IntroductionExcruciating pain is associated with lower limb orthopaedic surgeries involving femoral shaft fractures. Postoperative pain management is still ineffective in low-resource settings where the use of epidural and opioid-free analgesia is impractical. Literature is scarce with respect to the effect of a preemptive multimodal analgesia regimen on the requirement of postoperative epidural demand boluses. Hence, the present study aimed to evaluate the effect of pre-emptive multimodal analgesia in reducing the requirement of epidural demand boluses postoperatively, and to find out the time required to receive the first epidural bolus. Material and methodsThis double-blinded randomized control study included 48 subjects. Patients aged 18-60 years with lower limb fractures requiring surgery under combined spinal-epidural anesthesia were included. Patients were divided into two groups through random allocation. Group A: Preemptive multimodal group received intravenous paracetamol 1 g, IV diclofenac 75 mg diluted in 100ml NS, IV tramadol 50 mg diluted in 100ml NS and tab pregabalin 75 mg orally, 30 mins before surgery. Group B: Placebo group received 3 pints of 100ml NS IV and tab ranitidine 150 mg, 30 mins before surgery. Intraoperatively, combined spinal-epidural anaesthesia was administered taking all the aseptic precautions. Visual analogue scale (VAS) was recorded immediately on shifting to a postoperative room, and then at 1, 4, 8, 12, and 24 hr for both groups. Epidural boluses (10 ml of 0.125% bupivacaine with 2 μg/ml of fentanyl) were given whenever the patient's visual analogue scale was more than 4. The time at which the first epidural bolus was required by the patient was recorded. The total number of epidural boluses given over 24 hours based on VAS was recorded for both, the preemptive and placebo groups. If the patient still complained of pain, IV diclofenac 75 mg was given if the VAS was more than 4, while IV diclofenac 75 mg along with IV tramadol 50 mg was given if the VAS was more than 6. Patient satisfaction with anesthesia care, in general, was assessed 24 hrs postoperatively. ResultsA total of 48 subjects were included in the study. During the immediate-postoperative period, and at 8, 12 and 24 hr, the median VAS was significantly low in group A as compared to group B. A significant increase in the demand for epidural bolus immediate-postoperatively was observed in group B (70.83%) compared to group A (4.17%) (p-value of <0.001). At 8 hr, 12hr, and 24hr, patients in group A found a significantly less need for epidural boluses compared to Group B. The mean total number of epidural boluses taken in group A was significantly less compared to group B (1.79 ± 0.41 VS 3.33 ± 0.48, p-Value <0.001). In group A, all patients reported no requirement for diclofenac and tramadol. In group B, 8.33% required diclofenac 75 mg, while the remaining 91.66% had no requirement for diclofenac and tramadol. The difference in patient satisfaction with anaesthesia care in general between the two study groups was f...

Introduction: Factors favouring patient satisfaction in anaesthesia are availability of services based on institutional facilities, mutual between with anaesthesiologist and patients, skill of health care experts and patient requirements. When one wishes to improve response rates and raise the calibre of the data captured, face-to-face surveys are among the greatest methods for gathering data. It can be challenging to quantify subject satisfaction in anaesthesia since subjective indications vary by person, culture and background. Patients rating of their own satisfaction can estimate the care given during procedure which cannot be easily assessed in any other way. Aim: To assess patient satisfaction regarding the care provided during anaesthesia and to find out whether dissatisfactions are better elicited through face-to-face interviews or questionnaire. Materials and Methods: This cross-sectional study was conducted on patients undergoing surgery under general or regional anaesthesia at Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka, India, from November 2021 to February 2022. Estimated sample size was 74. As per American Society of Anaesthesiologist (ASA) grades 1 and 2, adults in the age group of 18–65 years were divided into two groups using chits. In group A, face-to-face interview was done on postoperative day 2 by anaesthesiology resident. In group B, questionnaire was given on postoperative day 2 by anaesthesiology resident. The questions on anaesthesia-related dissatisfaction were posed in a semi dichotomous scale (no/yes-mild, moderate, severe); the questions on satisfaction with anaesthesia care were given on a 4-item scale (extremely satisfied/satisfied/ neutral/dissatisfied). The data was analysed by using Statistical Package for the Social Sciences (SPSS) software version 22.0, and R environment version 3.2.2 and Microsoft word and Excel have been used to generate graphs and tables. Results: Patient population included in study was 74, among which 63 (85.1%) patients were extremely satisfied with the care given by Anaesthesia Department in general, seven (9.5%) were satisfied, four (5.4%) were neutral, and no one were dissatisfied. Among questionnaire group 36 (97.3%) patients were extremely satisfied with anaesthesia care in general while 27 (73%) of face-to-face group were extremely satisfied with anaesthesia care in general. Among anaesthesia related dissatisfactions 65 (87.8%) of patients did not complain of postoperative nausea and vomiting. In this study 52 (70.3%) patients were extremely satisfied with pain relief after surgery. Conclusion: Face-to-face interview identifies more patients who report lower degree of satisfaction with anaesthesia, it can be concluded that interviewing is better suited for detecting quality problems with anaesthesia care than written questionnaire.