Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. Conclusion This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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Characterization of self-anticipated surgical pain prior to general anesthesia - a prospective observational study

10.21203/rs.3.rs-18199/v4 ◽

2021 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

General Anesthesia ◽

Pain Intensity ◽

Pain Score ◽

Prospective Observational Study ◽

Rating Scale ◽

Perioperative Period ◽

Pain Scores

Abstract Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (P<0.001). Higher anticipated pain scores (preoperative NRS³4) were associated with higher actual postoperative pain levels (P=0.032) in the PACU and higher total equivalent opioid use (P=0.001) for acute pain management during the perioperative period.Conclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

10.21203/rs.3.rs-18199/v2 ◽

2020 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

Pain Score ◽

Prospective Observational Study ◽

Rating Scale ◽

Elective Surgery ◽

Perioperative Period ◽

Anesthesia Care ◽

Post Anesthesia Care Unit

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Younger patients (<40 years) (P=0.042) and those took regular benzodiazepine at bedtime (P=0.043) anticipated significantly higher pain levels. Male patients anticipated significantly lower pain intensities than females (odd ratio 1.710; 95% CI 1.254-2.331, P=0.001). Patients who scheduled for laparotomies (P=0.037), orthopedic surgeries (P=0.040) or long procedures (P<0.001) reported higher anticipated pain. Although higher anticipated pain scores were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that patients who are female, younger age (<40 years), use regular benzodiazepines at bedtime and scheduled for long procedures (>2 h), laparotomies or orthopedic surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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The clinical application of preoperative self-anticipated pain score and the correlation with surgical pain after elective surgery - a prospective observational study

10.21203/rs.3.rs-18199/v3 ◽

2020 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Observational Study ◽

Pain Intensity ◽

Prospective Observational Study ◽

Elective Surgery ◽

Perioperative Period ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Pain Scores

Abstract Background: Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and correlated the scores with the pain levels and analgesic requirements after surgery.Methods: This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, 0-10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain.Results: A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.532, 95% confidence interval 1.125-2.086; P=0.007). Patients who took regular benzodiazepine at bedtime (P=0.040) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P<0.001). Although higher anticipated pain scores (NRS³4) were associated with higher postoperative pain levels (P=0.021) and higher total equivalent opioid dose (P=0.001) for acute pain management during the perioperative period, these surgical patients actually experienced less pain than they anticipated at the post-anesthesia care unit.Conclusion: This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction.

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The application of preoperative self-anticipating pain scores in predicting surgical pain after elective surgery

10.21203/rs.3.rs-18199/v1 ◽

2020 ◽

Author(s):

Wei-Shu Chang ◽

Yi-Ting Hsieh ◽

Moa-Chu Chen ◽

Shu-Ching Chang ◽

Tzu-Shan Chen ◽

...

Keyword(s):

Pain Management ◽

Observational Study ◽

Pain Score ◽

Orthopedic Surgery ◽

Rating Scale ◽

Elective Surgery ◽

Analgesic Requirement ◽

Cross Sectional ◽

Opioid Dose ◽

Patient’S Satisfaction

Abstract Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipating pain score before operation, and correlated the scores with the actual pain levels and analgesic requirement after operation. Methods This prospective cross-sectional, observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were invited to complete a structured questionnaire during preoperative anesthesia assessment that surveyed patient’s self-anticipating pain level (numeric rating scale, NRS 0-10) for the scheduled procedure. The actual pain score (visual analogue scale, VAS) experienced by the patient and the total equivalent dose of opioids administered after operation were recorded. Results A total of 996 patients were recruited and 1 patients were excluded due to incomplete data. Most of the patients (86%) received general anesthesia and 73.9% of them had prior operation history. Patients with younger ages (<40 years) and those took regular benzodiazepine for sleep disorder anticipated significantly higher pain levels. Male patients anticipated significantly lower NRS than females (odd ratio 1.710; 95% CI 1.254-2.331). Patients who scheduled for laparotomy, orthopedic surgery or long procedures had higher anticipating NRS. Although higher anticipating NRS were associated with higher postoperative VAS scores and higher total equivalent opioid dose for acute pain management, these surgical patients actually experienced less VAS than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that female, younger age (<40 years), regular benzodiazepine user and patients who scheduled for long procedure (>2 h), laparotomy or orthopedic surgery are anticipating significantly higher surgical-related pain. Therefore, appropriate preoperative counseling for analgesic control and elimination of unnecessary anticipating pain levels in these patients would be necessary to improve the quality of anesthesia service and patient’s satisfaction.

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Effects of Preoperative Parental Pain Management Educational Interventions on the Postoperative Pain Intensity and Duration of Small Children Who Underwent One-Day Surgery: A Prospective Randomized Controlled Trial

10.22514/sv.2020.16.0057 ◽

2020 ◽

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Pain Intensity ◽

Rating Scale ◽

Educational Interventions ◽

Control Groups ◽

Small Children ◽

Pain Scores ◽

And Control ◽

At Home

Objectives: To evaluate effects of parental pain management educational interventions on postoperative pain assessment, intensity and duration of small children after a one-day-pediatric surgery. Methods: We conducted a prospective randomized, observational study of parental and nurse’s pain assessments in children. The Parents’ Postoperative Pain Management rating scale (PPPM), Wong-Baker FACES Pain Rating Scale (W-B) or the Numerical Rating Scale (NRS) was used. The children’s pain was assessed by parents who were or were not (intervention vs. control groups) preoperatively educated about pain management postoperatively in the hospital and the first three days at home. Nurses who cared for the children postoperatively in the hospital, independently from the parents, assessed the children’s postoperative pain with W-B and NRS. Results: One hundred and fifty-two parents and their children were included in the study. Complete data were available for 142 parents and their children, with one parent, usually the mother (108 (76.1 %)), being involved at all stages of the study. No differences in children’s postoperative pain scores and analgesic use at home were found between the two parental groups (intervention and control groups). Parental pain scores after surgery was strongly positively correlated with pain duration, and analgesic use by their children at home. Pain intensity scores assessed by nurses in the hospital were lower compared to parental pain intensity scores. There was high inter-rater reliability between the PPPM, Wong-Baker, and NRS scales. Conclusions: No differences in postoperative pain in children were found between the intervention and control groups of parents. Parents gave higher scores of pain intensity in children than nurses did.

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Gestational Diabetes and Intraoperative Tubal Sterilization are Risk Factors for Pain After Cesarean Delivery: A Prospective Observational Study.

10.21203/rs.3.rs-116987/v1 ◽

2020 ◽

Author(s):

Patchareya Nivatpumin ◽

Pawinee Pangthipampai ◽

Sukanya Dej-Arkom ◽

Somkiat Aroonpruksakul ◽

Tripop Lertbunnaphong ◽

...

Keyword(s):

Gestational Diabetes ◽

Observational Study ◽

Pain Score ◽

Cesarean Delivery ◽

Severe Pain ◽

Prospective Observational Study ◽

Rating Scale ◽

Tubal Sterilization ◽

Number Of Patients ◽

Median Pain

Abstract Background: Postcesarean delivery pain leads to several adverse maternal outcomes. The primary objective of this study was to determine the incidence of moderate-to-severe pain after the use of spinal morphine for cesarean delivery. The secondary aim was to identify the factors influencing the moderate-to-severe pain.Methods: This prospective observational study was conducted at a single university hospital. The inclusion criteria were a patient age of ≥ 18 years, and undergoing elective cesarean delivery under spinal anesthesia with intrathecal morphine (200 mcg). Moderate-to-severe pain was defined as a numerical-rating-scale score of more than 3 within 24 hours postoperatively. Patients’ demographic characteristics, preoperative obstetric data, and intraoperative and postoperative data were collected and analyzed.Results: In all, 660 patients were enrolled. As 16 were subsequently removed because they met the study withdrawal criteria, data relating to 644 patients were analyzed. The incidence of moderate-to-severe pain during the first postoperative day was 451/644 patients (70.03%; 95% confidence interval [CI], 66.38%–73.44%). The median pain score (interquartile range [IQR]) was 5 (3–6), with 176/644 (27.33%) of patients requiring a rescue analgesic. A multivariate analysis revealed that two factors were associated with moderate-to-severe pain on the first postoperative day: gestational diabetes (adjusted OR [AOR], 1.849; 95% CI, 1.068–3.203; p-value = 0.028), and intraoperative tubal sterilization (AOR, 1.533; 95% CI, 1.060–2.218; p = 0.023). A significantly higher number of patients experienced moderate-to-severe pain on postoperative Day 1 (451/644 [70.03%]) than Day 2 (348/644 [54.19%]; p < 0.001). The median pain score (IQR) on postoperative Day 2 was 4 (3–5), which was less than that for Day 1 (p < 0.001).Conclusions: A high incidence of moderate-to-severe postoperative pain was found after a single dose of spinal morphine for cesarean delivery. Gestational diabetes and intraoperative tubal sterilization were the independent factors correlated with the pain.Trial registration: Clinicaltrial.gov registration number NCT03205813

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Circumcision in children: postoperative analgesic efficiency of transversus abdominis plan block vs caudal epidural block: a prospective observational study

10.31083/jomh.2021.096 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Pain ◽

