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Ambulatory Anaesthesia

Influence of pain on patient's preference to discharge after day case shoulder surgery

2AP1-3

Mupedziswa, N.; Gupta, P.; Jamadarkhana, S.; Grogan, H.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 32-32
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Background and Goal of Study: All patients who wish to go home and fulfill day case criterion are discharged after shoulder surgery in our institution. We designed this project to find out if pain during recovery at home would alter their choice to overnight hospital stay if they have to have the same operation again.

Materials and Methods: 60 consecutive, ASA 1-3, patients who underwent elective shoulder surgery at a day case hospital were recruited. All patients received GA and interscalene block with 0.25% bupivacaine and were provided with paracetamol, NSAIDS and dihydrocodeine / tramadol as appropriate to take home for analgesia. information regarding demographic data, surgical data, pain scores (1-mild, 2-moderate, 3-severe) and reflection on their choice to go home after their overnight experience was collected.

Results and Discussion: All patients were comfortable and pain free at the time of discharge. 49 patients could be contacted in accordance with the protocol. Pain scores were 1, 2 and 3 for 8, 25 and 16 patients respectively after the recession of the block.

40 patients stood firm on their preoperative choice of going home. 9 patients said that had they known the severity of the pain after the recession of block, they would have preferred to stay in the hospital overnight. Table 1 shows the details of these patients.

[Table 1: Patients who preferred Hospital Stay]

Compared to Wilson et al1 who reported that 20% patients suffer excruciating pain after shoulder surgery, 33% patients in our study reported severe pain and more than half of them said that they would prefer to be in hospital next time for a similar operation.

Conclusion(s): Our study suggests that patients with mild to moderate shoulder surgery may be discharged home on the day of surgery but patients undergoing major surgery such as rotator cuff repair should either be considered for overnight hospital stay or community nerve block.

References:

1. Wilson AT, Nicholson E, Burton L, et al, Br J Anaesth. 2004 Mar; 92(3): 414-5
© 2013 European Society of Anaesthesiology