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Introduction: Relief of postoperative pain is a major topic of public health and has been repeatedly shown to be inadequate., Study Design: A questionnaire survey performed in seven European countries (postoperative analgesic therapy observational survey) in 746 health structures--which perform more than 80% of the total number of surgical procedures of each country--has demonstrated significant improvement when compared with previous surveys, particularly regarding increased use of multimodal analgesia and regular administration of analgesic drugs. The present study describes specific results for the 178 French health care institutions surveyed and 345 questionnaires collected. Preoperative patient information is given on a regular basis for 84% of respondents., Results: Multimodal analgesia is used after major surgery in 87% of cases and prescribed on a regular basis for 84% of respondents. Written protocols are available in 36% of responding institutions. Pain scores are measured several times a day in 65% of institutions. An acute pain service (or any other structure with a similar aim) is found in 52% of institutions. Regular on-site training courses on pain control are delivered to 30% of anaesthesiologists, to 6% of surgeons, to 57% of recovery-room nurses and to 63% of ward nurses. Overall, the study suggests an improvement of current practices but also highlights remaining insufficiencies., Conclusion: Important efforts remain to be done, particularly in the field of initial and continuous education of all healthcare categories as this is believed to be the only real way to obtain long-term results.

Background: The French Society of Anaesthesia and Intensive Care has supported a national survey of postoperative pain (POP) management in various type of surgical centres., Methodology: The survey was cross-checking data on information, evaluation, treatment concerning POP of adult patient within 24h after surgery in surgical centres randomly selected according to teaching status, public or private funding and size. A local anaesthetist referent provided information on management of POP., Results: One thousand and nine hundred adult patients were audited. Information on POP was better understood in private centres. Rarely prescribed, written evaluation of POP was frequent on the ward (>90%) without any difference between centres. In all centres, POP evaluation tool were by decreasing frequency, numerical scale, nonspecific tool, visual analog scale and verbal scale. In all institutions, pain was rarely a criterion for recovery room discharge. Reported POP was mild at rest, moderate when moving and intense for maximal pain with no difference between centres. Incidence of side-effects was similar in all centres according to patient or chart, with mainly nausea and vomiting. Analgesics were frequently started during anaesthesia. Patient-controlled analgesia was used less frequently than subcutaneous morphine whose prescription frequently did not follow guidelines especially in small hospital. Non opioid analgesic included paracetamol, ketoprofen mainly in private structure and nefopam mainly in university hospital. Epidural or peripheral nerve blocks were underused similarly in all centres. Evaluation or treatment protocols were less frequent in university hospital., Conclusion: This national, prospective, patient-based, observational survey reveals similar achievements in different surgical centres but also some differences and persistent challenges for POP management.

Objective: To assess the impact of a pain management quality assurance program (PQAP) after abdominal surgery. The means used were mainly based on the French Society of anaesthesiology's pain management guidelines., Study Design: Prospective evaluation using a before after study design: two audits among surgical patients: a first one in 1997 before implementation of PQAP, and a second one year later., Patients and Methods: First, standards were defined including objectives about pain relief and patient satisfaction. After analysis of discrepancy observed between these objectives and the data of the first audit, a pain management program was introduced that included education of physicians, nurses and patients, systematic assessment of pain, organized pain relief protocols and implementation of modern analgesic technologies., Results: 201 consecutive inpatients were evaluated in the first audit, and 117 in the second one. Comparing the second audit with baseline, the visual analog pain scores decreased during the five postoperative days, and the rate of very satisfied patients increased (36% versus 26%). 43% of the patients were given a regular analgesic medication in 1998 versus 15% in 1997. 65% of medications were administered with an effective interval between doses versus 47% in 1997. Patient-controlled techniques were used in 28% of the cases in 1998 versus 9% in 1997., Conclusion: The PQAP provided an improvement in efficacy of postoperative pain management in our unit, with the help of the overall ward staff, but without requiring personnel specially qualified.

Unlabelled: Pain management has become a notable feature of public health policy and mass media communication in France over the past few years. To assess the evolution of the knowledge and attitudes of the French population with respect to pain management and morphine use, telephone surveys using similar questionnaires were conducted in 1990 (n = 1001) and 1996 (n = 1006). The proportion of respondents who would take pain management adequacy into consideration when selecting a surgical facility increased from 52% to 81% (P < 0.001), as did the proportion who associated morphine with pain treatment (from 44% to 80%; P < 0.001) or who would not be afraid of becoming addicted to morphine after it had been prescribed for pain relief (from 26% to 69%; P < 0.001). However, the proportion of respondents who agreed that morphine can be prescribed to patients with pain increased only slightly. In 1996, 58% of the respondents believed that their knowledge had improved over the past 5 yr and associated this improvement first with television, followed by written press articles and by interaction with physicians. Increased awareness of pain management possibilities among the public may generate increased demand on health professionals to provide adequate and precise information addressing each patient's needs., Implications: The results of two representative surveys conducted over a 6-yr interval show significant improvements of knowledge and attitudes regarding pain and its management in the French general population. However, these results point to the need for additional specific information that should be provided through patient-physician interactions.

Objective: The aim of this study was to assess the incidence and severity of postoperative pain in patients undergoing operations in various surgery clinics in the Assistance Publique des Hôpitaux de Paris (AP-HP) and to evaluate management of pain during the 24 hours following surgery., Methods: Data from surgical and anesthesia observation sheets and from patient complaints collected in a one-day external audit were obtained for 96 surgery clinics in the AP-HP., Results: At the time of surgery, most patients were receiving opioids, especially fentanyl: low dose ( < 1 microgram/kg/h) was given in 17.1% of the patients and regional anesthesia was used in 13%. In 95% of the cases, postoperative orders were written by anesthesiologists. Initial orders were modified according to patient response in 11.8% of the cases. "On demand" prescriptions were used in 10% of the orders. Patient controlled analgesia and regional analgesia were not routine techniques (2 and 0% respectively). Finally, 37.8% of the patients were given a single prescription of a step-1 drug (e.g. propacetamol i.v.), 25.9% a step-2 drug either alone or in combination with a step-1 drug, and 28.9% of the patients were given strong opioids at least once., Conclusions: For all types of drugs, dosage level was considered as correct in 86.5% of the cases. For approximately 10% of the opioid prescriptions, an ineffective dose was used. The interval between doses was too long in 54.1% of the prescriptions for at least one drug (e.g. for peripheral analgesia with propacetamol). The incidence of severe pain was 46.4%, especially after abdominal, high urologic and back surgery.