Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm

Abstract

BackgroundAcute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.MethodsThis was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.ResultsA total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%–37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.ConclusionModerate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.Trial registration numberRoPR ID 43191.

Intraoperative Methadone in Next-day Discharge Outpatient Surgery: A Randomized, Double-blinded, Dose-finding Pilot Study

“…24,25 This finding is consistent with observations that many seemingly minor- to medium-level procedures do cause substantial pain, and laparoscopic surgery may not cause less pain than open surgery. 43–45…”

Virtual Pain Unit Is Associated with Improvement of Postoperative Analgesia Quality: A Retrospective Single-Center Clinical Study

“…[ 15 ] from the University of Florida in the USA showed that 63% of patients experienced moderate to severe pain within seven days postoperatively. Likewise, a large-scale multicenter study from Denmark [ 16 ] exhibited that 20% of patients experienced moderate to severe pain immediately after awakening. After the development of APS 30 years ago, the implementation has improved postoperative analgesia quality tremendously.…”

The OPI•AID Zone Tool as a composite outcome for postoperative pain management quality—A protocol for an observational pilot study

“…1 Despite optimized multimodal analgesia, a vast majority of the more than 300 million surgeries, that are performed annually, still result in moderate to severe postoperative pain. 2 Pain can be managed by increasing opioid doses. However, this is accompanied by an increased risk of opioidrelated adverse drug events (ORADEs), ranging from mild nausea to life-threatening respiration depression.…”

“…Balanced doses of opioids are crucial to ensure adequate and safe pain relief for patients in the postoperative setting 1 . Despite optimized multimodal analgesia, a vast majority of the more than 300 million surgeries, that are performed annually, still result in moderate to severe postoperative pain 2 . Pain can be managed by increasing opioid doses.…”