Pain after Cardiac Surgery

2006 ◽  
Vol 105 (4) ◽  
pp. 794-800 ◽  
Author(s):  
Pasi Lahtinen ◽  
Hannu Kokki ◽  
Markku Hynynen
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Scale Score ◽  
Severe Pain ◽  
Rating Scale ◽  
Artery Bypass ◽  
Numeric Rating Scale ◽  
Persistent Pain ◽  
Numeric Rating Scale Score ◽  
Numeric Rating

Background Persistent chest pain may originate from cardiac surgery. Conflicting results have been reported on the incidence of persistent poststernotomy pain with considerable discrepancies between the retrospective reports and the one prospective study conducted to assess this pain. Therefore, the authors conducted a follow-up survey for the first 12 months after cardiac surgery in 213 patients who had a sternotomy. Methods The authors performed a prospective inquiry of acute and chronic poststernotomy pain both before and after cardiac surgery. Two hundred thirteen coronary artery bypass patients received a questionnaire preoperatively, 4 days postoperatively, and 1, 3, 6, and 12 months postoperatively. All patients were asked about their expectations, their preferences, and the location and intensity of postoperative pain. Results The return rates for the postal questionnaires were 203 (95%) and 186 (87%) after 1 and 12 months, respectively. Patients experienced more pain postoperatively at rest than they had expected to preoperatively. At rest, the worst actual postoperative pain was 6 (0-10), and the worst expected pain as assessed preoperatively was 5 (0-10) (P = 0.013). The worst reported postoperative pain was severe (numeric rating scale score 7-10) in 49% at rest, in 78% during coughing, and in 62% of patients on movement. One year after the operation, 26 patients (14%) reported mild chronic poststernotomy pain at rest, 1 patient (1%) had moderate pain, and 3 patients (2%) had severe pain. Upon movement, persistent pain was even more common: 45 patients (24%) had mild, 5 patients (3%) had moderate, and 7 patients (4%) had severe pain. Patients who experienced moderate to severe acute postoperative pain also reported any chronic poststernotomy pain (numeric rating scale score 1-10) more frequently. Conclusions Although common, the incidence of persistent pain after sternotomy was lower than previously reported. Also, reassuringly, 1 year after surgery this pain was mostly mild in nature both at rest and on movement.

Postoperative Pain and Age: A Retrospective Cohort Association Study

2021 ◽  
Author(s):  
Jacqueline F. M. van Dijk ◽  
Ruth Zaslansky ◽  
Regina L. M. van Boekel ◽  
Juanita M. Cheuk-Alam ◽  
Sara J. Baart ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Retrospective Cohort ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
The Elderly ◽  
Numeric Rating Scale ◽  
Opioid Administration ◽  
Patient Reported ◽  
Numeric Rating

Background As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors’ clinical experience, they hypothesize that pain scores are lower in older patients. Methods In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. Results A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; β = –0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. Conclusions The authors’ findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Pain Intensity on the First Day after Surgery

2013 ◽  
Vol 118 (4) ◽  
pp. 934-944 ◽  
Author(s):  
Hans J. Gerbershagen ◽  
Sanjay Aduckathil ◽  
Albert J. M. van Wijck ◽  
Linda M. Peelen ◽  
Cor J. Kalkman ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Surgical Procedures ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Numeric Rating Scale ◽  
Treatment Needs ◽  
Pain Scores ◽  
Numeric Rating

Abstract Background: Severe pain after surgery remains a major problem, occurring in 20–40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0–10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6–7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many “minor” surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of “major” abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia. Conclusions: Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.

Baseline endometriosis-associated pain burden: Data from 1600+ women enrolled in elagolix clinical trials

2019 ◽  
Vol 11 (3) ◽  
pp. 117-125 ◽  
Author(s):  
Nicholas Leyland ◽  
Stephanie J Estes ◽  
Samantha Eichner ◽  
Ahmed M Soliman ◽  
Yabing Mai ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Pelvic Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Phase 3 ◽  
Double Blind ◽  
Scale Range ◽  
Study Participants ◽  
Numeric Rating Scale Score ◽  
Numeric Rating

