epidural (6.8%) and spinal morphine with PCA (5.2%), while the primary modality for pain control at CMU was IV PCA (97%). Resting pain for CMU patients was less than that reported by KKU patients (6 vs. 9.5 percent, respectively); however, dynamic pain was not assessed at CMU. Serious complication was not found and patient rated satisfy with APS approximately 94% and 97% (CMU, KKU).Conclusion: The delivery of APS for orthopedic surgery patients at two regional university hospitals in Thailand were studied and benchmarked. There was some difference in the strengths of the APS system between the two institutions; such as, techniques of pain treatment, pain scores and system for pain management. Strengths and weaknesses observed during this benchmarking exercise will be used to improve the delivery of APS at both institutions.Keywords: Acute Pain Service; Benchmark; Post-Operative Pain; University Hospital
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Introduction: The adequate treatment of acute pain after surgery is a humanitarian obligation for heath care professionals. Analgesia plays an important role in speeding the patient’s recovery, in reducing and limiting morbidity, as well as probably improving clinical outcomes. Significant knowledge deficit regarding currently accepted principles of pain management practice as well as beliefs that could interfere with optimal care, mandate a need for educational interventions.Objective: To assess the pain knowledge and attitudes toward postoperative pain management by acute pain service (APS) of healthcare providers in Srinagarind HospitalDesign: Descriptive \& prospective research Setting: The surgical, obstetrics \& gynecological, orthopaedics and otorhinolaryngology wards in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University Population: All physicians and nurses work at those wards in Srinagarind Hospital Material and methods: The total 286 questionnaires from physicians and nurses were collected during August to October 2005. The informed consents were obtainedfrom all subjects. The demographic data, previous pain education, clinical experience, pain knowledge scores, level of satisfaction to APS and other variables were analysed. The data were analyzed using, and presented as, descriptive statistics. The Chi-square test was used to test for significant difference variables. A p-value of less than 0.05 was considered statistically significant.Results: The response rate of questionnaire in physicians and nurses were 99.2% and 77.5%, respectively. The physicians’ knowledge scores were moderate to high and higher in nurse groups. The level of physicians’ knowledge significantly associated with previous pain education (p= 0.001). Attitudes toward postoperative pain management by APS of healthcare providers in term of physicians and nurses on satisfaction level were satisfied and highly satisfied, respectively. This survey suggests that our healthcare providers need the continuing organization and education in pain management and consultation system.Conclusion: Most physicians and nurses were satisfactory in attitudes towards postoperative pain management by APS. Practical recommendations are presented for increasing physicians and nurses’ knowledge about pain management. The continuing education and good consultation system might be useful in order to improve the quality of postoperative pain management in our hospital.Keywords: knowledge, Attitude, Acute pain service
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Background: Recently, the proportion of elderly persons is rising worldwide leading to increase amount of surgical patients of this age group. The evidences about pain control clearly supported that elderly persons received under-treatment. Whatever, data from our institute is limited and needs to be determined.Objective: To survey postoperative pain management and its outcomes in elderly patients at Srinagarind Hospital. Study design: Cross-sectional descriptive study.Setting: Post anesthesia care unit (PACU) and surgical wards, Srinagarind Hospital.Materials and Methods: Pain management and its outcomes were evaluated in patients over 65 years old underwent elective general surgery for a two months period. Data were collected from medical records and from patient assessment including method of pain treatment, pain intensity (at rest), pain relief, patient’s satisfaction and side effects of the treatment.Results: Ninety-one patients with the mean age of 72.0 + 5.7 years were evaluated. Most of them (72.5%) received general anesthesia and 56.1% underwent intra-abdominal surgery. Intravenous injection was the most common technique used for pain control (63.8%) while PCA pump was used about 20.9%. Pain assessment usingNRS was achieved in between 62-95.6% (average 75.5%). The proportion of patients experienced moderate to severe pain during arrival at the PACU, at discharged from the PACU and at 24 hours after operation were 29.4%, 23.1% and 18.8%, respectively. The most common side effect was nausea and vomiting (12.2%). Only 8.9% of patients reported that pain was not relief and 1.1% of patients unsatisfied with the treatment received. Conclusion: About 29.4% of the elderly patients experienced moderate to severe pain after surgery. Most of them received pain treatment by intravenous injection while only 20.9% received acute pain service from the acute pain unit of Anesthesiology department.Keyword: older patients, postoperative pain management
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Background and Objectives: Effective pain control can minimize post operative complications especially for pulmonary complications. Previous reports showed pain management using combined spinal morphine (spinal MO) plus patient-controlled analgesia (IV PCA) was more effective than either intravenous or PCA alone. This technique had been conducted in our institute since 2004 but its effect on postoperative pain control was not reported. Aim is study the effect of spinal morphine plus IV PCA on postoperative pain control. Methods: The author conducted this descriptive study at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, by retrospectively reviewing all medical record of surgical patients who received spinal morphine plus PCA for postoperative analgesia between January 2005 and December 2006. Data extracted were age, gender, types of operation, dosage of spinal morphine, pain scores (both at rest and during movement) on the first post operative day, adverse effects, and patient’s satisfaction. Effect of the pain control were classified as; effective (pain score 0-4) and ineffective (pain score 5-10)Results: Two hundred and sixty two records were analyzed. There were 63% female with a mean age of 49.6+10.5 years. Most of patients (69%) underwent abdominal surgery (excluded cesarean section and kidney surgery). Median dosage of spinal morphine was 0.3 mg depending on types of surgery. There were 62% of cases received effective analgesia at rest whereas 35.4% received while movement. No respiratory depression was reported but 1.5% of patients experienced severe nausea and vomiting. However, 92% of patients were satisfied with the treatment received.Conclusion: Spinal morphine plus PCA is effective for pain control in the first postoperative day only for at rest, but not during movement. Keywords: postoperative pain, spinal morphine, patient-controlled analgesia