Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

ObjectivesWe aimed to investigate the factors associated with variations in postoperative pain trajectories over time in patients using intravenous patient-controlled analgesia (IV-PCA) for postoperative pain.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsPatients receiving IV-PCA after surgery.Primary and secondary outcome measuresPrimary outcome was the postoperative pain scores.ResultsA total of 3376 patients and 20 838 pain score observations were analysed using latent curve models. Female and longer anaesthesia time increased the baseline level of pain (p=0.004 and 0.003, respectively), but abdominal surgery and body weight decreased it (both p<0.001). Regarding the trend of pain resolution, lower abdominal surgery steepened the slope (p<0.001); older age, American Society of Anesthesiologists (ASA) class ≥3 and longer anaesthesia time tended to flatten the slope (p<0.001, =0.019 and <0.001, respectively). PCA settings did not affect the variations in postoperative pain trajectories.ConclusionsPatient demographics, ASA class, anaesthesia time and surgical sites worked together to affect postoperative pain trajectories in patients receiving IV-PCA. Latent curve models provided valuable information about the dynamic and complex relationships between the pain trajectories and their influential factors.

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Dynamic analysis of variations in postoperative pain trajectories over time in patients receiving epidural analgesia using latent curve models

Journal of the Chinese Medical Association ◽

10.1097/jcma.0000000000000200 ◽

2020 ◽

Vol 83 (1) ◽

pp. 89-94 ◽

Cited By ~ 1

Author(s):

Ming-Ying Lee ◽

Wen-Kuei Chang ◽

Hsiang-Ling Wu ◽

Shih-Pin Lin ◽

Mei-Yung Tsou ◽

...

Keyword(s):

Postoperative Pain ◽

Epidural Analgesia ◽

Dynamic Analysis ◽

Latent Curve ◽

Latent Curve Models ◽

Pain Trajectories ◽

Over Time

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Evaluating the association of preoperative parecoxib with acute pain trajectories after video-assisted thoracoscopic surgery: a single-centre cohort study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2020-038985 ◽

2021 ◽

Vol 11 (2) ◽

pp. e038985

Author(s):

Yu-Hsiang Ling ◽

Ying-Hsuan Tai ◽

Hsiang-Ling Wu ◽

Wei-Lun Fu ◽

Mei-Yung Tsou ◽

...

Keyword(s):

Cohort Study ◽

Postoperative Pain ◽

Epidural Analgesia ◽

Thoracoscopic Surgery ◽

Curve Analysis ◽

Pain Scores ◽

Latent Curve ◽

Pain Trajectories ◽

Video Assisted Thoracoscopic Surgery ◽

Over Time

ObjectiveThe efficacy of parecoxib as pre-emptive analgesia still remains controversial. This study aimed to investigate how pre-emptive analgesia with parecoxib affected postoperative pain trajectories over time in patients undergoing thoracic surgery.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsWe collected 515 patients undergoing video-assisted thoracoscopic surgery at a tertiary medical centre between September 2016 and August 2017.InterventionsPre-emptive parecoxib before surgery.Primary and secondary outcome measuresDaily numeric rating pain scores in the first postoperative week.ResultsA total of 196 (38.1%) of the recruited patients received parecoxib preoperatively. The latent curve analysis revealed that woman, higher body weight and postoperative use of parecoxib were associated with increased baseline level of pain scores over time (p=0.035, 0.005 and 0.048, respectively) but epidural analgesia and preoperative use of parecoxib were inclined to decrease it (both p<0.001). Regarding the decreasing trends of changes in daily pain scores, older age and epidural analgesia tended to steepen the slope (p=0.014 and <0.001, respectively). Preoperative use of parecoxib were also related to decreased frequency of rescue morphine medication (HR=0.4; 95% CI 0.25 to 0.65).ConclusionsPre-emptive analgesia with parecoxib was associated with decreased baseline pain scores but had no connection with pain decreasing trends over time. Latent curve analysis provided insights into the dynamic relationships among the analgesic modalities, patient characteristics and postoperative pain trajectories.