Background: The daily pain burden experienced by women with endometriosis has not been well studied. Objective: To characterize baseline pain among women with moderate-to-severe endometriosis-associated pain enrolled in phase 3 studies of elagolix, an oral, nonpeptide gonadotropin-releasing hormone antagonist. Study design: Data were pooled from the screening phase of two randomized, double-blind, placebo-controlled clinical trials. After cessation of endometriosis medications, patients entered the screening phase during which symptoms (dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia) and rescue medication use were recorded daily in electronic diaries. Endometriosis-associated pain was also scored using the Numeric Rating Scale (range 0–10). Baseline was defined as the last 35 days during the screening period. Results: Endometriosis-associated pain was reported by the 1686 study participants on most days during the baseline interval. Pain was often moderate or severe, with a mean Numeric Rating Scale score of 5.6 ± 1.7. Women reported dysmenorrhea an average of 8.1 ± 3.0 days (97.9% ± 7.0% of menstruating days), nonmenstrual pelvic pain on 20.5 ± 5.4 days (90.3% ± 15.8% of nonmenstruating days), and dyspareunia on 8.7 ± 8.0 days (81.7% ± 29.7% of sexually active days). When they occurred, dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia were frequently moderate or severe in intensity. Women were free of pelvic pain for an average of 2.4 ± 3.9 days during the 35-day evaluation interval. Conclusion: Among women with untreated moderate-to-severe endometriosis pain, the daily burden of pain was extensive, both during menstruation and on nonmenstruating days.

scholarly journals Effectiveness of Ketoprofen Suppositoria as Preemptive Analgesia for Postoperative Pain in Patients Undergoing Elective Surgery with General Anesthesia

2020 ◽  
Vol 2 (1) ◽  
pp. 20
Author(s):  
Lupi Lestari ◽  
Elizeus Hanindito ◽  
Arie Utariani
Keyword(s):  
Pain Management ◽  
Side Effects ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Rating Scale ◽  
Postoperative Pain Management ◽  
Numeric Rating Scale ◽  
Preemptive Analgesia ◽  
Acute Postoperative Pain ◽  
Numeric Rating

Introduction: Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk deep vein thrombosis, fast recovery, and reduced cost of care. Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period, has the potential to be more effective than a similar analgesic treatment initiated after surgery. As a part of multimodal analgesia, the use of NSAIDs should always be considered for acute postoperative pain management. NSAIDs can be used preoperatively as a part of the preemptive regimen and for postoperative pain control to increase the efficacy of opioids and reduce its side effects. Material and Method: This research was experimental research with a case-control design of the study. The samples separated into two groups, the first group got ketoprofen suppository before the induction, and the second group didn’t get the ketoprofen suppository The intensity of pain measured with the Numeric Rating Scale (NRS) or Wong-Baker Faces Pain Scale was the variable studied at different postoperative times (30 min, 60 min, 120 min, 2-6 hours, 6-12 hours). The total amount of rescue analgesics (fentanyl) and side effects were other variables of this study. Result and Discussion: The result is ketoprofen suppository as preemptive analgesia administrations can reduce postoperative pain. Numeric Rating Scale was significantly lower in the ketoprofen group compared to the control group (p < 0,05) at 30 min, 60 min, 230 min, 2-6 hours, 6-12 hours. The number of postoperative analgesics needed in the recovery room was significant differences among both groups (p < 0,05). Conclusion: Preemptive analgesia in patients who underwent an operation with general anesthesia with ketoprofen suppository was effectively in blocking noxious stimuli and central sensitization, with subsequent prevention of acute postoperative pain.

scholarly journals Effects of Korean Medicine Treatment focusing on Acupotomy of headache: A Case Report of Four Patients

2021 ◽  
Vol 42 (3) ◽  
pp. 176-184
Author(s):  
Joohyun Lee ◽  
Hongmin Chu ◽  
Kyungho Kang ◽  
Ju-hyeon Moon ◽  
Jongchul Kim ◽  
...  
Keyword(s):  
Clinical Effect ◽  
Rating Scale ◽  
Case Series ◽  
Numeric Rating Scale ◽  
Attack Frequency ◽  
Headache Attack ◽  
Positive Clinical Effect ◽  
Headache Impact ◽  
Numeric Rating Scale Score ◽  
Numeric Rating

Background: The aim of this study was to report the effect of acupotomy for patients with headache. Methods: Four patients with headache were treated with acupotomy. The improvement of symptoms was evaluated by numeric rating scale(NRS), Headache impact test-6(HIT-6) and headache attack frequency. Results: The numeric rating scale score and headache attack frequency decreased throughout the treatment period. No side effects were observed during treatment. Conclusion: Acupotomy had shown a positive clinical effect in the treatment of a headache in this case series. Further studies are required for its application on various headache.

scholarly journals Exploration of the Clinical Effect of Modified Peroneal Nerve Block in Foot Operation Under the Plane of the Ankle joint: A Non-Randomized Clinical Feasibility Observational Study.

2020 ◽  
Author(s):  
ya tuo ◽  
XUEQIANG FU ◽  
YI QIU ◽  
XIAODONG WANG ◽  
SHENGJUAN YAN ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Scale Score ◽  
Nerve Block ◽  
Analogue Scale ◽  
Peroneal Nerve ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Deep Peroneal Nerve ◽  
Pain Visual Analogue Scale ◽  
Numeric Rating

Abstract Background This study was aimed at exploring the clinical effect of a modified dorsal peroneal nerve block in foot operation under the ankle plane. Methods The study was observational study, thirty patients ( n =30) were observed with single-center and non-randomized. The patients were treated with an ankle nerve block (including the posterior tibial nerve, superficial peroneal nerve, saphenous nerve, and sural nerve block in the plane of the ankle) and a deep peroneal nerve block (7.5 mg/ml). The primary outcomes were intraoperative visual analogue scale score (0-10 points), numeric rating scale score (0-10 points), and Neuropen score (0-2 points). The secondary outcomes were postoperative pain visual analogue scale and numeric rating scale scores (0-10). Histograms and normal probability QQ plots were used to test the distribution of normality. Results We analyzed the data of 30 patients. It was found that after 20 min of ankle block and deep peroneal nerve block, 23 patients achieved a perfect block effect (visual analogue scale and Neuropen scores = 0), and the operation was performed smoothly. Six patients experienced slight pain (visual analogue scale score: ≤ 3, Neuropen score = 1). An intravenous sedative drip (dexmedetomidine 4 µg/ml, 1 µg/kg dexmedetomidine hydrochloride injection 2 ml:0.2 g; Jiangsu Nhwa Pharmaceutical Co., Ltd . , China) was used. The block failed in one patient, and the operation was performed under general anesthesia with a laryngeal mask in this patient. Conclusions The modified deep peroneal nerve block combined with an ankle nerve block can meet the anesthesia needs for foot surgery under the ankle plane. However, due to the limited number of patients evaluated, it is difficult to accurately predict the effect and a large degree of uncertainty exists regarding these findings. Trial registration This study had been registered at http://www.chictr.org.cn/index.aspx with No. ChiCTR2000037880 on Sep 3, 2020.It was a retrospectively registered.

scholarly journals Efficacy and Safety of Transdermal Buprenorphine versus Oral Tramadol/Acetaminophen in Patients with Persistent Postoperative Pain after Spinal Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Jae Hyup Lee ◽  
Jin-Hyok Kim ◽  
Jin-Hwan Kim ◽  
Hak-Sun Kim ◽  
Woo-Kie Min ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Surgery ◽  
Rating Scale ◽  
Medication Compliance ◽  
Pain Reduction ◽  
Numeric Rating Scale ◽  
Persistent Pain ◽  
Efficacy And Safety ◽  
Open Label ◽  
Persistent Postoperative Pain

Purpose. Control of persistent pain following spinal surgery is an unmet clinical need. This study compared the efficacy and safety of buprenorphine transdermal system (BTDS) to oral tramadol/acetaminophen (TA) in Korean patients with persistent, moderate pain following spinal surgery.Methods. Open-label, interventional, randomized multicenter study. Adults with persistent postoperative pain (Numeric Rating Scale [NRS] ≥ 4 at 14–90 days postsurgery) were enrolled. Patients received once-weekly BTDS (n=47; 5 μg/h titrated to 20 μg/h) or twice-daily TA (n=40; tramadol 37.5 mg/acetaminophen 325 mg, one tablet titrated to 4 tablets) for 6 weeks. The study compared pain reduction with BTDS versus TA at week 6. Quality of life (QoL), treatment satisfaction, medication compliance, and adverse events (AEs) were assessed.Findings. At week 6, both groups reported significant pain reduction (mean NRS change: BTDS −2.02; TA −2.76, bothP<0.0001) and improved QoL (mean EQ-5D index change: BTDS 0.10; TA 0.19, bothP<0.05). The BTDS group achieved better medication compliance (97.8% versus 91.0%). Incidence of AEs (26.1% versus 20.0%) and adverse drug reactions (20.3% versus 16.9%) were comparable between groups.Implications. For patients with persistent pain following spinal surgery, BTDS is an alternative to TA for reducing pain and supports medication compliance. This trial is registered with Clinicaltrials.gov:NCT01983111.

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