The proportion of patients treated with other pain management measures was 64.7%. The incidence of patients with undesirable effects was 2.9%. The proportion of patients who agreed to use the epidural anesthesia, if indicated for another procedure, was 50%. It could be concluded that postoperative pain relief by epidural anesthesia is a safe and effective method of pain relief
JOURNAL OF MEDICAL RESEARCH SATISFACTION AND EFFICACY OF EPIDURAL ANALGESIA AFTER SURGERY AT THE DEPARTMENT OF REQUIRED SERVICES TREATMENT IN THE NATIONAL HOSPITAL OF OBSTETRICS AND GYNECOLOGY Nguyen Thi Bich Van, Nguyen Thi Phuong Thao, Phan Thi Anh National Hospital of Obstetrics and Gynecology This cross-sectional descriptive study was conducted to monitor the analgesic effects of epidural analgesia in postoperative patients and to evaluate the satisfaction of patients using epidural anesthesia for the purpose of postoperative pain management at the Department of required services treatment in the National Hospital of Obstetrics and Gynecology from 01/08/2018 to 31/10/2018 34 patients with postmenopausal and gynecologic problems were enrolled and applied with epidural analgesia to release pain after the operation Results showed that the mean age of subjects was 34.3 ± 4.2 years The mean VAS score at 12 hours was highest at 3.76 ± 2.64 The percentage of patients who were satisfied with the epidural analgesia was 73.5%, and the dissatisfaction rate was 26.5% The proportion of patients treated with other pain management measures was 64.7% The incidence of patients with undesirable effects was 2.9% The proportion of patients who agreed to use the epidural anesthesia, if indicated for another procedure, was 50% It could be concluded that postoperative pain relief by epidural anesthesia is a safe and effective method of pain relief Key words: epidural anesthesia Satisfaction, efficacy I INTRODUCTION factor [1] Postoperative pain can cause the Pain relief is always a matter of concern for patients and physicians, particularly in the field of obstetrics and gynecology, due to its tremendous effects on physiology and recovery of the patient More specifically, obstetric patients have different characteristics than those of general surgical patients There is the exposure of infants to pain relief medication patient to lose the ability to take care of the baby, affecting the newly established motherchild relationship [2] Thus, pain relief is a necessary medical intervention, helping patients rapidly balance physiology, reducing hospital stay, strengthening maternal and neonatal relationships, and thus helping them to return to the daily life as quickly as possible through breast milk to contend with, and pa- Up until now, there have been many au- tients should soon regain their self-control and thors who have investigated various pain relief self-care to take care of their baby When methods for postoperative patients Epidural investigating what women fear and want after analgesia is considered to be the optimal caesarean section, pain is the most relevant method for postoperative pain relief, severe surgery, and especially in patients with comorbidities Understanding the importance of post- Corresponding author: Nguyen Thi Phuong National Hospital of Obstetrics and Gynecology Email: ntpthao270888@gmail.com Received: 03/10/2018 Accepted: 26/11/2018 68 Thao, operative analgesia, from the beginning of 2018, the National hospital of Obstetrics and Gynecology has implemented epidural analge- JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH sia to relieve pain after surgery So we con- 2018 to October 31st 2018 at the National ducted this study with the following aims: Hospital of Obstetrics and Gynecology, we To monitor the pain relief effects of epidural analgesia for postoperative patients had a total of 34 patients for this study - Sampling: convenience sampling epidural To assess of patients' satisfaction with analgesia in postoperative patients at the De- the use of epidural analgesia for postoperative partment of requires services treatment, the patients National Hospital of Obstetrics and Gynecology II METHODS Step 1: Develop research tool to collect study data Subjects The research was conducted with the pain relief by epidural analgesia for postoperative patients at the Required services treatment Step 2: Select postoperative patients who were given epidural analgesia and were willing to participate in the study Department, The National hospital of Obstet- Step 3: Instruct the patient to use the Vis- rics and Gynecology from August 2018 to Oc- ual Analogue Scale (VAS) to assess pain with tober 2018 10 points equivalent to 10 scores from Astra Zeneca Brand Inclusion criteria - Patients undergoing cesarean section and gynecological surgery at the National Hospital of Obstetrics and Gynecology who underwent epidural analgesia therapy for postoperative surgical pain - Patients with normal mental health and willing to participate in the study Step 4: Interview and monitor the patients to collect information