title: A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges.
abstract: We carried out a national survey on postoperative pain (POP) management in a representative sample (public/private, teaching/non-teaching, size) of 76 surgical centers in France. Based on medical records and questionnaires, we evaluated adult patients 24h after surgery, concerning information: pre and postoperative pain, evaluation, treatment and side effects. A local consultant provided information about POP management. Data were recorded for 1900 adult patients, 69.3% of whom remembered information on POP. Information was mainly delivered orally (90.3%) and rarely noted on the patient's chart (18.2%). Written evaluations of POP were frequent on the ward (93.7%) with appropriate intervals (4.1 (4.0)h), but not frequently prescribed (32.7%). Pain evaluations were based on visual analog scale (21.1%), numerical scale (41.2%), verbal scale (13.8%) or non-numerical tool (24%). Pain was rarely a criterion for recovery room discharge (19.8%). Reported POP was mild at rest (2.7 (1.3)), moderate during movement (4.9 (1.9)) and intense at its maximal level (6.4 (2.0)). Incidence of side effects was similar according to patient (26.4%) or medical chart (25.1%) including mostly nausea and vomiting (83.3%). Analgesia was frequently initiated during anesthesia (63.6%). Patient-controlled analgesia (21.4%) was used less frequently than subcutaneous morphine (35.1%) whose prescription frequently did not follow guidelines. Non-opioid analgesics used included paracetamol (90.3%), ketoprofen (48.5%) and nefopam (21.4%). Epidural (1.5%) and peripheral (4.7%) nerve blocks were under used. Evaluation (63.4%) or treatment (74.1%) protocols were not available for all patients. This national, prospective, patient-based, survey reveals both progress and persistent challenges in POP management.
authors.affiliation: Université de Versailles St-Quentin, AP-HP, Hôpital Raymond Poincaré, Service d'Anesthésie Réanimation Chirurgicale, 104 boulevard Raymond Poincaré 92380 Garches, France Université de Versailles St-Quentin, AP-HP, Hôpital Ambroise Paré, Clinical Research Unit, 9 Avenue Charles de Gaulle, 92100 Boulogne, France INSERM, U-792, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, F-92100, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fletcher
authors.forename: Christophe
authors.initials: C
authors.lastname: Fermanian
authors.forename: Alain
authors.initials: A
authors.lastname: Mardaye
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods / Q000706:statistics & numerical data; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid