The First Postoperative Day

Guntinas‐Lichius, Orlando; Volk, Gerd Fabian; Zaslansky, Ruth; Meißner, Winfried

doi:10.1097/ajp.0000000000000050

Cited by 26 publications

(25 citation statements)

References 19 publications

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“…In accordance to the present study, preoperative pain counselling, no perioperative antibiotics (not analysed in the present study) and use of opioids on ward were associated with more postoperative pain in a univariate analysis performed in a previous prospective QUIPS single centre study on 65 patients after tonsillectomy [ 6 ]. Also two other small series in children using QUIPSI showed an association between (probably underdosed) opioid treatment on ward and more postoperative pain after otorhinolaryngological surgery [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, only patients were included when of the three NRS pain outcome measures at least the maximal pain score was available. Some of the patients were already included in a recent study comparing postoperative pain between 179 surgical procedures [ 5 ] or in a study comparing different otorhinolaryngological surgeries [ 7 , 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…The authors concluded that patients who undergo minor surgery perhaps are given less analgesia than needed. Two recent German studies with relative small sample size confirmed that postoperative pain is relevant but pain management may be is insufficient and needs improvement after tonsillectomy [ 6 – 8 ]. Nevertheless, not much is known about predictors for increased postoperative pain after tonsillectomy and there is no international standard pain therapy regime for children or adults after tonsillectomy.…”

Section: Introductionmentioning

confidence: 99%

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Inter-Hospital Variability of Postoperative Pain after Tonsillectomy: Prospective Registry-Based Multicentre Cohort Study

et al. 2016

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ObjectivesAlthough tonsillectomy is one of the most frequent and painful surgeries, the association between baseline and process parameters and postoperative pain are not fully understood.MethodsA multicentre prospective cohort study using a web-based registry enrolled 1,527 women and 1,008 men aged 4 to 85 years from 52 German hospitals between 2006 and 2015. Maximal pain (MP) score the first day after surgery on a numeric rating scale (NRS) from 0 (no pain) to 10 (MP) was the main outcome parameter.ResultsThe mean maximal pain score was 5.8±2.2 (median 6). Multivariable analysis revealed that female gender (Odds ratio [OR] = 1.33; 95% confidence interval [CI] = 1.12 to 1.56; p = 0.001), age <20 years (OR = 1.56; CI = 1.27 to 1.91; p<0.0001), no pain counselling (OR = 1.78; CI = 1.370 to 2.316; p<0.001), chronic pain (OR = 1.34; CI = 1.107 to 1.64; p = 0.004), and receiving opioids in recovery room (OR = 1.89; CI = 1.55 to 2.325; p<0.001) or on ward (OR = 1.79; CI = 1.42 to 2.27; p<0.001) were independently associated with higher experienced maximal postoperative pain (greater the median of 6). The effect of age on pain was not linear. Maximal pain increased in underage patients to a peak at the age of 18 to 20 years. From the age of ≥20 years on, maximal pain after tonsillectomy continuously decreased. Even after adjustment to all statistically important baseline and process parameters, there was substantial variability of maximal pain between hospitals with a heterogeneity variance of 0.31.ConclusionMany patients seem to receive insufficient or ineffective analgesia after tonsillectomy. Further research should address if populations at risk of higher postoperative pain such as females, younger patients or those with preexisting pain might profit from a special pain management protocol. Beyond classical demographical and process parameters the large variability between different hospitals is striking and indicates the existence of other unknown factors influencing postoperative pain after tonsillectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inter-Hospital Variability of Postoperative Pain after Tonsillectomy: Prospective Registry-Based Multicentre Cohort Study

et al. 2016

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“…The QUIPS questionnaires are presented in detail elsewhere [10]. Briefly, the QUIPS questionnaires consisted of two parts for each patient: This first part was covering the patient-reported outcome (PRO) parameters of the questionnaire, whereas the second part was filled by the investigator.…”

Section: Pain and Pain Management Measuresmentioning

confidence: 99%

“…Even though patients receive such a combination therapy postoperative pain after tonsillectomy remains at a high level and an improved therapy plan is needed [8,9,10].…”

