Defining trajectories of acute pain in surgical patients short title: acute pain follow-up

Abstract

SUMMARY INTRODUCTION: Assessment of acute postoperative pain is mandatory for effective treatments. Pain trajectories may help professionals improve treatments. It has been suggested that uncontrolled pain in the immediate postoperative period generates higher pain intensities on the following days of hospital stay. OBJECTIVE: To determine the relationship between pain during the first postoperative hour and the first 24 postoperative hours. METHODS: Setting: a general university hospital. Study design: a prospective observational, analytical study of patients undergoing surgical procedures under general anesthesia and hospitalized for at least 24 hours. Five assessments of pain were carried out during the first hour in the recovery room followed by three assessments during the first 24 hours. The slopes of pain trajectories were calculated, and the relationship between them was analyzed. RESULTS: 234 patients were recruited, 31.3% had uncontrolled pain on arrival at the recovery room; at the end of the first 24 hours after surgery, 5.5% of the patients had uncontrolled pain. The first pain intensity score in the recovery room correlated negatively with the slope for the first hour (P1): rS = −0.657 (p = 0.000). Similarly, the first pain intensity score had a negative association with the pain trajectory slope during the hospital stay (P2): rS = −0.141 (p = 0.032). When comparing the two slopes, a nonsignificant negative correlation was found: rS = −0.126. CONCLUSIONS: the trajectory of pain during the first hour does not predict the behavior of the trajectory during the first day after surgery.

A Bibliometric Analysis of Published Literature in Postoperative Pain in Elderly Patients in Low- and Middle-Income Countries

“…Postoperative pain (POP) remains a major challenge for surgeons and anesthesiologists worldwide, especially in low- and middle-income countries, due to important limitations, such as technological and human resources and availability of analgesics [ 1 , 2 , 3 , 4 ]. POP incidence available in the literature usually reflects data from specific surgeries or reflects regional realities and, therefore, presents great variability, showing averages ranging from 14–62% [ 1 , 2 , 5 , 6 ].…”

“…POP incidence available in the literature usually reflects data from specific surgeries or reflects regional realities and, therefore, presents great variability, showing averages ranging from 14–62% [ 1 , 2 , 5 , 6 ]. When looking for data from low- and middle-income countries, these numbers are scarce and frequently come from single-center or small samples studies [ 1 , 2 , 4 , 7 ].…”

Monitorização Anestésica

“…Tal dado é interessante tendo em vista que o uso da anestesia é um procedimento médico que visa bloquear temporariamente a capacidade do cérebro de reconhecer justamente o estímulo doloroso (AMERICAN SOCIETY OF ANESTHESIOLOGISTS, 2021). Nesse contexto, em estudo feito na Colômbia com 234 pacientes, um terço chegou à SRPA com dores insuportáveis, sendo que apenas quatro em cada 10 pacientes haviam recebido alívio adequado da dor ao chegar na SRPA (LECOMPTE et al 2019). Já um estudo feito na Turquia, com pacientes sujeitos a nefrectomia para doação de rim, indicou que a ansiedade pré-operatória piora o tempo de recuperação e aumenta escores de dor pós-operatória (TURKSAL et al, 2020).…”

“…Analisando as formas descritas de controle da dor pós-anestésica, os estudos citam principalmente a administração de morfina (LECOMPTE et al, 2019;TURKSAL et al, 2020). A morfina é um opioide forte, muito utilizada no tratamento da dor de múltiplas etiologias, e deve ser oferecida em intervalos regulares, de acordo com a duração do efeito analgésico, e não utilizada somente "conforme necessário".…”

Preemptive analgesia role of intravenous diclofenac in abdominal hysterectomy under general anesthesia in a limited resource settings: A prospective cohort study

“…Inadequately managed pain would have signi cant clinical, psychological, and economic implications. Evidence suggests that more than 50% of surgical patients reported inadequate postoperative pain relief that might end up in a negative effect on the quality of life and various organ systems [4][5][6][7].…”