Vol 92, No 2 (2021)
Research paper
Published online: 2021-02-02

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The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures — part I

Agnieszka Biskup1, Katarzyna Plagens-Rotman2, Maria Polocka-Molinska2, Piotr Merks34
Pubmed: 33576475
Ginekol Pol 2021;92(2):85-91.


Objectives: Pain and postoperative nausea and vomiting are among the most unpleasant sensations experienced after
surgery. Patients after gynaecological surgery are at higher risk for both complications. Former methods of pain management
based mainly on opioid administration were much less safe, especially for elderly patients. In addition, they generated
an even greater increase of postoperative nausea and vomiting.
Multimodal therapies in anesthesiology are currently being used more and more often. These include both multimodal
postoperative pain management and multimodal prophylaxis of postoperative nausea and vomiting.
The aim of the study was to assess the benefits of the methods used for gynaecological patients in the immediate postanesthetic
Material and methods: The research material is an analysis of medical documentation of 150 patients from the gynaecology
clinic who underwent surgical procedures of categories III and IV from October 2018 and until January 2019, carried out in
one of the clinical hospitals in Szczecin at the Anesthesiology and Intensive Care Clinic. Patients were divided into 3 groups:
1. Patients who received multimodal analgesia using non-opioid and opioid analgesics.
2. Patients who received multimodal analgesia using non-opioid and opioid analgesics and adjuvants.
3. Patients who received multimodal analgesia using non-opioid and opioid analgesics and central blockade.
Results: The highest age was in the third group at 57.48 years of age, 50.86 in the second group, and 47.8 in the first group.
Healthy patients classified as ASA 1 accounted for 14% of group I, 18% of group II and 10% of group III. Patients with severe
systemic disease (ASA 3) constituted 30% of group III 18%, of group II and 8% of group I. Upon leaving the operating room,
as many as 80% of the patients from groups II and III did not feel any pain. In group I was 52%. When entering the recovery
room, 26% of the patients in group I, 10% in group III, and 8% in group II rated their pain as higher than 5. The most used
antiemetic medication in the studied facility was ondansetron. In group II it was given to 36 (72%) patients, in group III to
23 (46%) patients, and 13 (26%) patients in group I. In the postanaesthetic care unit, 9 (18%) patients in group III, 6 (12%)
patients in group I, and 3 (6%) patients in group II received ondansetron. Metoclopramide was given only to patients in
group III — one intraoperatively, and the other in the recovery room.
Conclusions: Multimodal analgesia is effective in pain treatment. The use of PONV prevention is used for gynaecological
patients. The analysis of the surgical records facilitated the recognition of patient needs.

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