Analgésie Post-Opératoire au CAC Sétif (Etat des Lieux)

Abstract

Postoperative analgesia is becoming more and more predominant in the approach of anesthesiologists. On the one hand, because the postoperative pain is consecutive to any surgical act, on the other hand because it acts in return on the surgical prognosis and the comfort of the patient. We carried out a survey within the Anti-cancer center Setif in order to assess the management of postoperative pain for patients who have undergone surgery at this level, by comparing protocols and therapeutic combinations, based on a the only questionnaire intended for patients suffering from pain. Our prospective descriptive study focused on 60 patients, whose average age is 57 years, the female sex was the most represented in our series with a number of 46 patients. The majority of our patients have an average level of 45%. Different types of surgery have been included for different types of cancer: digestive cancer, breast cancer, gynecological, endocrine and hepatobiliary cancer. Whose digestive cancer surgery was most commonly performed with (51.7%) presented by colectomy most commonly used in 25% of patients, followed by breast cancer surgery which presented (23.3%) by mastectomy with (21.7%).The surgery is performed under different types of anesthesia: general anesthesia (GA) alone or associated with epidural analgesia or with spinal anesthesia, of which GA alone was used the most in 52% of patients. Regarding the intraoperative analgesic protocols performed, multimodal analgesia was the most widely used analgesia, aimed at preventing hyperalgesia before lifting the sensory motor block. The paracetamol + nefopam combination was the most used with 41.70% of the operated patients; then there is paracetamol alone used in 28.3% followed by the combination xylocaine + ketamine with 10% or 6 patients. The combination of paracetamol and nefopam had been shown to be effective compared to their use alone. The postoperative pain assessment was performed using a simple verbal scale (SVS) within 48 hours of surgery. In the first 24 hours 55% of patients complain of severe pain. Multimodal analgesia was the most prescribed postoperatively, the combination of paracetamol + nefopam presents 28.3% followed by paracetamol + nefopam + NSAID triple therapy in 16.7% then paracetamol + nefopam + bupivacaine 11.7%. Paracetamol has been at the heart of this analgesia, the most prescribed molecule retaining the advantage of its low toxicity.121 At the end of hospitalization, patient satisfaction was assessed by three very important factors which are the effectiveness of the treatment in the disappearance of the pain which presents 63%; the normal transit recovery presented by 77% and postoperative ambulation in 80% of our patients within 48 hours after surgery at the end of 77% of our patients declared that they were completely satisfied with the postoperative management.