Patients' views have been surveyed

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6984.937a (Published 08 April 1995) Cite this as: BMJ 1995;310:937
  1. P A Mallinder,
  2. S M Bonner,
  3. K M Lawler,
  4. C Sin Clair,
  5. C Dodds
  1. Registrar in anaesthesia Registrar in anaesthesia Sister in pain control Sister in pain control Consultant anaesthetist Department of Anaesthesia, South Cleveland Hospital, Middlesbrough TS4 3BW

    EDITOR,—We are concerned that the anaesthetist who inserted a diclofenac suppository into a patient under general anaesthesia without her prior consent was found guilty of serious professional misconduct.1 Non-steroidal anti-inflammatory drugs are particularly effective in relieving pain after dental extractions.2 Suppositories are widely used by anaesthetists for postoperative analgesia. They have several advantages over injectable forms, having a longer duration of action, cost benefits, and a lack of side effects related to injection itself. This is particularly relevant to the intramuscular injection of diclofenac.3 While specific verbal consent is usually obtained in our hospital, this is not universal.

    Evidence from expert witnesses in court pointed out that objection to the use of suppositories is, in their experience, extremely rare.1 It was also noted that, before this case, no source had ever given guidance on obtaining consent for the use of a suppository, and there was debate over the relative degree of personal invasion between a suppository and an intramuscular injection into the buttock.

    In view of this, we asked our patients their opinions on the acceptability of suppositories for postoperative analgesia. We devised a simple questionnaire and visited 112 consecutive patients preoperatively, selected from different specialties, over two weeks; none had received premedication. Seventy eight of the patients were female. Although 96 patients had no objections to a suppository being inserted while they were under general anaesthesia, 63 said that they would want to know preoperatively that this would be done. One hundred and eleven patients had no objections to the use of an intramuscular injection, but 40 said that they would still like to know preoperatively.

    This study shows that the use of analgesic suppositories is well accepted by our patients. Suppositories are, however, less acceptable than an intramuscular injection, and many of our patients said that they would like prior discussion before the insertion of a suppository. There is a large difference between having a suppository inserted in an operating theatre and while fully dressed in a dentist's chair. Our hope is that this case will not undermine the use of a simple, well established, and effective technique providing postoperative analgesia.


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