The Effectiveness of Revised Clinical Practice Guideline for Postoperative Pain Management in the Recovery Room Compared with the Previous Guideline

Abstract

Background: The postoperative pain guideline has been implemented, but two-third of moderate to severe pain patients were discharged from the recovery room untreated. The pain guideline was revised dosages of opioids depending on pain intensity instead of body weight (BW), morphine was injected 2 mg for BW 30-50 kg and 3 mg for more than 50 kg (fentanyl 10 mcg instead of morphine 1 mg). New guidelines, a maximum first dose of morphine for pain scores >7 was increased from 3 mg to 5 mg. Objective: To evaluate the effectiveness of the revised guideline for postoperative pain management in recovery room compared to the previous one. Methods: A retrospective study with analytic historical control was used to collect and analyses patients’ data from the record. The inclusion criteria were; age 10-65 years, pain scores >7 at the admission time to the recovery room. Outcomes were pain scores >4 before discharged from the recovery room and complications. Data from January-March 2017 was used for the previous guideline and October–December 2018 for a new guideline. Results: Seventy-two patients in each group were selected. Pain scores before discharged of the revised guideline were not different from the previous guideline; 45.8% (95% CI, 34.5-57.6) and 55.6% (95% CI, 55.6-66.8). Patients in the two groups received morphine and fentanyl in a comparable dose (morphine 25.0%, 26.4% and fentanyl 40.3, 41.7%, respectively). Complications were not found. Conclusion: Increasing a maximum first dose of opioids is not a factor that strong enough to improved postoperative pain management in the recovery room.