British Journal of Anaesthesia, 2000, Vol. 84, No. 2 270P-271p
© 2000 Oxford University Press
Abstract |
Does self-administered premedication improve patient acceptability of day-case surgery?
1 Royal Preston Hospital, Preston, UK
Abstract
Day-case surgery for minor gynaecological procedures has been routine in Preston for many years, but are patients still unnecessarily apprehensive in the time leading up to surgery? Giving patients self-administered premedication, however, may delay discharge home and patients might not actually like the tablets, or their amnesic effects at home.
Gynaecological day-case patients recruited for our previous presentation were allocated randomly to one of four premedication groups, as shown in Table 2. All were available for telephone contact and were interviewed on the first day after operation. They were asked about their well being, sleep the night before (better/same/worse), recall, pain, nausea and vomiting and whether they would have the tablets again (yes/no). We also noted the time of operation. Seventeen additional patients were excluded because of failure to contact or for administrative reasons.
Our premedication did not affect time to discharge. No patient reported problems with recall at home and there was a very low incidence of postoperative pain, and nausea and vomiting. There was no significant difference in quality of sleep on the night before operation between groups (Kruskal–Wallis). However, combining both groups who had some medication the night before (LP+LL) showed a significant improvement in sleep compared with the two other groups combined (PP+PL) who only had night-time placebo, regardless of morning medication.
There was no correlation between quality of sleep and anxiety (data from previous presentation) in any group or the whole study population (P=0.4; Spearman). Our patients had their operations throughout the morning and afternoon but interestingly, there was no correlation (P=0.5) between anxiety and time of operation. A higher dose of medication than we used is probably not appropriate for day-case patients, but a small dose of premedication the night before in day-case patients may have some benefit, rather than medication on the morning of surgery.