according to the data collection tool The patients were transferred from the Department of Anesthesiology & Recovery to Department of Required Services Treatment Informed consent was obtained from the patients; if patients refused to be excluded in the study, only follow up steps with the consent of Exclusion criteria - Patients with neurological and psychiatric conditions, patients with communication difficulties - Patients not willing to participate in the study the patient After instructing patients to use the VAS pain scale, patients recorded their own VAS pain score on the follow-up sheet Data analysis and processing Data after collecting was cleaned, entered Study design and processed by SPSS 16.0 We also ap- A cross sectional study was used for this plied descriptive analyze statistics for this study study Research ethics Sample size and Sampling - Sample size: After select all patient who The research only aimed to evaluate the st postoperative pain relief efficacy of epidural were given epidural analgesia from August JMR 116 E3 (7) - 2018 69 JOURNAL OF MEDICAL RESEARCH analgesia and patient satisfaction with this to research objects is encrypted and method Research subjects were provided confidential Every subject has the right to with sufficient information and agreed to refuse to participate in the research participate in the study All information related III RESULTS General characteristics of subjects 1.1 Age of patients Figure 3.1 Distribution of patients by age The mean age of the patients was 34.3 ± 4.2 (years old), the highest age was 47 and the lowest was 23 years old Those aged 25 to 35 accounted for 50%, aged over 35 years old accounted for 41.2%, and only 8.8% patients were under 25 years old 1.2 Surgery type In 34 patients who participated in the study, there were 30 cesarean patients which were 88.2%, and the remaining four patients underwent hysterectomy, which accounted for 11.8% Degree of pain at the time of the study Table Mean of VAS score at the time of the study VAS score after surgery Mean of VAS score VAS score after surgery hours 2.68 ± 2.37 VAS score after surgery hours 3.62 ± 2.55 VAS score after surgery 12 hours 3.76 ± 2.64 VAS score after surgery 18 hours 3.18 ± 2.39 VAS score after surgery 24 hours 3.32 ± 2.57 VAS score after surgery 36 hours 2.91 ± 1.99 VAS score after surgery 48 hours 3.15 ± 2.20 70 JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH The highest mean of postoperative VAS score at postoperative 12 hours was 3.76 ± 2.64, after that it tended to decrease At the time of 24-hour after surgery VAS score was 3.32 ± 2.57 and after 36 hours surgery was 2.91 ± 1.99 Combination with other pain relief therapies Table Combination with other pain relief therapies Combination with other pain relief therapies N Rate (%) Yes 22 64,7% No 12 35, 3% Total 34 100% There were 22 patients in combination with other analgesics such as paracetamol, suppository and morphine which account for 64.7% Side effects Table Side effects Adverse effects n Rate (%) Itching, urticarial 0 Nausea, vomiting 0 Headache 0 Scabies, weak in the lower limbs 2,9 % Total 2,9 % Side effects were recorded in 34 patients who had pain relief therapy postoperative Only one patient had scabies and lower extremity weakness, both accounting for 2.9% of patients each Satisfaction of patients Figure Satisfaction of patients after surgery JMR 116 E3 (7) - 2018 71 JOURNAL OF MEDICAL RESEARCH Of the 34 patients who used postoperative analgesia, there were 25 patients were satisfied with 73.5%, patients (26.5%) were dissatisfied with this therapy .6 Reusing this therapy in the next surgery Table Percentage rate of reusing epidural analgesia Yes Reusing No Level of satisfaction N Rate (%) n Rate (%) Satisfaction 17 50% 23,5% Dissatisfaction 0% 26,5% In 25 satisfied patients with the use of epidural analgesia, 17 patients agreed to use this therapy again if undergoing another procedure, accounted for 50% There were patients who was not going to reuse the epidural analgesia, account for 23% 5% Of the patients who were dissatisfaction, no patients wanted to use the therapy again IV DISCUSSION In Table 1, we found that the mean VAS Results in the Figure 3.1 show that the score at the 12 hours postoperative was 3.76 mean age of the patients was 34.3 ± 4.2 years ± 2.64, which then tended to decrease gradu- old, in which the proportion of patients in the ally At 24 hours postop, mean VAS score was age group from 25 to 35 accounted for the 3.32 ± 2.57, and after 36 hours the mean VAS highest rate of 50% Patients in the age group score was 2.91 ± 1.99 The results in Table of over 35 years old accounted for 41.2% and 3.2 show that the number of patients requiring only 8.8% of were aged < 25 years This is combination therapy with other pain relievers considered to be the age of reproduction; the such as paracetamol, suppository, and mor- patient is stable both in health status, fertility phine were 22 patients, accounting for 64.7%, as well as physiology According to the study, only 35.3% of