The impact of multimodal therapies on the comfort and safety of patients in the immediate post-anaesthetic period following gynaecological procedures — part I
Abstract
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
period.
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.
Keywords: painmultimodal analgesiaPONVsurgical gynaecologydirect anaesthesia supervision
References
- Zdrowie i zachowanie zdrowotne mieszkańców Polski w świetle Europejskiego Ankietowego Badania Zdrowia (EHIS) 2014 r. Główny Urząd Statystyczny. Warszawa, 2015.
- Larsen R. Anestezjologia Tom 1. wyd. 3. Kubler A (ed). Elsevier Urban & Partner, Wrocław 2010.
- Wołowicka L, Trojanowwska I. Anestezjologia gerotryczna. PZWL 2010.
- Charghi R, Backman S, Christou N, et al. Patient controlled i.v. analgesia is an acceptable pain management strategy in morbidly obese patients undergoing gastric bypass surgery. A retrospective comparison with epidural analgesia. Can J Anaesth. 2003; 50(7): 672–678.
- Woroń J, Dobrogowski J, Wordliczek J. Oksykodon w leczeniu bólu pooperacyjnego. Anest Ratow. 2011; 5: 246–249.
- Schug SA, Raymann A. Postoperative pain management of the obese patient. Best Pract Res Clin Anaesthesiol. 2011; 25(1): 73–81.
- Rapley JH, Beavis RC, Barber FA. Glenohumeral chondrolysis after shoulder arthroscopy associated with continuous bupivacaine infusion. Arthroscopy. 2009; 25(12): 1367–1373.
- Paul JE, Arya A, Hurlburt L, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty: a meta-analysis of randomized controlled trials. Anesthesiology. 2010; 113(5): 1144–1162.
- Drobnik L. Metamizol – lek ciągle nowoczesny. Anestezjologia Intensywna Terapia. 2004; 36: 135–42.
- Fijałkowska A, Trela-Stachurska K, Rechberger T. Ocena skuteczności dożylnej infuzji paracetamolu w leczeniu bólu pooperacyjnego we wczesnym okresie po zabiegach ginekologicznych. Anestezjologia Intensywna Terapia. 2006; 2: 76–79.
- Zeidan A, Mazoit JX, Ali Abdullah M, et al. Median effective dose (ED₅₀) of paracetamol and morphine for postoperative pain: a study of interaction. Br J Anaesth. 2014; 112(1): 118–123.
- Paxton LD, McKay AC, Mirakhur RK. Prevention of nausea and vomiting after day case gynaecological laparoscopy. A comparison of ondansetron, droperidol, metoclopramide and placebo. Anaesthesia. 1995; 50(5): 403–406.
- Świątkowski J, Psujek M, Ząbek M, et al. Porównanie profilaktycznego działania przeciw-wymiotnego dehydrobenzperidolu, ondansetronu i metoklopramidu u pacjentek poddanych ginekologicznym operacjom laparoskopowym. Anestezjologia Intensywna Terapia. 2002; 3: 182–186.
- De Oliveira GS, Castro-Alves LJ, Ahmad S, et al. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013; 116(1): 58–74.
