الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
More than 80% of patients who undergo surgical procedures experience acute postoperative pain and approximately 75% of those with postoperative pain report the severity as moderate, severe, or extreme. Evidence suggests that less than half of patients who undergo surgery report adequate postoperative pain relief. Inadequately controlled pain negatively affects quality of life, function, and functional recovery, the risk of post-surgical complications, and the risk of persistent postsurgical pain.
It has been repeatedly confirmed by studies in the past 3 to 4 decades that 20 to 80% of patients undergoing surgery suffer from inadequately treated pain.Improving the management of post-operative pain requires crucially important changes that involve patients, clinicians, hospital organization, funding and sometimes even existing legislation. Many of these changes are well established in principle, but have yet to be widely implemented.
The aim of the present study was to study the pain management in postoperative patients of Alexandria University Students Hospital and with the following objectives:
1. To describe the pattern of postoperative pain management and the pattern of using analgesics.
2. To compare this pattern with the international guidelines.
3. To identify the outcomes of inadequate postoperative pain management.
4. To investigate the possible factors associated with the inadequate postoperative analgesics regimen.
A cross sectional study was conducted among three targeted populations:
• Adult patients who have undergone any surgical operations.
• Nurses of each word of the hospital.
• Physicians who perform surgical operation in different specialties and decides the analgesics treatment given on each surgical ward.
Data collection was done using four tools:
• Record review sheet for patients.
• Revised American pain society patient outcome questionnaire (APS-POQ-R) the Arabic revision for patients.
• Nurses Knowledge and Attitude Survey regarding Pain modified for Postoperative Pain (KASRP-P) for nurses.
• Postoperative Analgesics Therapy Observational Survey (PATHOS) for physicians.
Data entry and statistical analysis were done using the software Statistical Package for Social Science (SPSS) version 23. Statistical analysis was performed in both descriptive and inferential forms.
The study revealed the following main results:
Section (I): Patients sample:
• One hundred and thirty-nine patients were males that constituted 47.9%of the sample. One hundred and fifty-one patients were females and that constituted 52.1% of the patient sample.
• The mean age of the patient sample is 34.71(SD±16.82).
• One hundred and fifty-two patients (52%) performed extensive surgeries, One hundred and eight patients (37%) performed moderate surgeries and thirty patients performed slight surgeries.
• About 98% of patients understudy reported pain in the first 24 hours.
• Most of the patients suffered from severe pain postoperatively and the mean of the worst pain score is 7.6±2.6 reported in the first 24 hours after surgery.
• About 58% of patients reported their worst pain as severe pain.
• Pain is completely interfere with or prevent movement in bed for one hundred and thirty-two patients (45.5%), pain completely interfere with or prevent movementout of bed for ninety-two patients (31%).
• High pain interference level with falling asleep, high tendency toward high pain interference levels with staying asleep.
• About half the patients sample reported didn’t feel depressed, frightened or helpless.
• More than half the patients sample reported no side effects of analgesics.
• More than half the patients sample reported no side effects.
• More than half patients (57%) were satisfied of the pain management received andmoderate to high degree of pain relief had been reported by majority of patients.
• All patients reported no participation in their pain treatment decisions.
• No patients recorded any information has been received regarding pain treatment.
• No patients received non-medicine pain treatment.
• Two hundred and eighty-two patients (97%) were receiving non-complying regimen of the postoperative pain management.
• Pain assessment sheets weren’t included in the patient files and pain wasn’t assessed
Section (II): Physician sample:
• Physicians were 16 (34.8%) were abdominal surgeons, 10(21.7%) were orthopedic surgeons, 2(4.3%) were gynecologists,5(10.9%)were ENT surgeons and 13(28.3%) were anaesthesiologists.
• All respondents stated that there was no training at all in their institution andno regular on-site postoperative pain management training, for any of the health-care providers of the hospital.
• About 90% of physician stated that patients weren’t informed about degree of pain and pain relief expected.
