Factors Predicting Frequency and Severity of Postoperative Pain After Arthroscopic Rotator Cuff Repair Surgery

2020 ◽  
Vol 49 (1) ◽  
pp. 146-153
Author(s):  
Syed Mohammed Taif Rizvi ◽  
Mitchell Bishop ◽  
Patrick H. Lam ◽  
George A.C. Murrell
Keyword(s):  
Postoperative Pain ◽  
Preoperative Pain ◽  
Work Related ◽  
Pain Scores ◽  
Work Related Injury ◽  
Younger Age ◽  
Pain Frequency ◽  
Arthroscopic Rotator Cuff ◽  
Tear Size ◽  
Injury Status

Background: Postoperative pain after arthroscopic rotator cuff repair (RCR) is difficult to predict and manage. The experience of pain is thought to be influenced by a range of different factors. Determining which patient factors contribute to the pain may help us to better understand and manage it. Purpose: To evaluate the preoperative patient characteristics that may be predictive of, and correlated with, postoperative pain after arthroscopic RCR. Study Design: Cohort study; Level of evidence, 3. Methods: The study evaluated 2172 patients who underwent an arthroscopic RCR between February 2004 and December 2015. Pain frequency and severity were measured preoperatively and at 6 weeks after surgery using a modified L’Insalata questionnaire with Likert scales. This 6-week time point was chosen as previous studies have shown patients rank this time point as high in terms of pain after RCR. Logistic regression analysis was conducted to examine the relationship between postoperative pain scores and preoperative pain scores, age, sex, tear size, strength, level of sporting and work activity, and work-related injury status. Results: The severity of preoperative pain at night ( r = 0.33; P < .001), preoperative pain at rest ( r = 0.32; P < .001), and frequency of extreme pain ( r = 0.31; P < .001) were the strongest independent associations with the frequency of pain at 6 weeks postoperatively. Other associations with postoperative pain frequency included reduced liftoff strength ( r = −0.21; P < .001), work-related injury status ( P < .001), younger age ( P = .001), and female sex ( P = .04). Tear size was inversely related with pain severity ( R2 = 0.85). The severity of preoperative pain had the strongest independent association with the severity of postoperative pain at 6 weeks after surgery ( r = 0.35; P < .001). Other associations with postoperative pain severity included increased patient-ranked preoperative stiffness ( P < .001), a poorer impression of one’s shoulder ( P < .001), reduced level of sporting activity ( P < .001), and work-related injury status ( P < .001). Conclusion: Multiple risk factors have been identified for postoperative pain after RCR, the strongest of which is preoperative pain. However, of note, the magnitude of the correlations between preoperative severity and frequency of pain and postoperative severity and frequency of pain were found to be weak to moderate ( r = 0.30-0.35). This suggests that while preoperative pain and its severity are associated with postoperative pain, other factors are likely involved in predicting pain. Smaller tear size, younger age, female sex, and work-related injuries were also associated with postoperative pain at 6 weeks after surgery.

The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs

2016 ◽  
Vol 45 (4) ◽  
pp. 788-793 ◽  
Author(s):  
Daniel Y.T. Yeo ◽  
Judie R. Walton ◽  
Patrick Lam ◽  
George A.C. Murrell
Keyword(s):  
Postoperative Pain ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Rotator Cuff Repair ◽  
Cuff Tear ◽  
Pain Scores ◽  
Arthroscopic Rotator Cuff ◽  
The Relationship ◽  
Cuff Repair ◽  
Tear Size

Background: Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L’Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Results: Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively ( r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm2 but reached 44% in tears >8 cm2. Conclusion: There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.

scholarly journals Predicted Versus Non-Predicted Opioid Administration Using Preoperative Pain Sensitivity in Patients Undergoing Gynecological Surgery: A Randomized-Controlled Trial

2021 ◽  
Vol 10 (4) ◽  
pp. 585
Author(s):  
Sun-Kyung Park ◽  
Hansol Kim ◽  
Seokha Yoo ◽  
Won Ho Kim ◽  
Young-Jin Lim ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Sensitivity ◽  
Control Group ◽  
Gynecological Surgery ◽  
Control Groups ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Pressure Pain Thresholds ◽  
Opioid Administration ◽  
And Control

Individualized administration of opioids based on preoperative pain sensitivity may improve postoperative pain profiles. This study aimed to examine whether a predicted administration of opioids could reduce opioid-related adverse effects after gynecological surgery. Patients were randomized to the predicted group or control group. Participants received a preoperative sensory test to measure pressure pain thresholds. Patients were treated with a higher or lower (15 or 10 μg/mL) dose of fentanyl via intravenous patient-controlled analgesia. The opioid dose was determined according to pain sensitivity in the predicted group, while it was determined regardless of pain sensitivity in the control group. The primary outcome was the incidence of nausea over the first 48 h postoperative period. Secondary outcomes included postoperative pain scores and opioid requirements. There was no difference in the incidence of nausea (40.0% vs. 52.5% in predicted and control groups, respectively; p = 0.191) and postoperative pain scores (3.3 vs. 3.5 in predicted and control groups, respectively; p = 0.691). However, opioid consumptions were lower in the predicted group compared to the control group (median 406.0 vs. 526.5 μg; p = 0.042). This study showed that offering a predicted dose of opioids according to pain sensitivity did not affect the incidence of nausea and pain scores.

