A survey of postoperative pain management in fourteen hospitals in the UK

Summary 

The effectiveness of acute pain services in 14 hospitals in one English region was audited. We collected data on analgesia used, its efficacy and patient satisfaction for 522 patients after four commonly performed procedures: abdominal hysterectomy, total knee replacement, mastectomy and major abdominal surgery.

Pain scores were measured on a verbal numeric rating scale in the recovery room and both pain scores and patient satisfaction were assessed at 24h and 7 days postoperatively.

Pain was managed well in recovery rooms but less well on the wards. Epidural analgesia gave significantly better pain scores than other therapies. Better pain relief was obtained if opioids were combined with NSAIDs than when given alone. There were marked differences between hospitals in the delivery of postoperative analgesia. Pain scores in most hospitals left room for improvement, particularly following abdominal hysterectomy, but patient satisfaction was good. The better efficacy of multimodal analgesia was confirmed. Evidence from this data for the effectiveness of multidisciplinary acute pain services was equivocal.

Keywords: Postoperative analgesia, Audit, Major surgery, Acute pain