Clinical performance and quality health care
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Clin Perform Qual Health Care · Jan 2000
Comparative StudyIntroducing ropivacaine into a department's epidural analgesic practice. Improving acute pain service practice.
The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2 mg/ml (R), or the mixtures in current use: fentanyl 5 (micrograms/ml with bupivacaine 1 mg/ml (BF5) and fentanyl 10 (micrograms/ml) with bupivacaine 1 mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied. ⋯ Older patients demanded less analgesia (p < 0.001). Postoperatively BF5 provided better pain relief with trends demonstrating fewer side-effects and complications than BF10 or R. We now use fentanyl 5 (micrograms/ml and bupivacaine 1 mg/ml as our standard epidural infusion mixture.
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The pre-operative anaesthetic records of 195 patients were analysed for the presence of 12 agreed core items of pre-operative assessment. This study showed that anaesthetists recorded 26.8 per cent of this information. In up to one-third of patients the following were recorded: smoking history, family history, gastro-oesophageal reflux, airway assessment, dental assessment, chest examination, heart-sounds and blood pressure. ⋯ With a view to improving the level of record-keeping, a formatted, pre-printed pre-operative assessment record was introduced into practice and two months later the audit was repeated. A small but non-significant improvement in record keeping was observed. An argument is made for the introduction of an interdisciplinary, unified anaesthetic pre-operative record.