|Year : 2020 | Volume
| Issue : 3 | Page : 125-126
Assessment of utilization and rationality of analgesic drugs in perioperative setting in a tertiary care teaching institute
Nirmik Dongre1, Sujata Dudhgaonkar2, Kavita M Jaiswal2, Nandkishore Jaiswal3, Lohit S Vaishnao1
1 Final MBBS Student, Government Medical College, Gondia, Maharashtra, India
2 Departments of Pharmacology, Government Medical College, Gondia, Maharashtra, India
3 Departments of Surgery, Government Medical College, Gondia, Maharashtra, India
|Date of Submission||17-May-2020|
|Date of Decision||15-Jul-2020|
|Date of Acceptance||03-Oct-2020|
|Date of Web Publication||23-Dec-2020|
Kavita M Jaiswal
Department of Surgery, Government Medical College, Gondia, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dongre N, Dudhgaonkar S, Jaiswal KM, Jaiswal N, Vaishnao LS. Assessment of utilization and rationality of analgesic drugs in perioperative setting in a tertiary care teaching institute. J Pharmacol Pharmacother 2020;11:125-6
|How to cite this URL:|
Dongre N, Dudhgaonkar S, Jaiswal KM, Jaiswal N, Vaishnao LS. Assessment of utilization and rationality of analgesic drugs in perioperative setting in a tertiary care teaching institute. J Pharmacol Pharmacother [serial online] 2020 [cited 2021 Apr 14];11:125-6. Available from: http://www.jpharmacol.com/text.asp?2020/11/3/125/304442
Postoperative pain is one of the most commonly reported symptoms after the surgery. If poorly controlled, it is associated with increased morbidity, functional and quality-of-life impairment, delayed recovery time, prolonged duration of opioid use, and higher health-care costs. Preemptive analgesia refers to the administration of an analgesic treatment before the surgery to minimize sensitization induced by noxious stimuli arising throughout the perioperative period. “Multimodal analgesia” which is recommended in the management of acute postoperative pain is the use of different classes of analgesics administered by diverse routes to produce a synergistic action and minimize the adverse effects of the individual drug. The American Pain Society suggests that clinicians routinely incorporate nonpharmacologic therapies into multimodal analgesia regimens for additional effects consistent with the biopsychosocial model of pain. Management of postoperative pain depends on the type of surgery performed, analgesics usage. Progress has been made in recognition of pain after the surgery as an important public health problem. To prevent the progression from acute to chronic postoperative pain, analgesics are given in preoperative, intraoperative, and postoperative phases. The present study was carried out to evaluate analgesics utilization pattern during abdominal surgeries for control of postoperative pain and to assess the rationality in the use of analgesics. This was a retrospective, observational study conducted by the department of pharmacology of a tertiary care teaching institute with the prior permission of the Institutional Ethics Committee. Data were collected from medical records of postoperative patients from the general surgery department who underwent operative procedures during the period from January 1 to December 31, 2018. Details of patients in the age group of 18 and above were included in the study, whereas the same of patients who were psychologically disabled and from extreme age groups were excluded from the study. The information was noted in a pro forma devised to gather the following information-patient demographics, diagnosis, type of surgical intervention, analgesics administered, routes of administration, nonpharmacological measures for control of pain. Rationality in prescribing analgesics was assessed using the WHO prescribing indicators. The data were analyzed and expressed as numbers and/or percentages.
