The application of preoperative self-anticipating pain scores in predicting surgical pain after elective surgery

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipating pain score before operation, and correlated the scores with the actual pain levels and analgesic requirement after operation. Methods This prospective cross-sectional, observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were invited to complete a structured questionnaire during preoperative anesthesia assessment that surveyed patient’s self-anticipating pain level (numeric rating scale, NRS 0-10) for the scheduled procedure. The actual pain score (visual analogue scale, VAS) experienced by the patient and the total equivalent dose of opioids administered after operation were recorded. Results A total of 996 patients were recruited and 1 patients were excluded due to incomplete data. Most of the patients (86%) received general anesthesia and 73.9% of them had prior operation history. Patients with younger ages (<40 years) and those took regular benzodiazepine for sleep disorder anticipated significantly higher pain levels. Male patients anticipated significantly lower NRS than females (odd ratio 1.710; 95% CI 1.254-2.331). Patients who scheduled for laparotomy, orthopedic surgery or long procedures had higher anticipating NRS. Although higher anticipating NRS were associated with higher postoperative VAS scores and higher total equivalent opioid dose for acute pain management, these surgical patients actually experienced less VAS than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that female, younger age (<40 years), regular benzodiazepine user and patients who scheduled for long procedure (>2 h), laparotomy or orthopedic surgery are anticipating significantly higher surgical-related pain. Therefore, appropriate preoperative counseling for analgesic control and elimination of unnecessary anticipating pain levels in these patients would be necessary to improve the quality of anesthesia service and patient’s satisfaction.

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The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

10.21203/rs.3.rs-18199/v2 ◽

2020 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

Pain Score ◽

Prospective Observational Study ◽

Rating Scale ◽

Elective Surgery ◽

Perioperative Period ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Younger patients (<40 years) (P=0.042) and those took regular benzodiazepine at bedtime (P=0.043) anticipated significantly higher pain levels. Male patients anticipated significantly lower pain intensities than females (odd ratio 1.710; 95% CI 1.254-2.331, P=0.001). Patients who scheduled for laparotomies (P=0.037), orthopedic surgeries (P=0.040) or long procedures (P<0.001) reported higher anticipated pain. Although higher anticipated pain scores were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that patients who are female, younger age (<40 years), use regular benzodiazepines at bedtime and scheduled for long procedures (>2 h), laparotomies or orthopedic surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study

BMC Anesthesiology ◽

10.1186/s12871-021-01303-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

Pain Intensity ◽

Pain Score ◽

Prospective Observational Study ◽

Rating Scale ◽

Elective Surgery ◽

Perioperative Period ◽

Pain Scores

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. Conclusion This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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Exploration of pain management following implementation of WHO pain guidelines

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19646 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19646-19646

Author(s):

S. Subongkot ◽

S. Khounnikhom ◽

N. Pratheepawanit Johns ◽

A. Sookprasert

Keyword(s):

Pain Management ◽

Pain Score ◽

Rating Scale ◽

Numeric Rating Scale ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Daily Life Activities ◽

Naive Group ◽

Who Guideline

19646 Background: Pain is among the most common symptoms encountered in cancer patients and remains the first priority of care. Methods: This cross sectional study aimed to explore a pattern of pain management at KKU Hospital by utilizing a numeric rating scale (0–10). Cancer pain patients were categorized based on prior analgesic exposure into two groups; Naïve group, and Routine group. Treatments were defined according to WHO as 1) drug treatment relevant to pain severity, 2) analgesics being prescribed as around-the- clock and 3) analgesics used for break-through pain for patients receiving strong opioid. Results: From Dec 2005 to Jul 2006, 261 patients were enrolled. 93.1% (n=243) were in advanced stages and 88.5% (n=231) were in moderate to severe pain. This pain interfered with patient’s daily life activities mildly to moderately as each pain score increased (p-value<0.01). In Naive group (n=159), 32.7% (n=52) were given analgesics following the WHO on both days 1 and day 3 of admission whereas 40.2% (n=64) patients were not. A decreased pain score was greater (2.61, SD±1.5) in a group following the WHO on day 1. Additionally, a decreased pain score was greater (3.91, SD±1.8) in a group following the WHO on day 3 (p-value <0.0001). This pain score decreased was also clinically significant as pain score reduced more than 3 points. In Routine group (n=102), 32 (31.4%) were given analgesics following the WHO guideline on both day 1 and day 3 of admission. In contrast, 36 (35.3%) were not. A decreased pain score was greater (2.59, SD±1.8) in a routine group following the WHO on day 1. Moreover, a decreased pain score was greater (3.95, SD±1.8) in a group following the WHO on day 3. The clinical significance of pain score reduced was also found on day 3. Of the 261 evaluable patients, the pattern of analgesics usage following the WHO guideline was increased in both groups comparing to at the beginning of the study. Conclusions: The results demonstrated that patients who received pain management following the WHO guideline reported significantly lower pain intensity than those not following the WHO. No significant financial relationships to disclose.