Medicaid Payer Status Is a Predictor of Early Postoperative Pain Following Upper Extremity Procedures

Hand ◽  
2020 ◽  
pp. 155894472091256
Author(s):  
Michael T. Scott ◽  
Allison L. Boden ◽  
Stephanie A. Boden ◽  
Lauren M. Boden ◽  
Kevin X. Farley ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Upper Extremity ◽  
Private Insurance ◽  
Insurance Status ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Patient Reported ◽  
Before And After ◽  
Subjective Pain

Background: The purpose of this study was to investigate the relationship between insurance status and patient-reported pain both before and after upper extremity surgical procedures. We hypothesized that patients with Medicaid payer status would report higher levels of pre- and postoperative pain and report less postoperative pain relief. Methods: In all, 376 patients who underwent upper extremity procedures by a single surgeon at an academic ambulatory surgery center were identified. Patient information, including insurance status and Visual Analog Scale pain score (VAS-pain) at baseline, 2 weeks, and 1, 3, and 6 months, were collected. VAS-pain scores were compared with t-tests and linear regression. Results: Preoperatively and at 2-week, 1-month, and 3-month follow-up, Medicaid patients reported statistically significant higher pain levels than patients with Private insurance, finding a mean adjusted increase of 0.51 preoperatively, 0.39 at 1 month, and 0.79 at 3 months. Preoperatively and at 3-month follow-up, Medicaid patients reported statistically significant higher pain than patients with Medicare, finding increases in VAS-pain of 0.99 preoperatively and 0.94 at 3 months. There was no difference in pain improvement between any insurance types at any time point (all P values > .05). Conclusions: Patients with Medicaid report higher levels of preoperative pain and early postoperative pain, but reported the same improvement in pain as patients with other types of insurance. As healthcare systems are becoming increasingly dependent on patient-reported outcomes, including pain, it is important to consider that differences may exist in subjective pain depending on insurance status.

scholarly journals Influence of maintaining apical patency in post-endodontic pain

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Linear Regression Analysis ◽  
Secondary Outcome ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Number Of Visits

Abstract Background The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. Methods Preselected (n = 178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non-patency which was further treated in either single or multiple visits. After exclusion, 160 patients were included. Each group (n = 80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single-rooted (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann–Whitney U test, Spearman correlation and Multiple linear regression analysis. Results The primary outcome of this study showed statistically significant difference (p < 0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency-maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p = 0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference. Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

scholarly journals Factors Affecting Prolonged Postoperative Pain and Analgesic Use After Arthroscopic Full-Thickness Rotator Cuff Repair

2021 ◽  
Vol 9 (7) ◽  
pp. 232596712110124
Author(s):  
Abdulhamit Misir ◽  
Erdal Uzun ◽  
Turan Bilge Kizkapan ◽  
Mustafa Ozcamdalli ◽  
Hazim Sekban ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Degeneration ◽  
Arthroscopic Rotator Cuff Repair ◽  
Narcotic Analgesic ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Tear Size ◽  
Analgesic Use

Background: Postoperative pain and analgesic use after arthroscopic rotator cuff repair remain important issues that affect rehabilitation and overall outcomes. Purpose: To evaluate the pre- and intraoperative factors that may cause prolonged duration of postoperative pain and analgesic use. Study Design: Case-control study; Level of evidence, 3. Methods: We included 443 patients who underwent arthroscopic rotator cuff repair and subacromial decompression. Visual analog scale (VAS) scores for pain were obtained preoperatively and at 30 and 90 days postoperatively. Patients were divided into a group who had prolonged postoperative pain (duration ≥1 and <3 months; n = 86 patients) and a group with nonprolonged pain (duration <1 month; n = 357 patients). The following factors were compared between groups: age, sex, body mass index, repair technique, tear size, retraction amount, repair tension, tendon degeneration, preoperative pseudoparesis, symptom duration, application of microfracture to the rotator cuff footprint for marrow stimulation, smoking, degree of fatty degeneration, preoperative narcotic analgesic use, diabetes, acromioclavicular joint degeneration, and preoperative Douleur Neuropathique 4 (DN4) and American Shoulder and Elbow Society (ASES) scores. Results: Significant differences were seen between the prolonged and nonprolonged groups regarding the median duration of pain (54 vs 27 days, respectively; P < .001) and analgesic use (42 vs 28 days, respectively; P < .001). Significant differences were noted between the groups for symptom duration ( P = .007), smoking status ( P = .001), degree of fatty degeneration ( P = .009), preoperative narcotic analgesic use ( P < .001), preoperative DN4 and ASES scores, 30-day VAS score ( P < .001), duration of opioid and nonopioid analgesic use ( P < .001), tear size ( P = .026), and retraction stage ( P = .032). Tear size ( P = .009), retraction amount ( P = .005), preoperative narcotic analgesic use ( P < .001), degree of fatty degeneration ( P < .001), and preoperative DN4 score ( P = .024) were factors independently associated with prolonged postoperative pain and analgesic use. Conclusion: Patients with larger size tears, retracted tendons, preoperative use of narcotic analgesics, higher tensioned tendon after repair, and Goutallier grade 3 or 4 fatty degeneration faced an increased risk of prolonged postoperative pain and analgesic use after arthroscopic rotator cuff repair. These factors might be mitigated by psychosocial support; gentle, controlled, and individualized postoperative rehabilitation approaches; detailed preoperative evaluation; and closer follow-up of patients who are treated operatively.

