Utilization, availability of analgesics and quality of pain control for post-operative pain in surgical patients
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Effective post-operative pain control can provide patient comfort and satisfaction and also improve quality of life.
The study aimed to determine the amount of opioid and non-opioid analgesics used during the 24-h post-operative period, as well as the effectiveness of pain control, in the general surgical wards of Thingangyun Sanpya General Hospital and Yangon General Hospital in Yangon, Myanmar.
We conducted this hospital-based, prospective, cross-sectional descriptive study over a period of 5 months (May to September, 2016). World Health Organization (WHO) Anatomical Therapeutic Chemical classification (ATC)/Defined Daily Dose (DDD) methodology and drug utilization (DU) 90% segments were used to determine the amount of opioid and non-opioid analgesics used during the 24-h post-operative period. The effectiveness of pain control was determined using a numerical rating scale (NRS) and the pain Management Index (PMI).
Among total 233 post-operative patients, 161 patients (69%) received combined opioids and non-opioid analgesics, 36 patients (15.5%) received opioid analgesics only and 36 patients (15.5%) received non-opioid analgesics only. Total analgesic usage was 11.04 DDD/1000 inhabitants/days. Diclofenac was the most frequently prescribed analgesic (5.9 DDD/1000 inhabitants/days), followed by tramadol (1.9), and ketorolac (1.75); fentanyl was the least frequently prescribed (0.04). Diclofenac, tramadol and ketorolac were included in the DU 90% segment. Six hourly NRS records reveal 7–25% of patients suffered moderate pain and 0.9–2.1% suffered severe pain. By using PMI, 208 patients (89.3%) received adequate pain medication and 25 patients (10.7%) received ineffective pain medication. All analgesics listed in the 2016 Myanmar National List of Essential Medicines were available on these wards.
The results of this study can provide information to the prescriber about to what extent analgesics were being used and to policy makers or administrators for planning services on management of post-operative pain.
We wish to thank Professor Thein Myint, Professor Soe Myat Mon, Dr. Kyaw Swar and Dr. Kyaw Swar Mya for their help and advice.
Compliance with Ethical Standards
This study was approved by the Postgraduate Board of Studies (Pharmacology), University of Medicine 1, Yangon (an institutional review board). The trial was registered at Thai Clinical Trial registry with the trial registration number TCTR20180808006. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflict of interest.
No financial support was received for this study.
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