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Preoperative education and outcome of patient controlled analgesia

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Abstract

Purpose

To determine the effect of intensive preoperative education on the outcome of Patient Controlled Analgesia (PCA) postoperatively.

Methods

This prospective randomised study was carried out in a single teaching hospital over three months. One group of patients (n = 42) received a 20 min standardised tutorial regarding PCA use from a single investigator and the other group (n = 43) received no additional education apart from the routine preoperative anaesthetic consultation. A blinded investigator assessed the patients following surgery. Pain scores and morphine consumption, patient satisfaction, side-effect profile and anti-emetic use were recorded at six, 24 and 48 hr post-operatively.

Results

Pain scores, satisfaction scores and morphine consumption were similar in both groups throughout the study period. Fewer patients in the tutored group complained of nausea from 6 to 24 hr than did untutored patients (28%vs 51 %;P < 0.05). More tutored patients used antiemetic medication from 0 to 6 (28%vs 12%;P < 0.05) and 6 to 24 hr (37%vs 19%;P < 0.05). Side effect profile and requirement for rescue analgesia was otherwise similar in both groups.

Conclusion

Our results suggest that specific preoperative education of patients using PCA does not alter pain scores, morphine consumption or patient satisfaction but may result in earlier and more effective use of anti-emetic medication.

Résumé

Objectif

Déterminer l’effet d’un enseignement préopératoire intensif sur l’évolution postopératoire de l’analgésie contrôlée par le patient (ACP).

Méthode

On a réalisé une étude prospective et randomisée dans un seul hôpital d’enseignement pendant trois mois. Un groupe de patients (n = 42) a reçu d’un unique expérimentateur un cours individuel standardisé concernant l’utilisation de l’ACP et l’autre groupe (n = 43) n’a reçu aucun enseignement additionnel après la visite de routine de l’anesthésiste avant l’intervention. Un expérimentateur impartial a évalué les patients après la chirurgie. Les scores de douleur et la consommation de morphine, la satisfaction du patient, le profil des effets secondaires et l’utilisation d’antiémétique ont été enregistrés six, 24 et 48 h après l’opération.

Résultat

Les scores de douleur et de satisfaction et la consommation de morphine étaient similaires dans les deux groupes tout au long de l’expérience. Il y a eu moins de plaintes de nausée entre 6 et 24 h chez les patients qui ont reçu un enseignement que chez ceux qui n’en ont pas eu (28 %vs 51 %;P < 0,05). Un plus grand nombre de patients informés a utilisé des médicaments antiémétiques de 0 à 6 (28 %vs 12 %;P < 0,05) et de 6 à 24 h (37 %vs 19 %;P < 0,05). Le profil des effets secondaires et la demande d’analgésie supplémentaire ont été, par ailleurs, similaires dans les deux groupes.

Conclusion

Nos résultats laissent croire qu’un enseignement préopératoire spécifique dispensé aux patients qui utilisent l’ACP n’a pas d’effet sur les scores de douleur, la consommation de morphine ou la satisfaction du patient, mais qu’il peut entraîner un usage précoce et plus efficace de médicaments antiémétiques.

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Correspondence to Michael J. Griffin.

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Griffin, M.J., Brennan, L. & McShane, A.J. Preoperative education and outcome of patient controlled analgesia. Can J Anaesth 45, 943–948 (1998). https://doi.org/10.1007/BF03012301

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Keywords

  • Morphine
  • Pain Score
  • Satisfaction Score
  • Patient Control Analgesia
  • Side Effect Profile