patients did not have any other we found that the group of cesarean section combination therapy of pain relief The re- surgery is significant, accounting for 88.2%, sults of our study differ from those of some patients with gynecological surgery accounted authors Tran Do Anh Vu, Nguyen Van Chung for 11.8% This may be due to anxiety, fear of (2014) showed that epidural analgesia had a postoperative pain and neonatal care and significant effect of pain relief, which was breast feeding of the mothers In addition, due 62.2% and good effect was 21.6% 83.8% of to increasing living conditions, access to re- patients were satisfied with the level of analge- productive health services is becoming easier, sia alone, without other pain relief therapies which influences the choices patients make in [3] Nguyen Trung Kien, Nguyen Huu Tu, order to be comfortable and in less pain, with- Cong Quyet Thang (2012) recorded that after out maternal or neonatal effects There is in- epidural analgesia from hour onwards, 100% creasing concern about the need for postpar- of participants had mild pain or no pain (VAS < tum analgesia 2) [4] Block et al (2003) performed a meta- 72 JMR 116 E3 (7) - 2018 JOURNAL OF MEDICAL RESEARCH analysis of 1404 scientific articles with 100 apy but the quality of the pain is not adequate, article selection criteria, comparing the pain so patients not intend to use the method relief quality of epidural analgesia with the use again next time In the 25 patients who were of bodily opioids The authors concluded that satisfied with this method, there were 17 pa- pain relief by epidural analgesia has better tients who would undergo this therapy again quality than using bodily opioids and was (68%), and eight patients who would not use th effective until the day postoperatively [5] the method again (32%) Of the patients who This difference may be due to the fact that our were satisfied with this method but did not hospital plan to use it next time, two patients under- recently began implementing epidural went sterilization and so did not intend to have analgesia, so the number of patients in our another baby and two patients underwent hys- study was low and the dosage may not be terectomy In addition, four patients found that appropriate for each patient the cost of the epidural analgesia therapy to postoperative anesthesia with Our records indicate that none of the pa- be quite high (3,000,000 VND) compared with tients had symptoms of vomiting or headache, other pain relief therapies and they could not and only one patient had lower extremity tolerate that the injection site felt irritated for weakness, and rehabilitation after hours of days stop using drug and continue to use lower doses Our results are similar to those of V CONCLUSION other authors, Phan Ton Ngoc Vu, Nguyen Postoperative pain relief with epidural anal- Van Chung (2011) who reported the number gesia is a safe technique with a significant of patients with lower extremity weakness after effective on pain relief, but initial implementa- receiving epidural analgesia was 2.8% and tion has not reached the expected results The improved after hours of using lower doses optimal analgesic effect should be combined Hoang Xuan Quan, Nguyen Quoc Kinh (2014) with other analgesic therapies, which not reported nausea and vomiting side effects in achieve the desired results and need to con- the group of patients with epidural analgesia duct large scale studies, with strict designa- were 9% versus 28% in the intravenous mor- tion, reasonable doses phine group [7] The results in Figure 3.2 and Table 3.4 show that 73.5% of patients were ACKNOWLEDGEMENTS satisfied with epidural analgesia therapy The We would like to give many thanks to the remaining patients accounted for 26.5% patients and staff members at the Department were not happy about this therapy Nine pa- of Required services Treatment, the National tients were not satisfied with this method be- hospital of Obstetrics and Gynecology for their cause postoperative pain remained severe assistance during this study according to their VAS scores, and so patients had to use other pain management methods REFERENCES such as suppository combination with the high Lavand’homme P (2006) Postcesarean cost of pain relief with epidural analgesia ther- analgesia: effective strategies and association JMR 116 E3 (7) - 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10 JMR 116 E3 (7) - 2018 ... with analgesia in postoperative patients at the De- the use of epidural analgesia for postoperative partment of requires services treatment, the patients National Hospital of Obstetrics and Gynecology. .. therapy in the next surgery Table Percentage rate of reusing epidural analgesia Yes Reusing No Level of satisfaction N Rate (%) n Rate (%) Satisfaction 17 50% 23,5% Dissatisfaction 0% 26,5% In. .. 2.57 and after 36 hours surgery was 2.91 ± 1.99 Combination with other pain relief therapies Table Combination with other pain relief therapies Combination with other pain relief therapies N Rate