Pre-packed take-home analgesics in ambulatory surgery

Summary 

Clinical studies have revealed that a high percentage of patients experience moderate or severe pain during the first 24–48h following ambulatory surgery. We examined, in a prospective, randomised study, if standardizing by dispensing a pre-packed take-home analgesics (fixed combination codeine phosphate/acetaminophen), would lead to high adherence with pain treatment together with an improved alleviation of pain after discharge compared to normal practice. “Normal practice” implied that analgesics were prescribed at the surgeon's discretion without any standardisation. A total of 150 patients were included (surgical procedures: knee arthroscopy, breast surgery and surgery of varicose veins or anal fistulae). Analgesic efficacy and influence of pain on daily functions after discharge were evaluated by self-assessment of pain intensity by selected items of the BPI-SF. Adherence to treatment, frequency of adverse events and analgesic intake were also recorded during the study period.

No significant difference in pain intensity could be seen regardless of high adherence in the intervention group.

We conclude that pre-packed medication is an opportunity to provide patients with an easy method of handling postoperative analgesics, but a high frequency of drug related adverse events and the absence of better analgesia indicates that customised analgesic therapies are warranted.

Keywords: Ambulatory surgical procedures, Pre-packed analgesics, Adherence, Postoperative pain, Brief Pain Inventory, Codeine, Acetaminophen