Postoperative pain remains a significant concern in surgical care and, if inadequately managed, can lead to complications and delayed recovery [1]. Pain is a subjective experience influenced by several factors including type of surgery, patient age, gender, and psychological status [2–4]. The World Health Organization and multiple national guidelines emphasize a multimodal analgesic approach to optimize pain relief while minimizing opioid-related side effects [5–7].

Opioids like tramadol and morphine are mainstays of moderate to severe pain management [8], but their long-term use is associated with tolerance, dependence, and adverse effects [9,10]. Hence, combining opioids with non-opioids such as paracetamol or NSAIDs is advocated to enhance analgesic effects and reduce opioid requirements [11–13].

Paracetamol has been widely used as a first-line agent due to its favorable safety profile [14]. NSAIDs, including diclofenac and etoricoxib, provide anti-inflammatory benefits but come with risks of gastrointestinal and renal complications [15–17].

Pain assessment tools like the Numeric Rating Scale (NRS) offer reliable means to quantify pain intensity [18]. Studies have demonstrated that regular monitoring of NRS scores helps in tailoring analgesic regimens and improving patient satisfaction [19,20].

Despite the availability of guidelines, practices vary widely between institutions and among practitioners [21,22]. Therefore, continuous audit and analysis of analgesic use and pain outcomes are necessary to inform better pain management protocols [23–25].

This study aims to assess the types of analgesics used in postoperative care and their impact on pain scores over 48 hours, with particular focus on comparing elective and emergency surgical cases.

A hospital-based observational study was conducted to assess the use of analgesics and the trend of postoperative pain scores among patients undergoing elective and emergency surgeries. The study included 100 patients who underwent surgery and received postoperative analgesic management at a tertiary care centre. Patients were selected based on predefined inclusion and exclusion criteria.

Inclusion Criteria:

• Adult patients aged 18 years and above
• Patients undergoing either elective or emergency surgery
• Patients willing to provide informed consent
• Patients who were conscious and able to report pain using the Numeric Rating Scale (NRS)

Exclusion Criteria:

• Patients with impaired cognitive function or communication difficulties
• Patients with chronic pain conditions already on analgesic therapy
• Patients who were re-operated within the 48-hour study period

Data Collection: A structured data collection form was used to record:

• Demographic details (age, gender)
• Type of surgery (elective or emergency)
• Type and combination of analgesics administered
• Pain scores at 6, 12, 24, and 48 hours postoperatively using the Numeric Rating Scale (NRS), where 0 indicates no pain and 10 indicates the worst possible pain

Analgesics used were categorized as opioid and non-opioid. Specific drugs included Tramadol, Paracetamol, Diclofenac, Pethidine, and Etoricoxib, with some patients receiving combinations such as Tramadol + Paracetamol.

Statistical Analysis: Descriptive statistics were used to analyze the data. The mean and standard deviation were calculated for age and NRS scores at different time points. Frequencies and percentages were calculated for categorical variables such as gender, type of surgery, and type of analgesic used.

Ethical clearance was obtained from the Institutional Ethics Committee prior to the initiation of the study, and informed consent was obtained from all participants.

Table 1   Gender

Of the 100 patients considered for this study, more than one-third patients (38 %) were male and nearly two-third patients (62 %) were female.

Table 2   Mean Age

Mean Age of the patients considered for this study was found to be 38.26 with a standard deviation of 13.46.

Table 3   Type of Surgery

Of the 100 patients present in this study, majority of the patients (61 %) underwent Elective Surgeries while Emergency Surgeries were performed on (39%) of the patients.

Table 4   Type of Analgesic

All of the patients considered for this study (100 %) received Opioid Analgesics while Non-Opioid Analgesics were given to most of the patients (90 %).

Table 5   Analgesic Drug

All of the patients present in this study (100 %) were given Tramadol and Paracetamol. More than one-third of the patients (38 %) received Diclofenac while an almost equal number of patients (36 %) were given Pethidine. The combination of Tramadol + Paracetamol was given to about one-fourth of the patients (26 %) while only (4 %) patients were given Etoricoxib.

Table 6   Mean NRS Score

The Mean NRS Scores along with Standard Deviation were deduced for follow up time periods of 6 hours, 12 hours, 24 hours and 48 hours. After 6 hours, Mean NRS was found to be 7.91 ± 1.12. After 12 hours, Mean NRS was 7.64 ± 1.08. After 24 hours, Mean NRS was 7.12 ± 1.43 while the Mean NRS after 48 hours was found to be 5.08 ± 1.12.

