Manejo farmacológico del dolor agudo postoperatorio en España. Datos de la encuesta nacional de la Sociedad Española del Dolor (SED)

Abstract

Introduction: The Spanish Pain Society SED-IASP launched a national survey in order to determine how was postop pain managed throughout Spain. This article analyses the drugs and routes employed comparing them according to the presence or not of an Acute Pain Unit (APU) or Acute Pain Management program (APMP) in hospitals with > 200 beds that participated and answered the survey. Patients and methods: Members of the Spanish Pain Society and APS/APMP heads were asked to respond to a survey. Responses were stratified by hospital size (< 200 or ≥ 200 beds) and APS/APMP presence or not. Categorical variables were described by percentages and the 95 % confidence interval and continuous ones by the median and interquartile range. The drugs employed, associations of them and routes of administration were also analysed. Results: A total of 112/537 hospitals responded the survey (78 with >200 beds and 34 < 200) which represents a 20,9 % response tax). Responses were received from 42.4 % of hospitals with ≥ 200 beds (vs. 9.6 % of the smaller ones). We fully analysed data concerning routes and ways of administration only for the larger hospitals, 57.7 % of which had an APS or APMP. Solely drugs were analysed considering all 112 hospitals. Oral route is employed in 60,3 % hospitals (no differences between those with or not APU), intramuscular (IM) in 15,8 %, subcutaneous (SC) 48,3 %, intravenous (IV) bolus 75,9 %, IV continuous 77,6 %, IV PCA 60,3 %, catheters in nerve plexus using bolus 51,7 %, catheters in nerve plexus with continuous infusion 56,9 %, epidurals with bolus 40,4 %, continuous epidurals 75,9 %, epidural PCA 43,1 %, (63,8 % local anesthetic and opioid and 15,8 % local anesthetic with adrenaline/clonidine/ opioid). Statistical significant differences were found in IV PCA route, continuous infusión through catheters in nervous plexus and epidural PCA (more employed in hospitals having an APU) and IM route (significantly less employed in them). A total of 81,3 % hospitals with > 200 beds used oral NSAIDs to treat postoperative pain (ibuprophen 38,1 % and dexketoprophen 28,6 %); paracetamol was employed in 68,8 % of them (associated to NSAID in 22 %) and 28,1 % employed oral opioids (tramadol 21,9 %). Coadjuvants are only employed in 2,3 % of 112 hospitals. IV dexketoprophen and oral ibuprophen were the most frequent NSAIDs employed. Tramadol is the most commonly IV and oral opioid employed. Morphine is the strong opiod more frequently used, especially in IV PCA. Paracetamol is used in 54,7 % (112 hospitals) of IV bolus way of administration. Multimodal analgesia concept although well known is not widely established among the survey responders (only 30 % apply it). Conclusion: Paracetamol and NSAIDs are used by IV (54,7 y 56,6 % respectively) and oral routes (67,4 y 86,1 % respectively). Hospitals with > 200 beds having an APU or APMP significantly employ more IV PCA, nerve plexus catheters continuous infusion and epidural PCA and less IM route to treat postoperative pain. Multimodal analgesia is not widely used in Spanish Hospitals.