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Characterization of self-anticipated surgical pain prior to general anesthesia - a prospective observational study

10.21203/rs.3.rs-18199/v4 ◽

2021 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

General Anesthesia ◽

Pain Intensity ◽

Pain Score ◽

Prospective Observational Study ◽

Rating Scale ◽

Perioperative Period ◽

Pain Scores

Abstract Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (P<0.001). Higher anticipated pain scores (preoperative NRS³4) were associated with higher actual postoperative pain levels (P=0.032) in the PACU and higher total equivalent opioid use (P=0.001) for acute pain management during the perioperative period.Conclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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An observational study on quality of life and preferences to sustain life in locked-in state

Neurology ◽

10.1212/wnl.0000000000008064 ◽

2019 ◽

Vol 93 (10) ◽

pp. e938-e945 ◽

Cited By ~ 9

Author(s):

Magdalena Kuzma-Kozakiewicz ◽

Peter M. Andersen ◽

Katarzyna Ciecwierska ◽

Cynthia Vázquez ◽

Olga Helczyk ◽

...

Keyword(s):

Quality Of Life ◽

Observational Study ◽

Physical Function ◽

Rating Scale ◽

Well Being ◽

Psychosocial Adaptation ◽

Subjective Well Being ◽

Cross Sectional ◽

Hastened Death

ObjectiveThis is an observational study on well-being and end-of-life preferences in patients with amyotrophic lateral sclerosis (ALS) in the locked-in state (LIS) in a Polish sample within the EU Joint Programme–Neurodegenerative Disease Research study NEEDSinALS (NEEDSinALS.com).MethodsIn this cross-sectional study, patients with ALS in LIS (n = 19) were interviewed on well-being (quality of life, depression) as a measure of psychosocial adaptation, coping mechanisms, and preferences towards life-sustaining treatments (ventilation, percutaneous endoscopic gastroscopy) and hastened death. Also, clinical data were recorded (ALS Functional Rating Scale–revised version). Standardized questionnaires (Anamnestic Comparative Self-Assessment [ACSA], Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), ALS Depression Inventory–12 items [ADI-12], schedule of attitudes toward hastened death [SAHD], Motor Neuron Disease Coping Scale) were used, which were digitally transcribed; answers were provided via eye-tracking control. In addition, caregivers were asked to judge patients' well-being.ResultsThe majority of patients had an ACSA score >0 and a SEIQoL score >50% (indicating positive quality of life) and ADI-12 <29 (indicating no clinically relevant depression). Physical function did not reflect subjective well-being; even more, those with no residual physical function had a positive well-being. All patients would again choose the life-sustaining techniques they currently used and their wish for hastened death was low (SAHD <10). Caregivers significantly underestimated patient's well-being.InterpretationSome patients with ALS in LIS maintain a high sense of well-being despite severe physical restrictions. They are content with their life-sustaining treatments and have a strong will to live, which both may be underestimated by their families and public opinion.

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Prevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda: A Cross-Sectional Study

Surgery Research and Practice ◽

10.1155/2020/1464098 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Alfred Ogwal ◽

Felix Oyania ◽

Emmanuel Nkonge ◽

Timothy Makumbi ◽

Moses Galukande

Keyword(s):

