AB006. Less postoperative pain in hybrid-NOTES transvaginal cholecystectomy than in the conventional laparoscopic procedure by numeric rating scale: a single institute matched-cohort study

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.

Download Full-text

The Influence of Chronic Pain on Number Sense and Numeric Rating Scale: A prospective Cohort Study

Anesthesiology and Pain Medicine ◽

10.5812/aapm.103532 ◽

2020 ◽

Vol 10 (2) ◽

Author(s):

Hossein Majedi ◽

Mahsa Mohammadi ◽

Abbas Tafakhori ◽

Zahra Khazaeipour

Keyword(s):

Chronic Pain ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Rating Scale ◽

Number Sense ◽

Numeric Rating Scale ◽

Numeric Rating

Download Full-text

Pain after Cardiac Surgery

Anesthesiology ◽

10.1097/00000542-200610000-00026 ◽

2006 ◽

Vol 105 (4) ◽

pp. 794-800 ◽

Cited By ~ 135

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.

Download Full-text

Postoperative Drip-Infusion of Remifentanil Reduces Postoperative Pain—A Retrospective Observative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179225 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9225

Author(s):

Yi-Hsuan Huang ◽

Meei-Shyuan Lee ◽

Yao-Tsung Lin ◽

Nian-Cih Huang ◽

Jing Kao ◽

...

Keyword(s):

Postoperative Pain ◽

Adverse Effects ◽

Rating Scale ◽

Numeric Rating Scale ◽

Intravenous Anesthesia ◽

Anesthetic Care ◽

Drip Infusion ◽

Pain Scores ◽

Unpleasant Experience ◽

Numeric Rating

Development of remifentanil-induced hyperalgesia (RIH) postoperatively is an unpleasant experience that requires further treatment. This study assessed the effects of gradual withdrawal combined with drip infusion of remifentanil on postoperative pain and the requirement for rescue analgesics. A total of 559 patients receiving total intravenous anesthesia with propofol and remifentanil were enrolled. All patients either underwent gradual withdrawal of remifentanil (GWR) or gradual withdrawal combined with drip infusion (GWDR) with a dose of 1 mcg·kg−1 for 30 min after extubation. The numeric rating scale (NRS) and the requirement of rescue analgesics were assessed. The requirement for rescue analgesics was significantly lower in the GWDR group than in the GWR group (13.2% vs. 35.7%; p < 0.001). At the post-anesthetic care unit (PACU), patients in the GWDR group had a lower NRS pain score (p < 0.001). In addition, in the postoperative 2nd hour, patients in the GWDR group had a significantly lower NRS than the GWR group (beta, −0.31; p = 0.003). No remifentanil-related adverse effects were observed. We found that gradual withdrawal combined with drip infusion of remifentanil required less rescue analgesics and reduced pain scores. The new way of remifentanil administration may be effective to prevent RIH.

Download Full-text

Postoperative Pain and Age: A Retrospective Cohort Association Study

Anesthesiology ◽

10.1097/aln.0000000000004000 ◽

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

Download Full-text

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.

Download Full-text