A total of 348 records was studied parental synthetic opioid injection. tramadol as a sole agent was used as a perioperative analgesic of choice in patients in preoperative (68.96%) intraoperative (77.01%) and postoperative (62.35%) cases. Unlike codeine and morphine, tramadol is devoid of respiratory depression, and abuse potential which improves its tolerability. Nonsteroidal anti-inflammatory analgesic (NSAID) injection diclofenac was also used as an analgesic monotherapy in preoperative (11.49%) intraoperative (10.63%) and postoperative (14.08%) cases. Pal et al. in their study concluded that parental diclofenac appears to be a superior postoperative analgesic compared to IV paracetamol, with no added advantage of their combination. Injection. paracetamol was used as a single agent in 5.74% of preoperative cases and 9.48%of intraoperative cases. Injection. aceclofenac was used as a single agent to control pain in 8.90% of patients. A study conducted in 2010 concludes that intravenous paracetamol reduces opioid consumption, the extubation time, and opioid side effects such as nausea, vomiting, and itching. Paracetamol is a useful, relatively inexpensive, generic analgesic given after the surgery for patients with contraindications to nonsteroidal anti-inflammatory drugs (e.g., patients with asthma or peptic ulcer) and can be helpful when providing balanced postoperative analgesia. Tablet diclofenac as a single agent was used in 5.74% of preoperative and 2.58% of postoperative cases, respectively. One hundred and eight (31.03%) patients were on combination analgesics or “multimodal analgesics.” The combined use of parental (opioid + nonopioid) analgesic was observed in 22.04% of patients, the most frequent combination was a synthetic opioid and NSAID (injection. tramadol + injection. diclofenac 13.79% in preoperative stage). The other commonly used drug combinations were (injection. tramadol + injection. acelofenac in preoperative and intraoperative stages 2.29%), (injection. tramadol + injection. paracetamol in preoperative stage 6.32%). The combined use of oral aceclofenac + paracetamol was observed in 1.72% of preoperative cases and in 1.14% of postoperative cases. [Table 1]. Tramadol, diclofenac, paracetamol, and aceclofenac were prescribed as generics and 99.42% of the analgesics prescribed comply with that mentioned in the National List of Essential Medicines. The Medical Council of India has called upon for generic prescribing but has a long way to go. Most analgesics were administered through the parenteral route. The average number of analgesics was 1.31 per prescription. Fixed-Dose Combinations (FDCs) analgesics were used in 50 (14.36%) cases and 298 (85.63%) cases were managed without FDCs. All the prescribed FDCs were approved by DCGI from 1961 to December 31, 2019 [Table 2].
|Table 1: Prescribing pattern of analgesics in pre, intra and postoperative phases of surgery (n=348)|
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|Table 2: WHO indicators assessed regarding prescription of analgesics for pre, intra and postoperative stages (n=348)|
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To sum up, postoperative pain was managed by following the standard guidelines, there was the use of appropriate preemptive analgesia and multimodel analgesia except the use of nonpharmacological measures. Tramadol and diclofenac recorded high use as monotherapy in our study and in combination therapy, the most common combination used was tramadol plus diclofenac followed by tramadol plus paracetamol. The analgesics were prescribed rationally as per the WHO indices. The side effects of each therapy could not be assessed.
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| References|| |
Rosero EB, Joshi GP. Preemptive, preventive, multimodal analgesia: What do they really mean? Plast Reconstr Surg 2014 Oct; 134 (4 Suppl 2):85S-93S. doi: 10.1097/PRS.0000000000000671. PMID: 25255012.
Kaye AD, Urman RD, Rappaport Y, Siddaiah H, Cornett EM, Belani K, Salindas OJ, Fox CJ. Multimodal analgesia as an essential part of enhanced recovery protocols in the ambulatory settings. J Anaesthesiol Clin Pharmacol 2019;35:S40-5.
Wardhan R, Chelly J. Recent advances in acute pain management: Understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy. F1000Res 2017;6:2065.
De Vries TP. Guide to good prescribing a practical manual. World Health Organization; 1994.
Pal A, Biswas J, Mukhopadhyay P, Sanyal P, Dasgupta S, Das S. Diclofenac is more effective for post-operative analgesia in patients undergoing lower abdominal gynecological surgeries: A comparative study. Anesth Essays Res 2014;8:192-6. [Full text]
Kehlet H, Werner M, Perkins F. Balanced analgesia: What is it and what are its advantages in postoperative pain? Drugs 1999;58:793-7. Doi: 10.2165/00003495-199958050-00002. PMID: 10595860.
Li Z, Seeram NP, Carpenter CL, Thames G, Minutti C, Bowerman S. Cranberry does not affect prothrombin time in male subjects on warfarin. J Am Diet Assoc 2006;106:2057-61. doi: 10.1016/j.jada. 2006.09.012. PMID : 17126638.
[Table 1], [Table 2]