Abstract
At the Osaka National Hospital the day on which to extract an epidural anesthesia catheter is decided via a critical path. However deviation in the chosen day and problems with postoperative pain control suggested problems with the current critical path. To research these problems a survey questionnaire on pain control was prepared regarding six critical paths, including of the upper gastrointestinal tract, lower alimentary canal and laparoscopic cholecystectomy, which were carried out with postoperative pain control using epidural anesthesia. Results showed that patient satisfaction with laparoscopic cholecystectomy for pain control was high, that pain score and additional frequent use of painkiller were low and that complications overall were also low. On the other hand, regarding the other critical paths, patient satisfaction towards pain control was low, frequent painkiller use was high and pain score was also higher. Moreover, when the pain score was over “3” more than half of the cases required additional painkiller the extraction of an epidural anesthesia catheter was overdue in many of these case, and use painkiller increased after extraction.
In regard of these results the management methods in all critical paths other than laparoscopic cholecystectomy was changed by varying the quantity of epidural anesthesia and by extending the setting of the day when to extract the epidural anesthesia catheter. Afterwards the same questionnaire as before was given again and validity was verified.
As a result, although there was no big difference in the pain scores and the frequency of painkiller use compared to the results before the revision, patient satisfaction increased afterwards. Therefore, as a revision based on the results of variance analysis and postoperative pain management improved, the validity of the revision could be verified.
