title: Impact of analgesic drug-use guidelines for the management of postoperative pain: a drug utilization study.
abstract: OBJECTIVE
  Postoperative pain is inadequately treated in many surgical settings. The present study evaluates the impact of analgesic drug-use guidelines in the management of postoperative pain.
  
  
  METHODS
  A prospective drug utilization study was carried out in 3 stages in a traumatology, orthopedic and rehabilitation tertiary hospital. The first stage, aimed at describing the patterns of use of analgesic strategies in the management of postoperative pain, identified habits, practices and misconceptions regarding this therapeutic area. After this, an ad hoc representative institutional working group agreed on analgesic drug-use guidelines for the management of postoperative pain. These were then published, presented and discussed with surgeons and nurses. After the guidelines had been implemented, their impact was evaluated in terms of the analgesics used, their dosage and their administration schedule.
  
  
  RESULTS
  101 patients were studied before the implementation of the guidelines and 108 patients after. Patients receiving opiate analgesics during the immediate postoperative period increased from 70-94% (p < 0.05). First-choice analgesics used according to the guidelines increased from 40-89% of choices after the implementation of the guidelines (p < 0.05). Administration of analgesics at regular predetermined intervals increased from 45-58% of medical orders, but this increase was not statistically significant (p = 0.07). Prescription of analgesics at adequate doses increased from 67-87% (p < 0.05).
  
  
  CONCLUSIONS
  Education on the treatment of postoperative pain is made up of several messages including the drug of choice and dose regimen. Prescribers seemed more receptive to a change in drug rather than issues related to the correct dose regimen. More research is needed to assess how educational activities can improve the management of postoperative pain.
authors.affiliation: Fundació Institut Català de Farmacologia, Hospital Universitari Vail d'Hebron, Departament de Farmacologia, Universitat Autònoma de Barcelona, WHO Collaborating Centre for Research and Training in Pharmacoepidemiology, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Vallano
authors.forename: J
authors.initials: J
authors.lastname: Llinares
authors.forename: J M
authors.initials: JM
authors.lastname: Amau
authors.forename: M
authors.initials: M
authors.lastname: Martorell
authors.forename: L
authors.initials: L
authors.lastname: Girona
authors.forename: J R
authors.initials: JR
authors.lastname: Laporte
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid