COMPARISON OF TREATMENT MODALITIES FOR ACUTE PAIN

 

ABSTRACT

 

Aim: To evaluate the efficacy of different modalities of pain relief in patients undergoing lower limb surgery and see which is the best.

 

Study Design and Setting: This was a Quasi-experimental study done in anesthesia department of Railway Hospital from 1st June 2006 to 15th May 2007

 

Subjects and Methods: Three hundred cases undergoing lower limb surgery were included in the study. Patients were divided into 6 groups with 50 patients in each group. All patients received basic pain treatment (BPT) consisting of Diclofenic Sodium. In cases where NSAIDs were contra-indicated, paracetamol was prescribed. The groups were:

Group I:           Patient received only Basic Pain Treatment (Oral NSAIDs)

Group II:          Patient received Nalbuphine I/V + Basic Pain Treatment (Oral NSAIDs)

Group III.         Patient received local istillation of wound with 0.125% Bupivacaine just at the end of operation and continued with NSAIDs post-operatively.

Group IV:         Patient received local nerve block according to site of operation + Basic Pain Treatment (Oral NSAIDs)

Group V:          Patient received TENS + Basic Pain Treatment (Oral NSAIDs)

Group VI:         Patient received Epidural Anesthesia.

 

All patients were observed 48 hours post-operatively and the pain was measured using Pakistan Coin Pain Scale          

 

Results: Pain relief with NSAID (group I) was 50%, with nalbuphine + NSAIDs (group II) was 70%, with local anaesthetic technique (group III) was 75% but most patients also required NSAIDs. In group IV with nerve block it was 75% with TENS plus NSAID (group V), pain relief was 55% while with epidural (group VI) it was 65%

 

Conclusions: Local anesthetic (nerve block, local instillation) followed by NSAIDs was a better choice for post-operative analgesia. TENS was almost as effective as local anesthetic technique and there was no pricking pain of syringes as in local anesthetic techniques but its duration of action was short and it had to be repeated several times during 48 hours.

 

Key words: Acute pain services, Postoperative pain, Epidural, Intrathecal, Local infiltration, Local instillation. Non Steroidal Anti-inflammatory Drugs.