Satisfaction and efficacy of epidural analgesia after surgery at the department of required services treatment in the national hospital of obstetrics and gynecology

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

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 analge-sia in postoperative patients and to evaluate the satisfaction of patients using epidural anestheanalge-sia 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 pa-tients 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

Pain relief is always a matter of concern for

patients and physicians, particularly in the field

of obstetrics and gynecology, due to its

tre-mendous effects on physiology and recovery

of the patient More specifically, obstetric

pa-tients have different characteristics than those

of general surgical patients There is the

expo-sure of infants to pain relief medication

through breast milk to contend with, and

pa-tients should soon regain their self-control and

self-care to take care of their baby When

investigating what women fear and want after

caesarean section, pain is the most relevant

factor [1] Postoperative pain can cause the patient to lose the ability to take care of the baby, affecting the newly established mother-child relationship [2] Thus, pain relief is a nec-essary 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

Up until now, there have been many au-thors who have investigated various pain relief methods for postoperative patients Epidural

analgesia is considered to be the optimal

method for postoperative pain relief, severe surgery, and especially in patients with comor-bidities Understanding the importance of post-operative analgesia, from the beginning of

2018, the National hospital of Obstetrics and Gynecology has implemented epidural

analge-Corresponding author: Nguyen Thi Phuong Thao,

National Hospital of Obstetrics and Gynecology

Email: ntpthao270888@gmail.com

Received: 03/10/2018

Accepted: 26/11/2018

sia to relieve pain after surgery So we

con-ducted this study with the following aims:

1 To monitor the pain relief effects of

epi-dural analgesia for postoperative patients

2 To assess of patients' satisfaction with

the use of epidural analgesia for postoperative

patients

II METHODS

1 Subjects

The research was conducted with the pain

relief by epidural analgesia for postoperative

patients at the Required services treatment

Department, The National hospital of

Obstet-rics and Gynecology from August 2018 to

Oc-tober 2018

Inclusion criteria

- Patients undergoing cesarean section

and gynecological surgery at the National

Hospital of Obstetrics and Gynecology who

underwent epidural analgesia therapy for

post-operative surgical pain

- Patients with normal mental health and

willing to participate in the study

Exclusion criteria

- Patients with neurological and psychiatric

conditions, patients with communication

diffi-culties

- Patients not willing to participate in the

study

2 Study design

A cross sectional study was used for this

study

3 Sample size and Sampling

- Sample size: After select all patient who

were given epidural analgesia from August 1st

2018 to October 31st 2018 at the National Hospital of Obstetrics and Gynecology, we had a total of 34 patients for this study

- Sampling: convenience sampling epidural analgesia in postoperative patients at the De-partment of requires services treatment, the National Hospital of Obstetrics and Gynecol-ogy

Step 1: Develop research tool to collect study data

Step 2: Select postoperative patients who were given epidural analgesia and were willing

to participate in the study

Step 3: Instruct the patient to use the Vis-ual Analogue Scale (VAS) to assess pain with

10 points equivalent to 10 scores from Astra Zeneca Brand

Step 4: Interview and monitor the patients

to collect information according to the data collection tool

The patients were transferred from the De-partment of Anesthesiology & Recovery to Department of Required Services Treatment Informed consent was obtained from the pa-tients; if patients refused to be excluded in the study, only follow up steps with the consent of the patient After instructing patients to use the VAS pain scale, patients recorded their own VAS pain score on the follow-up sheet

4 Data analysis and processing

Data after collecting was cleaned, entered and processed by SPSS 16.0 We also ap-plied descriptive analyze statistics for this study

5 Research ethics

The research only aimed to evaluate the postoperative pain relief efficacy of epidural

analgesia and patient satisfaction with this

method Research subjects were provided

with sufficient information and agreed to

participate in the study All information related

to research objects is encrypted and confidential Every subject has the right to refuse to participate in the research

III RESULTS

1 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 low-est 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%

2 Degree of pain at the time of the study

Table 1 Mean of VAS score at the time of the study

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

3 Combination with other pain relief therapies

Table 2 Combination with other pain relief therapies

Combination with other pain relief therapies N Rate (%)

There were 22 patients in combination with other analgesics such as paracetamol, suppository and morphine which account for 64.7%

4 Side effects

Table 3 Side effects

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

5 Satisfaction of patients

Figure 2 Satisfaction of patients after surgery

Of the 34 patients who used postoperative analgesia, there were 25 patients were satisfied with 73.5%, 9 patients (26.5%) were dissatisfied with this therapy

.6 Reusing this therapy in the next surgery

Table 3 Percentage rate of reusing epidural analgesia

Reusing Level of satisfaction

In 25 satisfied patients with the use of epidural analgesia, 17 patients agreed to use this ther-apy again if undergoing another procedure, accounted for 50% There were 8 patients who was not going to reuse the epidural analgesia, account for 23% 5% Of the 9 patients who were dissat-isfaction, no patients wanted to use the therapy again