• Majority of surgeons (n=40) recommended I.V mode of administration for opioid and non-opioid analgesics for major surgeries. While the percentage of recommendation decreased in minor.
• Balanced analysis is reported to be used in more than 75% of patients by 56% of the physicians following minor surgeries and 80.4% following major surgeries.
• The POP management uses reported to be continued on the ward as prescribed in the recovery room for 100% of respondents. The change of POP treatment was performed without consultation of an anesthetist or APS member (not existed). POP was declared to be treated on the ward on regular basis for 100% of the respondents.
• Written POP management protocols were in place for all patients for treating POP on the ward for 100% of respondents. These protocols were always applied in daily practice for 39.1% of physicians.
Section (III): Nurses Sample:
• The age of participants ranged between 20 and 56 with of mean age of 34.31±9.57 years.
• Males constituted 1.3% of the participants while females constituted 98.6%.
• Eighty-seven nurses were technician nurses and 63 nurses were Bachelor
• Nurses with more than 15 years of experience constituted the highest percentage (49.3%).
• 51.3% of them described nursing work load as moderate while 48.7% described it as high while none described their nursing work load as low.
• The highest percentage of nurses 56% reportedmoderate satisfaction level.
• Majority of nurses reported 45% score for moderate level of professional autonomy and 26.7% for high level of professional autonomy.
• Majority of nurses reported (70.7%) showed low participation.
• Nurses who have satisfied relations with supervisors and with physicians constituted 62% and 68.7% respectively.
• High previous personal experience of postoperative pain was shown in 54.7% of nurses.
• The mean of the overall score percentage of NKARSP-Pis 33.11%±9.25%, ranging 97.3% with poor scores (˂50%).
• Age and the education level of the nursing staff are significantly related to the score of the general pain management questions.
• Work satisfaction level and professional autonomyare significantly related to the general pain management score and the overall score (p<0.001).
• Taking professional decision freely (professional autonomy)(p=0.005), sharing in continuing education programs (p<0.001) , relation with senior staff in work (p=0.009) andrelation with physicians (p=0.004) are significantly related to the general pain management questions score.
• Age, years of experience, education and work status and feeling towards work score were significantly correlated with general management score of pain.
• A Multiple regression analysis shows that work status and feeling towards work score was the only significant predictor for general management score of pain.
• Age, years of experience, education and knowledge score were significantly correlated with work status and feeling towards work score.
• Years of experience and knowledge about pain had a significant impact on work status and feeling towards work score.
Based on the results of the current study, the following can be concluded:
• Postoperative pain is widely prevalent among postoperative patients. About 98% of patients enrolled in this study reported POP pain. Most of the patients suffered from severe pain.
• POP affected moderately to severely the patients outcomes as movement in and out of bed and falling and staying asleep and affected mildly the patient´s mood and emotions. Besides, mild side effects appeared from the use of analgesics.
• High satisfaction levels have been reported and moderate to high levels of percentage of pain relief has been reported.
• No participation of patients in their pain treatment decision and no information regarding pain has been received by the patients.
• Most POP management regimens received by the patients were non-complying.
• Pain was assessed by any tool at all and pain assessment sheet wasn’t included in the patient´s file.
• Despite that the majority of patients received Multimodal analgesic therapy, the most regimens described were non-complying to the international practice guidelines of POP management 2014. Besides, however opioid analgesics have been received by about half the patients postoperatively, most of which were severe under-dose.
• Most Physicians recommend using balanced analgesia in major and minor surgeries. Also most of them recommended I.V opioids and I.V non-opioids after major and minor surgeries.
• Poor Nurses Knowledge and negative attitudes toward postoperative pain were reported.
• Age, education level and the years of experience are significantly correlated with the general pain management score of nurses.
• Work satisfaction, profession autonomy and relation with physicians are significantly correlated with the nurses´ knowledge and attitudes toward POP.