Section: Introductionmentioning

confidence: 99%

The effect of adjuvant oral application of honey in the management of postoperative pain after tonsillectomy in adults: A pilot study

et al. 2020

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Objective To analyze the effect of adjuvant oral application of honey for treating postoperative pain after tonsillectomy. Design Single centre prospective cohort study. Setting Two cohorts of patients after tonsillectomy. Participants 56 patients treated with honey 8 times per day (honey group), 18 patients treated without honey (control group); baseline analgesia were non-steroidal anti-inflammatory drugs (NSAID) or coxibs; opioids were used as pro re nata (PRN) medication; mean age 34.4 ± 13.4 years; 36% women. Main outcome measures On first to fifth postoperative day, patients rated their pain using the validated questionnaire of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including a numeric rating scale (NRS, 0-10) for determination of patient's pain. QUIPS allows standardized assessment of patients' characteristics andpain-associated patientreported outcomes (PROs). The influence of preoperative and postoperative parameters on patients' postoperative pain were estimated by univariate and multivariate statistical analysis.

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Postoperative Pain Treatment With Continuous Local Anesthetic Wound Infusion in Patients With Head and Neck Cancer

Gostian

Loeser

Albert

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Up to 80% of patients with head and neck cancer undergoing ablative surgery and neck dissection develop postoperative pain with detrimental effects on quality of life that also contributes to neuropathic and chronic postoperative pain.OBJECTIVE To investigate the association of continuous local anesthetic wound infusion with pain management after head and neck surgery.DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal, nonrandomized clinical study carried out in a single tertiary referral center (December 1, 2015, to July 1, 2017) included 2 groups of 30 patients. Patients were consecutively enrolled and presented for ablative head and neck surgery including selective neck dissection and studied from the preoperative through the fourth postoperative day. INTERVENTIONSThe control group was treated according to a standardized escalating oral treatment protocol (ibuprofen, metamizole, opioids). The intervention group was treated with an intraoperatively applied pain catheter (InfiltraLong plus FuserPump, Pajunk, ropivacaine, 0.2%, 3 mL/h) that was removed 72 hours after operating. MAIN OUTCOMES AND MEASURESAverage and maximum pain intensities on a numeric rating scale; quality of life using the acute version of the validated 36-Item Short Form Survey; and neuropathic pain using the validated 12-Item painDETECT questionnaire. Consumption of opioid and nonopioid analgesics and evaluation of catheter-associated complications. RESULTS Duringpostoperative days 1 through 4, patients of the intervention group (mean [SD] age, 63.2 [13.3 years; 9 [30%] women) experienced lower mean (SD) (1.6 [1.4] vs 2.7 [1.8]; η 2 p = 0.09 [0.01-0.21]) and maximum (2.4 [2.2] vs 4.2 [2.0]; η 2 p = 0.11 [0.01-0.24]) pain intensities compared with the control group (mean [SD] age, 62.5 [13.6] years; 5 [17%]women). The intervention group also reported less neuropathic pain (mean [SD], 5.4 [3.4] vs 7.6 [5.1]; η 2 p = 0.09 [0.004 -0.22]) and higher quality of life regarding vitality (56.2 [21.5] vs 43.8 [20.9], r = 0.29; 95% CI, 0.01-0.52) and pain (66.8 [27.3] vs 49.5 [27.7], r = 0.31; 95% CI, 0.04-0.54). Patients from the intervention group requested nonopioid analgesics considerably less often (n = 17 [57% ]vs n = 29 [97%]; = 0.47; 95% CI, 0.30-0.67) associated with a noticeably lower need to escalate pain treatment (n = 3 [10%] vs n = 9 [30%]; mean [SD] ibuprofen dose: 500 [173] mg vs 1133 [650] mg; r = 0.64; 95% CI, 0.02-0.91). No catheter-associated complications were observed.CONCLUSIONS AND RELEVANCE Continuous anesthetic wound infusion is associated with reduced postoperative pain and decreased demand for analgesics. It therefore expands the treatment options for postoperative pain in head and neck cancer.

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The First Postoperative Day

Abstract: Analgesia and perioperative pain management in otorhinolaryngologic surgery seems to be highly variable. After otorhinolaryngologic surgery many patients seem to receive less analgesia than needed or ineffective analgesic drug regimes.

Cited by 26 publications

References 19 publications

Inter-Hospital Variability of Postoperative Pain after Tonsillectomy: Prospective Registry-Based Multicentre Cohort Study

Inter-Hospital Variability of Postoperative Pain after Tonsillectomy: Prospective Registry-Based Multicentre Cohort Study

The effect of adjuvant oral application of honey in the management of postoperative pain after tonsillectomy in adults: A pilot study

Postoperative Pain Treatment With Continuous Local Anesthetic Wound Infusion in Patients With Head and Neck Cancer

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