Surgical Procedures ◽

Orthopedic Surgery ◽

Elective Surgery ◽

Cross Sectional Study ◽

Mulago Hospital ◽

Sectional Study ◽

Related Factors ◽

Cross Sectional ◽

Elective Surgical Procedures ◽

Cancellation Rate

Introduction. The cancellation of elective procedures has been shown to waste resources and to have the potential to increase morbidity and mortality among patients. This study aimed to determine the prevalence of the cancellation of elective surgical procedures and to identify the factors associated with these cancellations at Mulago Hospital, a large public hospital in Kampala, Uganda. Methods. A cross-sectional study was conducted from January 10, 2018, to February 20, 2018. We recruited patients of all ages who were admitted to surgical wards and scheduled for elective surgery. Data on patients’ demographic characteristics and diagnosis, as well as the specialty of the surgery, the planned procedure, the specific operating theatre, cancellation, and the reasons for cancellation were extracted and analyzed using logistic regression. Results. Of a total of 400 cases, 115 procedures were canceled—a cancellation prevalence of 28.8%. Orthopedic surgery had the highest cancellation rate, at 40.9% (n = 47). Facility-related factors were responsible for 67.8% of all cancellations. The most common reason for cancellation was insufficient time in the theatre to complete the procedure on the scheduled day. No procedures were canceled because of a lack of intensive care unit beds. There was a significant association between surgical specialty and cancellation (P<0.05) at multivariate analysis. Conclusion. The prevalence of cancellation of elective surgical procedures at Mulago Hospital was 28.8%, with orthopedic surgery having the highest cancellation rate. Two-thirds of the factors causing cancellations were facility-related, and more than 50% of all cancellations were potentially preventable. Quality-improvement strategies are necessary in the specialties that are susceptible to procedure cancellation because of facility factors.

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Determinants of Pain Severity Changes in Ambulatory Patients With Cancer: An Analysis From Eastern Cooperative Oncology Group Trial E2Z02

Journal of Clinical Oncology ◽

10.1200/jco.2013.50.6071 ◽

2014 ◽

Vol 32 (4) ◽

pp. 312-319 ◽

Cited By ~ 19

Author(s):

Fengmin Zhao ◽

Victor T. Chang ◽

Charles Cleeland ◽

James F. Cleary ◽

Edith P. Mitchell ◽

...

Keyword(s):

Pain Management ◽

Pain Score ◽

Rating Scale ◽

Numerical Rating Scale ◽

Eastern Cooperative Oncology Group ◽

Pain Severity ◽

Initial Assessment ◽

Pain Level ◽

Ambulatory Patients

Purpose To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors. Patients and Methods We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity. Results We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status. Conclusion One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.

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Gestational Diabetes and Intraoperative Tubal Sterilization are Risk Factors for Pain After Cesarean Delivery: A Prospective Observational Study.

10.21203/rs.3.rs-116987/v1 ◽

2020 ◽

Author(s):

Patchareya Nivatpumin ◽

Pawinee Pangthipampai ◽

Sukanya Dej-Arkom ◽

Somkiat Aroonpruksakul ◽

Tripop Lertbunnaphong ◽

...

Keyword(s):

Gestational Diabetes ◽

Observational Study ◽

Pain Score ◽

Cesarean Delivery ◽

Severe Pain ◽

Prospective Observational Study ◽

Rating Scale ◽

Tubal Sterilization ◽

Number Of Patients ◽

Median Pain

Abstract Background: Postcesarean delivery pain leads to several adverse maternal outcomes. The primary objective of this study was to determine the incidence of moderate-to-severe pain after the use of spinal morphine for cesarean delivery. The secondary aim was to identify the factors influencing the moderate-to-severe pain.Methods: This prospective observational study was conducted at a single university hospital. The inclusion criteria were a patient age of ≥ 18 years, and undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine (200 mcg). Moderate-to-severe pain was defined as a numerical-rating-scale score of more than 3 within 24 hours postoperatively. Patients’ demographic characteristics, preoperative obstetric data, and intraoperative and postoperative data were collected and analyzed.Results: In all, 660 patients were enrolled. As 16 were subsequently removed because they met the study withdrawal criteria, data relating to 644 patients were analyzed. The incidence of moderate-to-severe pain during the first postoperative day was 451/644 patients (70.03%; 95% confidence interval [CI], 66.38%–73.44%). The median pain score (interquartile range [IQR]) was 5 (3–6), with 176/644 (27.33%) of patients requiring a rescue analgesic. A multivariate analysis revealed that two factors were associated with moderate-to-severe pain on the first postoperative day: gestational diabetes (adjusted OR [AOR], 1.849; 95% CI, 1.068–3.203; p-value = 0.028), and intraoperative tubal sterilization (AOR, 1.533; 95% CI, 1.060–2.218; p = 0.023). A significantly higher number of patients experienced moderate-to-severe pain on postoperative Day 1 (451/644 [70.03%]) than Day 2 (348/644 [54.19%]; p < 0.001). The median pain score (IQR) on postoperative Day 2 was 4 (3–5), which was less than that for Day 1 (p < 0.001).Conclusions: A high incidence of moderate-to-severe postoperative pain was found after a single dose of spinal morphine for cesarean delivery. Gestational diabetes and intraoperative tubal sterilization were the independent factors correlated with the pain.Trial registration: Clinicaltrial.gov registration number NCT03205813

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Pain Perception Associated with Mini-Implants and Interventions for Pain Management: A Cross-Sectional Questionnaire-Based Survey

BioMed Research International ◽

10.1155/2021/4842865 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Swapna Sreenivasagan ◽