Postoperative pain is a common problem after surgery and can affect how comfortable patients feel, how quickly they recover, and their overall health outcomes. Managing this pain well helps patients feel better, move around sooner, leave the hospital earlier, and lowers the chance of long-term pain. These days, doctors often use a mix of opioid and non-opioid painkillers to provide better pain relief while reducing side effects. The present study aimed to evaluate the use of analgesic medications and the trend in pain scores postoperatively over a 48-hour period in patients undergoing elective and emergency surgeries.

In the present study, out of 100 patients, 62% were females and 38% were males. This higher representation of females may reflect the general trend in surgical demographics reported in previous studies, where certain elective procedures are more frequently opted for by women [26]. A similar gender pattern was observed by Kaur et al. in their study on postoperative pain assessment, where females constituted 60% of the sample size [27]. It is also noteworthy that female patients often report higher pain scores postoperatively compared to males, which might be due to differences in pain perception and response to analgesics [28].

The mean age of the patients in this study was 38.26 years, with a standard deviation of 13.46. This age profile is consistent with other postoperative pain studies, which often report a wide age range among surgical patients, with means falling between the third and fifth decades of life [29]. For instance, Chou et al. reported a mean age of 40.3 years in their cohort undergoing general and orthopedic procedures [30]. Age can influence pain perception and response to analgesics, highlighting the need for age-adjusted pain management protocols [31].

Elective surgeries accounted for 61% of the cases, while emergency surgeries made up 39%. Similar trends were observed in a study by Sharma et al., where 64% of the patients underwent elective procedures [32]. Elective surgeries are typically better planned with preoperative pain management strategies in place, which may affect both analgesic use and pain outcomes. Emergency surgeries, conversely, often lead to higher pain scores postoperatively due to the urgent nature of the intervention and the patient’s pre-existing stress and anxiety levels [33].

All patients in the study received opioid analgesics, while 90% also received non-opioid analgesics. The high use of multimodal analgesia (combining opioid and non-opioid agents) is in line with current postoperative pain management guidelines that recommend opioid-sparing strategies to reduce the risk of side effects while maintaining adequate pain control [34]. This practice is consistent with findings by Joshi et al., who reported that 85% of patients received combination therapy for postoperative pain [35].

Tramadol and Paracetamol were administered to 100% of patients. Diclofenac and Pethidine were also widely used (38% and 36%, respectively), while Etoricoxib was administered to a smaller subset (4%). The popularity of Tramadol and Paracetamol aligns with WHO recommendations for managing moderate to severe postoperative pain [36]. The use of Pethidine, though effective, is declining due to its side-effect profile and potential for accumulation and toxicity [37]. The use of Etoricoxib in a small percentage of patients might be due to its COX-2 selectivity, making it a suitable choice for patients at risk of gastrointestinal complications [38].

Pain scores were assessed using the Numeric Rating Scale (NRS) at 6, 12, 24, and 48 hours postoperatively. The scores showed a gradual decline: 7.91 at 6 hours, 7.64 at 12 hours, 7.12 at 24 hours, and 5.08 at 48 hours. This trend reflects effective postoperative pain control over time, especially when multimodal analgesia is employed. A study by Apfelbaum et al. demonstrated a similar trajectory of decreasing pain scores over 48 hours following adequate analgesic administration [39]. However, early high NRS scores indicate a need for better pain control in the immediate postoperative period, potentially via pre-emptive analgesia or patient-controlled analgesia (PCA) [40].

This study highlights the importance of effective postoperative pain management in both elective and emergency surgical patients. The findings revealed that all patients received opioid analgesics, with a majority also receiving non-opioid drugs, reflecting the growing use of multimodal analgesia. Tramadol and Paracetamol were universally used, while Diclofenac, Pethidine, and Etoricoxib were also included as part of pain control strategies.  Pain scores were highest during the early postoperative period and gradually decreased over 48 hours, demonstrating the effectiveness of the analgesic regimen. However, the high initial pain scores suggest a need for enhanced pain control in the immediate postoperative phase.  Overall, this study supports the routine use of multimodal analgesia to ensure better postoperative outcomes and patient comfort. Further research involving a larger sample size and comparative analysis of different analgesic combinations could provide more insights into optimizing postoperative pain management protocols.

Ethical Clearance: Ethical Clearance Certificate was obtained from the Institutional Ethics Committee (IEC) prior to commencement of study

Conflict of Interest: Nil - No conflict of interest

Source of funding: Self

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