AUDIT OF POSTOPERATIVE PAIN MANAGEMENT IN UNIVERSITY HOSPITALS

Objective: The aim of this study was to assess the incidence and sever ity of postoperative pain in patients undergoing operations in various surgery clinics in the Assistance Publique des Hopitaux de Paris (AP- HP) and to evaluate management of pain during the 24 hours following s urgery. Methods: Data from surgical and anesthesia observation sheets and from patient complaints collected in a one-day external audit were obtained for 96 surgery clinics in the AP-HP. Results: At the time of surgery, most patients were receiving opioids, especially fentanyl: l ow dose (< 1 mu g/kg/h) was given in 17.1% of the patients and regiona l anesthesia was used in 13%, In 95% of the cases, postoperative order s were written by anesthesiologists. Initial orders were modified acco rding to patient response in 11.8% of the cases, ''On demand'' prescri ptions were used in 10% of the orders, Patient controlled analgesia an d regional analgesia were not routine techniques (2 and 0% respectivel y), Finally, 37.8% of the patients were given a single prescription of a step-1 drug (e.g. propacetamol i.v.), 25.9% a step-2 drug either al one or in combination with a step-1 drug, and 28.9% of the patients we re given strong opioids at least once. Conclusion: For all types of dr ugs, dosage level was considered as correct in 86.5% of the cases, For approximately 10% of the opioid prescriptions, an ineffective dose wa s used, The interval between doses was too long in 54.1% of the prescr iptions for at least one drug (e.g. for peripheral analgesia with prop acetamol), The incidence of severe pain was 46.4%, especially after ab dominal, high urologic and back surgery.