Aravind Kumar Subramanian ◽

Abirami Selvaraj ◽

Anand Marya

Keyword(s):

Pain Management ◽

Pain Perception ◽

Rating Scale ◽

Cross Sectional Study ◽

Average Score ◽

Cross Sectional ◽

Mini Implants ◽

Pain Scores ◽

Shelf Region ◽

Female Subjects

Background. Orthodontists use mini-implants temporarily as an effective mode of skeletal anchorage devices. The placement of mini-implants can cause pain and discomfort to the patients. Patients often develop swelling, and the pain could interfere with their daily activities. Practitioners tend to prescribe antibiotics and pain medication for management. Objectives. The main objectives of this study are to evaluate the pain perception and discomfort due to mini-implant placement experienced by the patient and evaluate the interventions for pain management commonly practiced among orthodontists. Materials and Methods. The study was designed as a questionnaire-based cross-sectional study. A total of 271 patients were assessed, for whom 625 mini-implants (ranging from 1.2 to 2 mm diameter and length 8-14 mm) were placed. Pain scores were assessed using the VAS and the “Faces” pain rating scale to collect data about discomfort in daily activity and function. Data was collected from 244 patients. A total of 155 orthodontists were questioned regarding the prescription of medications and the interventions for managing pain and adverse effects. Results. Average pain score among female subjects was 16.71 and among men was 13.5. The highest pain scores were recorded for palatal mini-implants with an average score of 36.29 and the least for interradicular mini-implants with an average score of 9.02. Among the subjects, 47.9% of them took analgesics, and the most commonly prescribed analgesics were paracetamol (39%). Swelling at the site is where the mini-implants were placed, and ulceration due to implants were commonly dealt with the excision of the surrounding soft tissue, composite placement, and palliative care with oral analgesic gels. Conclusion. Female subjects had more mini-implants placed, and female subjects had also given more pain scores than their male counterparts. Palatal mini-implants caused the highest pain, followed by mini-implants placed at the infrazygomatic crest and the buccal shelf region. Palatal mini-implants caused maximum discomfort during speech and eating, followed by the mini-implant in the buccal shelf and the infrazygomatic crest region that also caused difficulty in yawning and laughing. Infiltration anesthesia was commonly given for the placement of interradicular implants and extra-alveolar mini-implants. Paracetamol was the most prescribed by the orthodontists, and more than half the doctors did not regularly prescribe antibiotics.

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Pattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20180372 ◽

2018 ◽

Vol 5 (2) ◽

pp. 662 ◽

Cited By ~ 2

Author(s):

Mohna M. Toro ◽

Sheetal John ◽

Atiya R. Faruqui

Keyword(s):

Observational Study ◽

Pain Score ◽

Severe Pain ◽

Prospective Observational Study ◽

Rating Scale ◽

Numerical Rating Scale ◽

Tertiary Care ◽

Patient Characteristics ◽

Post Operative Pain ◽

Surgery Department

Background: Previous studies on post-operative pain document that most patients continue to experience pain after surgery. This study was done to record the drug use for post- operative pain in laparotomy and to determine the patient characteristics that affect their pain score.Methods: A prospective observational study in 250 adult patients undergoing laparotomy surgery from General Surgery and Obstetrics and Gynaecology (OBG) at a tertiary care hospital.Results: Among patients recruited, 161 (64.4%) were females, 134 (53.6 %) from surgery department, mean age 37.29±14.9 years. Caesarean section 85 (73.27%) followed by meshplasty 46 (34.3%) were most common.Parenteral tramadol 100mg (40%) was the most common analgesic post-operative, subsequently shifted to oral. Epidural analgesia used in 31 (12.4%) patients, only from surgery department. First analgesic received within 6 hrs in 55.5 % in surgery and 44.5 % in OBG (Pearson χ2 =2.535, p = 0.111) with mean time to first analgesic 2.85±2.33 hrs. Pain score, using Numerical Rating Scale (NRS) recorded for 200 (80%) patients showed 76 (30.4%) had severe pain on day 1 which decreased to 12 (4.8%) on day 3. Speciality (p=0.01) and nature of surgery (p=0.05) were significantly associated with severity of pain. Gender [OR = 0.55 (95% CI = 0.26, 1.19), p=0.13], nature of surgery [2.32 (1.02, 5.32), p=0.05], speciality [0.35 (0.15, 0.80), p=0.01] and surgical category [0.76 (1.01, 5.32), p=0.05] affected pain score on univariate logistic regression, but were not significant on multivariate analysis.Conclusions: Despite the use of opioids and combination analgesics, one third of patients reported severe pain on the first day after surgery.

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