Audit of pain management following emergency laparotomies in cancer patients: A prospective observational study from an Indian tertiary care hospital

• Published in: Indian journal of anaesthesia 2020-06, Vol.64 (6), p.470-476
• Main Authors: Bakshi, Sumitra, Gawri, Ajay, Panigrahi, Amit
• Format: Article
• Language: English
• Subjects: Analgesia; Analgesics; Anesthesia; Anesthesiology; Cancer; Cancer patients; Cancer research; Catheters; emergency laparotomy; Epidural; epidural analgesia; Laparotomy; Medical research; Morphine; Mortality; Narcotics; Observational studies; Original; Pain management; Patient satisfaction; postoperative pain management; Respiratory system agents; Supervision; Surgery; Tapentadol; Ventilators
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.IJA_45_20

Background: Emergency laparotomies present a challenge in pain management given sick patients, odd timings and poor outcomes. Current recommendations favour multimodal opioid-sparing analgesia following elective laparotomies. No recommendation exists for emergency surgeries. Methodology: After approval and registration of the trial, adult patients posted for emergency laparotomy in the hospital (tertiary centre for cancer care) starting August 2015, for 6 months, were included in this prospective study. Patients' details including indication for emergency surgery, preoperative haemodynamic parameters, baseline coagulation status were captured. Patients were followed for pain scores, satisfaction with pain management and outcome. The number of anaesthesiologists present and their experience concerning regional techniques were noted. Results: Intestinal obstruction was the commonest cause of emergency laparotomy. Most patients belonged to the ASA IE/IIE class (91%). Intraoperatively, opioids were the mainstay of pain management with an epidural catheter inserted in only 9% of cases even though most cases were conducted by anaesthesiologists confident/expert in thoracic epidural insertion. There was no correlation of choice of pain management technique with the time of surgery (P = 0.22), ASA grading (P = 0.28), predicted mortality by p-Possum scores (P = 0.24). Pain at movement was moderate-severe in more than 50% of patients within the first 24 h. The regional group had better satisfaction when compared to opioid and non-opioid based management. (P < 0.001). Conclusion: Regional techniques for pain management in emergency laparotomies are less preferred, therefore, opioids are the mainstay. Lack of experience is essentially not the primary reason for regional techniques not gaining popularity. Pain management in this group needs a thorough re-evaluation.