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Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2014-006239 ◽

2014 ◽

Vol 4 (10) ◽

pp. e006239 ◽

Cited By ~ 7

Author(s):

Aneel Bhangu ◽

J Edward Fitzgerald ◽

Stuart Fergusson ◽

Chetan Khatri ◽

Hampus Holmer ◽

...

Keyword(s):

Cohort Study ◽

Abdominal Surgery ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Perioperative Mortality ◽

Acute Surgery ◽

Emergency Abdominal Surgery

IntroductionEmergency abdominal surgery outcomes represent an internationally important marker of healthcare quality and capacity. In this study, a novel approach to investigating global surgical outcomes is proposed, involving collaborative methodology using ‘snapshot’ clinical data collection over a 2-week period. The primary aim is to identify internationally relevant, modifiable surgical practices (in terms of modifiable process, equipment and clinical management) associated with best care for emergency abdominal surgery.Methods and analysisThis is a multicentre, international, prospective cohort study. Any hospital in the world performing acute surgery can participate, and any patient undergoing emergency intraperitoneal surgery is eligible to enter the study. Centres will collect observational data on patients for a 14-day period during a 5-month window and required data points will be limited to ensure practicality for collaborators collecting data. The primary outcome measure is the 24 h perioperative mortality, with 30-day perioperative mortality as a secondary outcome measure. During registration, participants will undertake a survey of available resources and capacity based on the WHO Tool for Situational Analysis.Ethics and disseminationThe study will not affect clinical care and has therefore been classified as an audit by the South East Scotland Research Ethics Service in Edinburgh, Scotland. Baseline outcome measurement in relation to emergency abdominal surgery has not yet been undertaken at an international level and will provide a useful indicator of surgical capacity and the modifiable factors that influence this. This novel methodological approach will facilitate delivery of a multicentre study at a global level, in addition to building international audit and research capacity.Trial registration numberThe study has been registered with ClinicalTrials.gov (Identifier: NCT02179112).

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Nitroglycerin Plus Morphine on Iv Patient Controlled Analgesia for Abdominal Surgery: The Effect on Postoperative Pain

Anesthesiology and Pain Medicine ◽

10.5812/aapm.99582 ◽

2020 ◽

Vol 10 (3) ◽

Cited By ~ 1

Author(s):

Seyyed Hasan Karbasy ◽

Azadeh Sekhavati ◽

Amir Sabertanha ◽

BibiFatemeh Shakhsemampour

Keyword(s):

Blood Pressure ◽

Postoperative Pain ◽

Abdominal Surgery ◽

Systolic Blood Pressure ◽

Respiratory Rate ◽

Nitric Oxide Donor ◽

Case Group ◽

Patient Controlled Analgesia ◽

Reduction Of Pain ◽

The Mean

Background: Some studies have reported the effect of nitroglycerin on the reduction of pain after surgery. Objectives: The primary goal of the current study was to evaluate the addition of nitroglycerin (as a nitric oxide donor) to morphine in patient-controlled analgesia. Besides, its effects on the reduction of pain and stability in hemodynamic indices after abdominal surgery are also investigated. Methods: The current study was performed on 60 patients as candidates for abdominal surgery. Morphine (0.75 mg/mL) and nitroglycerin plus morphine (morphine 0.5 mg/mL + TNG 15 μg/mL) infusions were used for control and case groups, respectively, with the same induction of anesthesia. The severity of postoperative pain, hemodynamic indices of systolic blood pressure, diastolic pressure, heart rate, respiratory rate, and nausea were measured after surgery (immediately, 2, 6, 12, and 24 hours after surgery). Results: The pain score decreased for both groups almost similarly. The mean systolic blood pressure was highly reduced in both groups. However, the mean diastolic blood pressure in the control group was considerably lower than that of the case group. Besides, the respiratory rate in the case group dramatically diminished and approached the normal value. Conclusions: Combined administration of nitroglycerin and morphine had no synergistic effects on reducing postoperative pain. However, it led to more stable hemodynamic indices and improved breathing, without any side effects.

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