An observational audit of pain scores post-orthopaedic surgery at a level two state hospital in Cape Town

Abstract

Objectives: The aim was to determine whether postoperative pain is satisfactorily controlled in patients undergoing orthopaedic surgery at a level two state hospital in Cape Town.

Design: Two observational audits were performed 12 months apart as part of a full audit cycle.

Setting and subjects: In view of perceived poor postoperative pain control, an audit was performed of acute postoperative pain scores, anaesthesia techniques, and patient satisfaction with pain control. Orthopaedic patients undergoing surgical procedures at a level two state hospital in Cape Town were enrolled in the two audits. Patient groups included both patients admitted to the hospital and day-cases.

Outcome measures: Patients admitted to hospital following major surgery, rated their perceived pain over 48 hours, using a visual analogue scale (VAS). Day-case patients scored their pain in hospital, and were then contacted telephonically after 24 hours, and if required, after 48 hours. A VAS score ≥ 4 was regarded as unacceptable. The interventions employed after the first audit were: pain rounds, staff education and training, increased postoperative epidural time, patient-controlled analgesia
pumps and indwelling femoral catheters following total knee replacement.

Results: Data were analysed from 71 patients in each audit. Mean VAS scores were unacceptable 12 and 24 hours after major surgery (range 4 - 5.1 in audit 1). Following the introduction of the aforementioned interventions, the mean pain scores were < 4 at every time point measurement, and significantly lower than in audit 1 at most assessment times (p < 0.05). Patient satisfaction with pain control improved from 32.4% in audit 1 to 54.9% in audit 2.

Conclusion: Acute postoperative pain is an important clinical problem in orthopaedic surgery. Following the demonstration of unacceptable postoperative pain scores in the first audit, specific interventions were shown to significantly improve pain control in the follow-up audit.