Buhagiar LM, Cassar OA, Brincat MP, Buttigieg GG, Inglott AS, Adami MZ, Azzopardi LM. Pre-operative pain sensitivity: A prediction of post-operative outcome in the obstetric population.
J Anaesthesiol Clin Pharmacol 2013;
29:465-71. [PMID:
24249982 PMCID:
PMC3819839 DOI:
10.4103/0970-9185.119135]
[Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT
Experimental assessments can determine pain threshold and tolerance, which mirror sensitivity to pain. This, in turn, influences the post-operative experience.
AIMS
The study intended to evaluate whether the pre-operative pressure and electrical pain tests can predict pain and opioid requirement following cesarean delivery.
SETTINGS AND DESIGN
Research was conducted on females scheduled for cesarean section at a tertiary care hospital of the state. Twenty women were enrolled, after obtaining written informed consent.
MATERIALS AND METHODS
PAIN ASSESSMENT WAS PERFORMED ON THE EVE OF CESAREAN SECTIONS USING THREE DEVICES: PainMatcher(;) determined electrical pain threshold while the algometers PainTest(™) FPN100 (manual) and PainTest(™) FPX 25 (digital) evaluated pressure pain threshold and tolerance. Post-operative pain relief included intravenous morphine administered by patient-controlled analgesia, diclofenac (100 mg, every 12 h, rectally, enforced) and paracetamol (1000 mg, every 4-6 h, orally, on patient request). Pain scores were reported on numerical rating scales at specified time intervals.
STATISTICAL ANALYSIS USED
Correlational and regression statistics were computed using IBM SPSS Statistics 21 software (IBM Corporation, USA).
RESULTS
A SIGNIFICANT CORRELATION WAS OBSERVED BETWEEN MORPHINE REQUIREMENT AND: (1) electrical pain threshold (r = -0.45, P = 0.025), (2) pressure pain threshold (r = -0.41 P = 0.036) and (3) pressure pain tolerance (r = -0.44, P = 0.026) measured by the digital algometer. The parsimonious regression model for morphine requirement consisted of electrical pain threshold (r(2)= 0.20, P = 0.049). The dose of morphine consumed within 48 h of surgery decreases by 0.9 mg for every unit increment in electrical pain threshold.
CONCLUSIONS
The predictive power of pain sensitivity assessments, particularly electrical pain threshold, may portend post-cesarean outcomes, including opioid requirements.
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