Post-operative pain; multi-modal analgesia technique is superior to conventional single analgesia

ABSTRACT

To compare the efficacy of a multi-modal analgesic regime with conventional single drug analgesic therapy after total abdominal hysterectomy under general anaesthesia. Prospective, random clinical trial. A 250 bedded secondary care hospital. From march 2006 to September 2006. In this study, forty ASA 1-2 middle aged females presenting for elective total abdominal hysterectomy were randomized to receive multi modal pain treatment with oral celecoxib, intravenous tramadol, incisional bupivacaine and intramuscular diclofenac sodium until hospital discharge [Group I] or conventional therapy with intravenous nalbuphine peri and post-operatively [Group II]. Both groups received general anaesthesia. Visual analog pain score was recorded in recovery room, then 4 hourly during the first 12 hr, and then 6 hourly for next 12 hours. Post-operative analgesia was managed with diclofenac sodium 75mg im and nalbuphine 10mg im every 6 hourly in respective groups. Request for additional analgesic was noted and dealt accordingly. Incidence of side effects and surgical complications were recorded. In the recovery room only one patient of Group one [multi-modal group] [n=20] experienced severe pain as compared to 4 patients of group two 'single analgesic group [n=20] [5% vs, 40%]. In next 24 hours, pain score were considerably lower in group one as compared to group two. After 24 hours 15 patients had no pain on VRS as compared to 11 patients [75% vs. 55%]. Four patients of group two needed rescue analgesia while none of multi-modal group demanded it. Incidence respiratory depression, nausea and vomiting were also lower in multi-modal group. Multimodal analgesic regime is an effective tool in reducing the postoperative pain after major gynaecological surgery. By employing multimodal analgesic technique incidence of side effects like respiratory depression, nausea and vomiting were also reduced and patient satisfaction was more