Observational Study ◽

Postoperative Analgesia ◽

Prospective Observational Study ◽

Transversus Abdominis ◽

Tap Block ◽

Rescue Analgesia ◽

Pain Scores ◽

Significant Difference ◽

Caudal Epidural

Background and objective: Circumcision is one of the most common operations and can cause postoperative pain, fear, and anxiety for children. This study aims to compare the effects of transversus abdominis plane (TAP) block and caudal epidural (CE) anesthesia on postoperative analgesia after circumcision in providing postoperative pain control. Methods: Eighty boys aged 1 to 14 years who underwent elective circumcision surgery under general anesthesia either with USG-guided TAP block or with CE block for postoperative analgesia were enrolled consecutively to this prospective observational study equally in each group. Postoperative pain scores and need for rescue analgesia were recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in mean age and Aldrete scores (p > 0.05). Body mass index (BMI) of the caudal block group was statistically lower than the TAP group (p < 0.05). While there was no statistically significant difference between the groups in 30th-minute VAS values (p > 0.05), the CE block group's 1st, 2nd, 4th, 8th, 12th, 18th, and 24th hour VAS values were statistically lower than the TAP block group's (p < 0.05). Conclusion: USG-guided TAB block under general anesthesia was not associated with lower postoperative pain scores and delayed rescue analgesia need compared with CE block in patients who underwent elective circumcision surgery. CE block provided superior analgesia than the USG-guided TAP block after elective circumcision surgery in this study.

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Pattern of use of analgesics in post-operative pain management in adults undergoing laparotomy surgery: a prospective observational study

International Surgery Journal ◽

10.18203/2349-2902.isj20180372 ◽

2018 ◽

Vol 5 (2) ◽

pp. 662 ◽

Cited By ~ 2

Author(s):

Mohna M. Toro ◽

Sheetal John ◽

Atiya R. Faruqui

Keyword(s):

Observational Study ◽

Pain Score ◽

Severe Pain ◽

Prospective Observational Study ◽

Rating Scale ◽

Numerical Rating Scale ◽

Tertiary Care ◽

Patient Characteristics ◽

Post Operative Pain ◽

Surgery Department

Background: Previous studies on post-operative pain document that most patients continue to experience pain after surgery. This study was done to record the drug use for post- operative pain in laparotomy and to determine the patient characteristics that affect their pain score.Methods: A prospective observational study in 250 adult patients undergoing laparotomy surgery from General Surgery and Obstetrics and Gynaecology (OBG) at a tertiary care hospital.Results: Among patients recruited, 161 (64.4%) were females, 134 (53.6 %) from surgery department, mean age 37.29±14.9 years. Caesarean section 85 (73.27%) followed by meshplasty 46 (34.3%) were most common.Parenteral tramadol 100mg (40%) was the most common analgesic post-operative, subsequently shifted to oral. Epidural analgesia used in 31 (12.4%) patients, only from surgery department. First analgesic received within 6 hrs in 55.5 % in surgery and 44.5 % in OBG (Pearson χ2 =2.535, p = 0.111) with mean time to first analgesic 2.85±2.33 hrs. Pain score, using Numerical Rating Scale (NRS) recorded for 200 (80%) patients showed 76 (30.4%) had severe pain on day 1 which decreased to 12 (4.8%) on day 3. Speciality (p=0.01) and nature of surgery (p=0.05) were significantly associated with severity of pain. Gender [OR = 0.55 (95% CI = 0.26, 1.19), p=0.13], nature of surgery [2.32 (1.02, 5.32), p=0.05], speciality [0.35 (0.15, 0.80), p=0.01] and surgical category [0.76 (1.01, 5.32), p=0.05] affected pain score on univariate logistic regression, but were not significant on multivariate analysis.Conclusions: Despite the use of opioids and combination analgesics, one third of patients reported severe pain on the first day after surgery.

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Objective postoperative pain assessment using incentive spirometry values: a prospective observational study

Pain Management ◽

10.2217/pmt-2020-0080 ◽

2021 ◽

Vol 11 (3) ◽

pp. 315-324

Author(s):

Matthew J Hallman ◽

Nancy Dorinsky ◽

Yueting Wang ◽

Quefeng Li ◽

Robert Isaak ◽

...

Keyword(s):

Postoperative Pain ◽

Observational Study ◽

Pain Control ◽

Prospective Observational Study ◽

Medical Center ◽

Surrogate Data ◽

Thoracic Epidural ◽

Pain Scores ◽

Subjective Pain ◽

Incentive Spirometry

Aim: Determine if incentive spirometry (IS) values correlate with postoperative pain control. Design: Prospective observational study. Setting & participants: A total of 100 patients undergoing major abdominal procedures at the University of North Carolina Medical Center. Interventions: Patients studied as a single cohort. All patients received thoracic epidural analgesia preoperatively. Outcome: Preoperative and daily postoperative numeric pain scores, subjective pain description and IS values were collected for all patients. Results: There was a strong correlation with IS values relative to baseline for both the numeric pain scores (p < 0.0001), postoperative day (p < 0.0001) and the subjective pain score (p < 0.0007). Conclusion: IS values are an objective surrogate data point for pain control after surgery, particularly when followed over time and compared with a preoperative baseline value.

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Pain Intensity on the First Day after Surgery

Anesthesiology ◽

10.1097/aln.0b013e31828866b3 ◽

2013 ◽

Vol 118 (4) ◽

pp. 934-944 ◽

Cited By ~ 525

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.

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