IV DISCUSSION

Results in the Figure 3.1 show that the

mean age of the patients was 34.3 ± 4.2 years

old, in which the proportion of patients in the

age group from 25 to 35 accounted for the

highest rate of 50% Patients in the age group

of over 35 years old accounted for 41.2% and

only 8.8% of were aged < 25 years This is

considered to be the age of reproduction; the

patient is stable both in health status, fertility

as well as physiology According to the study,

we found that the group of cesarean section

surgery is significant, accounting for 88.2%, 4

patients with gynecological surgery accounted

for 11.8% This may be due to anxiety, fear of

postoperative pain and neonatal care and

breast feeding of the mothers In addition, due

to increasing living conditions, access to

re-productive health services is becoming easier,

which influences the choices patients make in

order to be comfortable and in less pain,

with-out maternal or neonatal effects There is

in-creasing concern about the need for

postpar-tum analgesia

In Table 1, we found that the mean VAS score at the 12 hours postoperative was 3.76

± 2.64, which then tended to decrease gradu-ally At 24 hours postop, mean VAS score was 3.32 ± 2.57, and after 36 hours the mean VAS score was 2.91 ± 1.99 The results in Table 3.2 show that the number of patients requiring combination therapy with other pain relievers such as paracetamol, suppository, and mor-phine were 22 patients, accounting for 64.7%, only 35.3% of patients did not have any other combination therapy of pain relief The re-sults of our study differ from those of some authors Tran Do Anh Vu, Nguyen Van Chung (2014) showed that epidural analgesia had a significant effect of pain relief, which was 62.2% and good effect was 21.6% 83.8% of patients were satisfied with the level of analge-sia alone, without other pain relief therapies [3] Nguyen Trung Kien, Nguyen Huu Tu, Cong Quyet Thang (2012) recorded that after epidural analgesia from 1 hour onwards, 100%

of participants had mild pain or no pain (VAS < 2) [4] Block et al (2003) performed a

meta-analysis of 1404 scientific articles with 100

article selection criteria, comparing the pain

relief quality of epidural analgesia with the use

of bodily opioids The authors concluded that

pain relief by epidural analgesia has better

quality than using bodily opioids and was

effective until the 4th day postoperatively [5]

This difference may be due to the fact that our

hospital recently began implementing

postoperative anesthesia with epidural

analgesia, so the number of patients in our

study was low and the dosage may not be

appropriate for each patient

Our records indicate that none of the

pa-tients had symptoms of vomiting or headache,

and only one patient had lower extremity

weakness, and rehabilitation after 2 hours of

stop using drug and continue to use lower

doses Our results are similar to those of

other authors, Phan Ton Ngoc Vu, Nguyen

Van Chung (2011) who reported the number

of patients with lower extremity weakness after

receiving epidural analgesia was 2.8% and

improved after 2 hours of using lower doses

Hoang Xuan Quan, Nguyen Quoc Kinh (2014)

reported nausea and vomiting side effects in

the group of patients with epidural analgesia

were 9% versus 28% in the intravenous

mor-phine group [7] The results in Figure 3.2 and

Table 3.4 show that 73.5% of patients were

satisfied with epidural analgesia therapy The

remaining 9 patients accounted for 26.5%

were not happy about this therapy Nine

pa-tients were not satisfied with this method

be-cause postoperative pain remained severe

according to their VAS scores, and so patients

had to use other pain management methods

such as suppository combination with the high

cost of pain relief with epidural analgesia

ther-apy but the quality of the pain is not adequate,

so patients do not intend to use the method again next time In the 25 patients who were satisfied with this method, there were 17 pa-tients who would undergo this therapy again (68%), and eight patients who would not use the method again (32%) Of the 8 patients who were satisfied with this method but did not plan to use it next time, two patients under-went sterilization and so did not intend to have another baby and two patients underwent hys-terectomy In addition, four patients found that the cost of the epidural analgesia therapy to

be quite high (3,000,000 VND) compared with other pain relief therapies and they could not tolerate that the injection site felt irritated for 3 days

V CONCLUSION

Postoperative pain relief with epidural anal-gesia is a safe technique with a significant effective on pain relief, but initial implementa-tion has not reached the expected results The optimal analgesic effect should be combined with other analgesic therapies, which do not achieve the desired results and need to con-duct large scale studies, with strict designa-tion, reasonable doses

ACKNOWLEDGEMENTS

We would like to give many thanks to the patients and staff members at the Department

of Required services Treatment, the National hospital of Obstetrics and Gynecology for their assistance during this study

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