[Impact of 2 strategies of analgesia on postoperative pain after emergency hand surgery performed on an ambulatory basis].

OBJECTIVES

The assessment of the impact of various analgesic regimens on postoperative pain at home, following emergency and ambulatory hand surgery.

STUDY DESIGN

Prospective comparative study of "before" and "after" groups by phone questionnaire on the first postoperative day.

PATIENTS

All emergency and ambulatory surgery patients undergoing hand surgery in a specialist university hospital unit.

METHODS

a) "Before" group (120 patients): analysis of current analgesic practice in the service (prescriptions by surgeon on duty), assessment of the incidence of pain scores with an intensity >/= 4 on a numerical score of 0 to 10, and identification of the most painful surgical interventions; b) formulation for these surgical interventions of multimodal analgesic protocols drown up by the anaesthetists; c) "After" group (51 patients): assessment of the efficacy of these analgesic protocols through comparison with the "before" group.

RESULTS

a) "Before" group: the total incidence of pain scores with an intensity >/= 4 was 42% and in the case of conditions involving a joint or sepsis, 88%. Dextropropoxyfen-paracetamol alone was prescribed in 66% of cases and was associated with a 48% analgesic failure rate. Non-steroidal anti-inflammatory drugs were prescribed in 14% of cases, tramadol in 7% and a combination of drugs in 15%; b) "After" group: the incidence of pain scores with an intensity >/= 4 decreased to 21% in surgical interventions involving joints or sepsis (p < 0.001).

CONCLUSION

Multimodal analgesic regimens are more effective than free prescriptions. This study underlines the need to further educate surgeons in this area. Despite these written protocols, there remains a 21% incidence of pain at home on day one.