scholarly journals Influence of maintaining apical patency in post-endodontic pain

2020 ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Linear Regression Analysis ◽  
Secondary Outcome ◽  
Preoperative Pain ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Number Of Visits

Abstract Background The concept of instrumentation beyond the apical foramen by small flexible file to prevent apical blockage is apical patency. However, this procedure might endow postoperative pain, thus to maintain apical patency or not is the matter of dilemma. Hence, the primary objective of this study was to compare postoperative pain between apical patency and non-patency groups and secondary objective was to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain.Methods Preselected (n=178) patients based on group of teeth and status of pulp were randomly divided into 2 groups, apical patency and non- patency which was further treated in either single or multiple visit. After exclusion, 160 patients were included. Each group (n=80) was subdivided in single visit (n = 40) and multiple visits (n = 40), including vital (n=20) and non-vital teeth (n=20) and single- rooted (n=10) and multiple-rooted teeth (n=10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using Numerical Rating Scale (NRS-11). Statistical analysis was done using Mann -Whitney U test, Spearman correlation and Multiple linear regression analysis.Results The primary outcome of this study showed statistically significant difference (p<0.05) in postoperative pain scores between patency and non-patency groups with higher pain scores in patency group on 1st, 2nd and 7th day follow up. The secondary outcome showed postoperative pain in patency maintained group was influenced by status of the pulp and preoperative pain only. Vital teeth of patency-maintained group treated in multiple visits showed statistically significant (p=0.02) post-operative pain in day 1 follow up. Pre-operative pain showed positive correlation with postoperative pain with statistically significant difference.Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Evaluation of influence of number of visits, status of pulp, group of tooth and preoperative pain revealed status of pulp and preoperative pain as influencing factors for postoperative pain in patency group.

scholarly journals Acute postoperative pain in 23 procedures of gynaecological surgery analysed in a prospective open registry study on risk factors and consequences for the patient

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jorge Jiménez Cruz ◽  
Angela Kather ◽  
Kristin Nicolaus ◽  
Matthias Rengsberger ◽  
Anke R. Mothes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Pain Management ◽  
Postoperative Pain ◽  
Caesarean Section ◽  
Pain Intensity ◽  
Data Availability ◽  
Pain Scores ◽  
Younger Age ◽  
Duration Of Surgery

AbstractEffective perioperative pain management is essential for optimal patient recovery after surgery and reduces the risk of chronification. However, in clinical practice, perioperative analgesic treatment still needs to be improved and data availability for evidence-based procedure specific analgesic recommendations is insufficient. We aimed to identify procedures related with high pain scores, to evaluate the effect of higher pain intensity on patients and to define patient and intervention related risk factors for increased pain after standard gynaecological and obstetrical surgery. Therefore, we performed a prospective cross-sectional study based on the German registry for quality in postoperative pain (QUIPS). A cohort of 2508 patients receiving surgery between January 2011 and February 2016 in our tertiary referral centre (university departments of gynaecology and obstetrics, respectively) answered a validated pain questionnaire on the first postoperative day. Maximal pain intensity was measured by means of a 11-point numeric rating scale (NRS) and related to procedure, perioperative care as well as patient characteristics. The interventions with the highest reported pain scores were laparoscopic removal of ovarian cysts (NRS of 6.41 ± 2.12) and caesarean section (NRS of 6.98 ± 2.08). Factors associated with higher pain intensity were younger age (OR 1.75, 95% CI 1.65–1.99), chronic pain (OR 2.08, 95% CI 1.65–2.64) and surgery performed outside the regular day shift (OR 1.67, 95% CI 1.09–2.36). Shorter duration of surgery, peridural or local analgesic and preoperative sedation reduced postoperative pain. Patients reporting high pain scores (NRS ≥ 5) showed relevant impairment of daily activities and reduced satisfaction. Caesarean section and minimal invasive procedures were associated with the highest pain scores in the present ranking. Pain management of these procedures has to be reconsidered. Younger age, receiving surgery outside of the regular shifts, chronic pain and the surgical approach itself have a relevant influence on postoperative pain intensity. When reporting pain scores of 5 or more, patients were more likely to have perioperative complications like nausea or vomiting and to be impaired in mobilisation. Registry-based data are useful to identify patients, procedures and critical situations in daily clinical routine, which increase the risk for elevated post-intervention pain. Furthermore, it provides a database for evaluation of new pain management strategies.

