Predicting Acute Pain After Surgery

Abstract

Objectives: To identify perioperative practice patterns that predictably impact postoperative pain. Background: Despite significant advances in perioperative medicine, a significant portion of patients still experience severe pain after major surgery. Postoperative pain is associated with serious adverse outcomes that are costly to patients and society. Methods: The presented analysis took advantage of a unique observational data set providing unprecedented detailed pharmacological information. The data were collected by PAIN OUT, a multinational registry project established by the European Commission to improve postoperative pain outcomes. A multivariate approach was used to derive and validate a model predictive of pain on postoperative day 1 (POD1) in 1008 patients undergoing back surgery. Results: The predictive and validated model was highly significant (P = 8.9E-15) and identified modifiable practice patterns. Importantly, the number of nonopioid analgesic drug classes administered during surgery predicted decreased pain on POD1. At least 2 different nonopioid analgesic drug classes (cyclooxygenase inhibitors, acetaminophen, nefopam, or metamizol) were required to provide meaningful pain relief (>30%). However, only a quarter of patients received at least 2 nonanalgesic drug classes during surgery. In addition, the use of very short-acting opioids predicted increased pain on POD1, suggesting room for improvement in the perioperative management of these patients. Although the model was highly significant, it only accounted for a relatively small fraction of the observed variance. Conclusion: The presented analysis offers detailed insight into current practice patterns and reveals modifications that can be implemented in today's clinical practice. Our results also suggest that parameters other than those currently studied are relevant for postoperative pain including biological and psychological variables.

‘Desire for more analgesic treatment’: pain and patient-reported outcome after paediatric tonsillectomy and appendectomy

“…For tonsillectomies, an interesting result not previously reported for children was the use of different classes of non-opioid analgesics given as a preventive dose, which seemed to improve patient-reported outcome. 11 Not receiving a preventive non-opioid analgesic was associated with an increased desire for more pain medication, higher opioid doses, more adverse events, and more pain-related interference.…”

“…18e21 A study in adults showed a dose-dependent association between the preventive use of non-opioid analgesics and postoperative pain scores, a finding which could be confirmed in our tonsillectomy group. 11 Some previous trials underlined that the addition of paracetamol to an NSAID did not always improve analgesia compared with an NSAID alone. 18e21 For metamizole, data on efficacy are scarce, specifically on the combinations with other non-opioid classes, as it is not marketed in all countries.…”

Perioperative Schmerztherapie mit Nichtopioidanalgetika

“…Ein eventueller Vorteil einer prä- und intraoperativen Gabe mehrerer NOPA unterschiedlicher Substanzgruppen wurde bis jetzt kaum systematisch untersucht, obwohl dieses Vorgehen in der klinischen Praxis weit verbreitet ist [ 70 ]. Aktuelle Registerdaten von über 1000 Patienten nach Rückenoperationen bestätigten eine bessere Analgesie bei intraoperativer Gabe von zwei oder sogar drei NOPA verschiedener Substanzgruppen (NSAID, Metamizol, Paracetamol) im Vergleich zu keinem oder nur einem NOPA [ 7 ]. Auch bei Kindern nach Tonsillektomien und Appendektomien war die intraoperative Gabe von mindestens zwei NOPA mit weniger Wunsch nach Schmerzmitteln für die ersten 24 h postoperativ assoziiert im Vergleich zu keinem oder einem NOPA [ 84 ].…”

Relationship between Preoperative Lower Back Pain and Severe Postoperative Pain after Gynecologic Laparoscopy: A Prospective Observational Study

“…Although laparoscopic surgery has advantages such as enhanced postoperative recovery and decreased hospital stay in comparison with open surgery [ 1 , 2 ], the incidence of moderate-to-severe acute postoperative pain, especially in the recovery room, remains up to 70% [ 3 , 4 ]. Moreover, pain intensities vary even after the same surgery, which suggests the need for individual evaluation of risk factors for postoperative pain [ 5 , 6 ].…”