Background: Emergency laparotomies present a challenge in pain management given sick patients, odd timings and poor outcomes. Current recommendations favour multimodal opioid-sparing analgesia following elective laparotomies. No recommendation exists for emergency surgeries. Methodology: After approval and registration of the trial, adult patients posted for emergency laparotomy in the hospital (tertiary centre for cancer care) starting August 2015, for 6 months, were included in this prospective study. Patients' details including indication for emergency surgery, preoperative haemodynamic parameters, baseline coagulation status were captured. Patients were followed for pain scores, satisfaction with pain management and outcome. The number of anaesthesiologists present and their experience concerning regional techniques were noted. Results: Intestinal obstruction was the commonest cause of emergency laparotomy. Most patients belonged to the ASA IE/IIE class (91%). Intraoperatively, opioids were the mainstay of pain management with an epidural catheter inserted in only 9% of cases even though most cases were conducted by anaesthesiologists confident/expert in thoracic epidural insertion. There was no correlation of choice of pain management technique with the time of surgery ( P = 0.22), ASA grading ( P = 0.28), predicted mortality by p-Possum scores ( P = 0.24). Pain at movement was moderate-severe in more than 50% of patients within the first 24 h. The regional group had better satisfaction when compared to opioid and non-opioid based management. ( P < 0.001). Conclusion: Regional techniques for pain management in emergency laparotomies are less preferred, therefore, opioids are the mainstay. Lack of experience is essentially not the primary reason for regional techniques not gaining popularity. Pain management in this group needs a thorough re-evaluation.

Background and Aims: It is essential that patients posted for day-care surgeries are adequately prepared preoperatively. Verbal information alone may not be always effective. This study aimed to prepare, validate, and evaluate the efficacy of a patient information leaflet (PIL) for patients undergoing day-care surgeries under general anesthesia (GA). Material and Methods: After approval from the hospital ethics committee a PIL was prepared in English. Readability and design of the leaflet were checked using standard tests: Flesch readability ease test (FRE), Flesch Kincaid grade level (FKGL), and Baker Able leaflet design (BALD). It was translated into three regional languages. The PIL was tested among patients using a questionnaire. Seventy-nine adult patients posted for elective day-care procedures were included while emergency surgeries were excluded. Patient knowledge pre and post-PIL was compared using paired ' t ' test. The influence of age, gender, and education level on the usefulness of PIL were analyzed using the Chi-square test and knowledge was compared using ANOVA. Results: The English leaflet had an FRE Score of 63.9 and FKGL of 6.4, which is “standard“. The BALD score for all leaflets was 25 (“above standard“). The overall knowledge scores significantly improved from 52.6% (preintervention) to 70.7% (postintervention), P < 0.001. Knowledge improvement was seen with the use of PIL in all four languages. Sixty eight percent of patients strongly recommended the PIL while 31% were willing to recommend it to others. Conclusion: The PILs developed in this study have standard readability, good design and validated for efficacy.

Background and Aims: In a day care setting, communication of preprocedure instructions prior to general anesthesia (GA) is critical. Verbal information may be inadequate at times leading to unnecessary rescheduling. The aim of the study is to evaluate the use of patient information leaflet (PIL) and its impact on rescheduling and patients’ satisfaction levels. Material and Methods: Adult ASA I-III patients scheduled for elective day care Head Neck procedures such as direct laryngoscopy, examination under anesthesia, and biopsy under GA were recruited. In the outpatient department (OPD), the attending surgeons verbally instructed the patients as well as handed them the PIL. The process was streamlined over a month and thereafter patients’ satisfaction levels and rescheduling rates were captured over 2 months. This was compared to the data from the pre-PIL phase. Result: Prior to PIL, 12% cases were rescheduled due to avoidable causes. After introducing of the PIL, only 8% case were rescheduled ( P = 0.02). There was a significant improvement seen in patient satisfaction with 89% patients reporting that the PIL was good or better while 77% were willing to recommend it to the others. Conclusion: PIL is an effective way of imparting perioperative instructions to patients which will improve not only satisfaction but also reduce patient rescheduling. The institution is in the process of implementing PIL to provide instructions to patient posted for day care procedures.