Title : Improving post-operative analgesia regimens after emergency major abdominal surgery
Abstract:
Background: Effective postoperative pain management is paramount for patient recovery after emergency major abdominal surgery, impacting morbidity, length of stay, and overall outcomes. Variability in analgesic prescribing, potential opioid overuse, and underutilisation of non-opioid analgesics are prevalent issues. A structured, stepwise approach to analgesia is particularly important when patients transition from patient-controlled analgesia (PCA) to regular oral analgesia. This quality improvement project aimed to standardise and optimise postoperative analgesia at the John Radcliffe Hospital's Surgical Emergency Unit (SEU).
Aim: To assess current analgesic practices, implement targeted interventions to align with evidence-based guidelines, and evaluate the impact of these interventions on postoperative pain management following emergency major abdominal surgery.
Methods: A retrospective audit of patients undergoing emergency major abdominal surgery was conducted. Patients were identified using the department’s National Emergency Laparotomy Audit registry. Data was collected on surgical, anaesthetic, and patient-related factors influencing postoperative pain, analgesia prescriptions and ward round documentation. Analgesic prescriptions during the first postoperative week were converted to Morphine Milligram Equivalents (MME) for comparative analysis. Key metrics included opioid consumption, non-opioid analgesic usage, documentation quality, and length of stay. Interventions included: (1) educational sessions for junior doctors on multimodal analgesia and guideline adherence, (2) implementation of a standardised analgesic prescription checklist including objective pain score and (3) promotion of a readily accessible electronic powerplan for analgesic prescribing. A post-intervention audit was performed to assess the impact of these changes.
Results: Post-intervention, significant improvements were observed in the documentation of analgesic plans during ward rounds and increased awareness of optimal postoperative analgesic regimens. Over time this has the potential to result in a demonstrable reduction in overall MME consumption and a trend towards decreased length of stay.
Conclusion: This quality improvement project demonstrates that targeted interventions, including education, checklists, and streamlined electronic prescribing, can improve postoperative analgesia following emergency major abdominal surgery. Implementing a standardised, multimodal approach to pain management enhances patient recovery, reduces opioid consumption, and improves clinical outcomes.