Longitudinal Perioperative Pain Assessment in Head and Neck Cancer Surgery

2017 ◽  
Vol 126 (9) ◽  
pp. 646-653 ◽  
Author(s):  
Marisa R. Buchakjian ◽  
Andrew B. Davis ◽  
Sebastian J. Sciegienka ◽  
Nitin A. Pagedar ◽  
Steven M. Sperry
Keyword(s):  
Neuropathic Pain ◽  
Head And Neck Cancer ◽  
Postoperative Pain ◽  
Head And Neck ◽  
Neck Cancer ◽  
Pain Assessment ◽  
Preoperative Pain ◽  
Pain Diary ◽  
Perioperative Pain ◽  
Pain Scores

Objective: To evaluate perioperative pain in patients undergoing major head and neck cancer surgery and identify associations between preoperative and postoperative pain characteristics. Methods: Patients undergoing head and neck surgery with regional/free tissue transfer were enrolled. Preoperative pain and validated screens for symptoms (neuropathic pain, anxiety, depression, fibromyalgia) were assessed. Postoperatively, patients completed a pain diary for 4 weeks. Results: Twenty-seven patients were enrolled. Seventy-eight percent had pain prior to surgery, and for 38%, the pain had neuropathic characteristics. Thirteen patients (48%) completed at least 2 weeks of the postoperative pain diary. Patients with moderate/severe preoperative pain report significantly greater pain scores postoperatively, though daily pain decreased at a similar linear rate for all patients. Patients with more severe preoperative pain consumed greater amounts of opioids postoperatively, and this correlated with daily postoperative pain scores. Patients who screened positive for neuropathic pain also reported worse postoperative pain. Conclusion: Longitudinal perioperative pain assessment in head and neck patients undergoing surgery suggests that patients with worse preoperative pain continue to endorse worse pain postoperatively and require more narcotics. Patients with preoperative neuropathic pain also report poor pain control postoperatively, suggesting an opportunity to identify these patients and intervene with empiric neuropathic pain treatment.

scholarly journals Pain Intensity in the First 96 Hours After Abdominal Surgery: A Prospective Cohort Study

Pain Medicine ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 803-813
Author(s):  
Matthieu Cachemaille ◽  
Fabian Grass ◽  
Nicolas Fournier ◽  
Marc R Suter ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Patient Satisfaction ◽  
Pain Management ◽  
Postoperative Pain ◽  
Abdominal Surgery ◽  
Pain Control ◽  
Independent Risk Factor ◽  
Pain Scores ◽  
Younger Age

Abstract Objective Multimodal pain management strategies aim to improve postoperative pain control. The purpose of this study was to analyze pain scores and risk factors for acute postoperative pain after various abdominal surgery procedures. Methods Data on 11 different abdominal surgery procedures were prospectively recorded. Pain intensity (rest, mobilization) and patient satisfaction at discharge were assessed using a visual analog scale (VAS; 0–10), and analgesic consumption was recorded until 96 hours postoperation. Demographic, surgery-related, and pain management–related univariate risk factors for insufficient pain control (VAS ≥ 4) were entered in a multivariate logistic regression model. Results A total of 1,278 patients were included. Overall, mean VAS scores were &lt;3 at all time points, and scores at mobilization were consistently higher than at rest (P &lt; 0.05). Thirty percent of patients presented a prolonged VAS score ≥4 at mobilization at 24 hours, significantly higher than at rest (14%, P &lt; 0.05). High pain scores correlated with high opioid consumption, whereas a variability of pain scores was observed in patients with low opioid consumption. The only independent risk factor for moderate and severe pain (VAS ≥ 4) was younger age (&lt;70 years, P = 0.001). The mean satisfaction score was 8.18 ± 1.29. Conclusions Among 1,278 patients, pain was controlled adequately during the first four postoperative days, resulting in high levels of patient satisfaction. Pain levels were higher at mobilization. Younger age was the only independent risk factor for insufficient pain control. Preventive treatment in patients &lt;70 years old and before mobilization could be evaluated for potential improvement.

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