Postoperative Analgesic THerapy Observational Survey (PATHOS): A practice pattern study in 7 Central/Southern European countries

Abstract

Surveys evaluating pain in hospitals keep on showing that postoperative pain (POP) remains undertreated. At the time when guidelines are edited and organisational changes are implemented, more recent data are necessary to check the impact of these measures on daily practice and needs for improvement. This prospective, cross-sectional, observational, multi-centre practice survey was performed in 2004-2005 in 7 European countries. It was conducted in surgical wards of a randomised sample of hospitals. Data on POP management practices following surgery in adult in-patients were collected anonymously via a standardised multiple choice questionnaire. Among 1558 questionnaires received from 746 European hospitals, 59% were provided by anaesthetists and 41% by surgeons. There are no regular on-site staff training programmes on POP management in the institution for 34% of the respondents, patients are systematically provided with POP information before surgery for 48% of respondents; balanced analgesia following major surgery and regular administration of analgesics are largely used; 25% of respondents have specific written POP management protocols for all patients in their ward; 34% of respondents say that pain is not assessed and 44% say that pain scores are documented in the patient's chart. This largest ever performed survey confirms the extensive body of evidence that current POP management remains suboptimal and identifies needs for improvement on European surgical wards. However, the wide use of balanced analgesia and the regular administration of analgesics are indicators of ongoing change.

A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges

“…Our survey reveals a high frequency of pain reporting (> 90%) in surgical wards, comparing favorably with previous French surveys ❞ in 1996 (0% reporting) [48] and 2000 (64-82% reporting) [30], recent surveys in Germany (53.4% reporting) [61], the United Kingdom (57% reporting) [59] and a recent European declarative survey (44% reporting) [8]. It has been suggested that educating nurses about pain and daily pain assessment with a numerical rating scale can improve the communication, assessment and documentation of patients' pain [23] and improve analgesic administration by nurses [24].…”

“…We found that non opioid analgesics were more widely prescribed in France (95.5%) than in a European survey in which intravenous non opioid drugs formed part of the first-line analgesic treatment after major surgery according to 64 to 72% of respondents (depending upon surgery type), and balanced analgesia use in more than 75% of patients was declared by 71% of respondents [8]. A combination of two non opioid analgesics with morphine may be considered optimal balanced analgesia [22].…”

“…The optimal frequency of PCA use remains unclear, and the frequency of use varies considerably with type of surgery and survey but increases in PCA prescription is considered an improvement of pain management [31]. In a recent European declarative survey, PCA pumps were used by almost half the respondents after major orthopedic or abdominal surgery [8]. There is therefore probably room for improvement in France.…”

“…Anesthesiologists in France must meet patients several days before surgery [21]. This facilitates the delivery of information about pain control, as shown by the higher frequency of preoperative information than in other European countries [8]. Information was mostly provided orally and was rarely ✎ ❩ reported on the patient's chart.…”

“…Postoperative pain (POP) control has frequently been shown to be inadequate in many countries including France, in general surveys [1,13,26,28] or studies focusing on patients undergoing surgery in individual teaching hospitals [48,62] at national [6,15,36,37,44,45,53] or international level [8,54]. The most frequent detected failings concern the information of the patient, limited pain evaluation, the under use of opioid and regional anesthesia techniques and inadequate organization.…”