Résumé : A cost analysis comparing the direct medical costs of two analgesics protocols was carried out in an orthopedic surgery department. The two protocols were: intravenous propacetamol, ketoprofen, and nalbuphin (protocol I) or propacetamol, ketoprofen and oral morphin (protocol II). Patients were treated at the time of surgery and were thereafter administred during 48 h. The economical evaluation compared the direct medical costs associated with resources mobilized by each protocol.
Twenty-four patients were included in this study. The equivalence between the analgesic effect of the protocols was checked. There was no statistical difference between the side effects of both protocols. The time used by perfusion in protocol 1 was longer than protocol II (3 h versus 1,45 h). The evaluation of directs costs (drug, side effects, nursing time) showed a difference of 55.3 euros in favor of protocol II.
This study shows an important reduction of drug and nursing costs with oral morphine. Because they were administered during a short period, treatments were well tolerated.
In classic orthopedic surgery, post-surgical pain control with oral morphine seems to be a good alternative to intravenous protocols, with similar effectiveness, acceptable side effects incidence and simplification of nursing cares resulting in a significant cost reduction.