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Rouholamin S, Ghahiri A, Dehghan Khalili B. The Efficacy of Ropivacaine 0.5% in Transversus Abdominis Plane Block to Relieve the Postoperative Pain of Female Laparoscopic Surgery Grade II. Adv Biomed Res 2022; 11:12. [PMID: 35386544 PMCID: PMC8977607 DOI: 10.4103/abr.abr_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/03/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022] Open
Abstract
Background The aim of this study was determination of the effect of the transversus abdominis plane block (TAP block) with ropivacaine 0.5% in relieving postoperative pain after laparoscopic gynecologic surgery. Materials and Methods The population of the double-blinded clinical trial study included 200 women candidates for elective laparoscopic gynecologic surgery who referred to Al-Zahra and Beheshti hospitals in Isfahan during 2016-2018. In the TAP block group in addition to standard general anesthesia, an anesthetic drug Ropivacaine (Naropin, 0.5%) was injected at a dose of 0.5 mg/kg between transverse abdominal muscle and internal oblique muscle facia. And in control group just received standard general anesthesia. Hence, the severity of pain and nausea and vomiting is recorded at the time of recovery, at 30 min, 2, 4, 6, 12, and 48 h after the surgery. Results The results of this study showed that in all periods of time (30 min, 2, 4, 6, 12, 24, 36, and 48 h after the surgery), mean pain score in TAP block group was lower than control group (P < 0.001). Hence that, in the 48 h after the surgery, the pain score in the TAP block group with a mean of 0.46 ± 0.50 was significantly lower than the control group with a mean of 1.06 ± 0.68 (P < 0.001). Nausea and vomiting between the two groups were no significant differences. There was no decrease in narcotic use or length of stay among those who received the TAP block. Conclusions TAP block with ropivacaine 0.5% had a significant role in reducing postoperative pain of laparoscopic surgery.
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Affiliation(s)
- Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ataollah Ghahiri
- Department of Obstetrics and Gynecology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Banafsheh Dehghan Khalili
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Banafsheh Dehghan Khalili, Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
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Chu NM, Chen X, Bae S, Brennan DC, Segev DL, McAdams-DeMarco MA. Changes in Functional Status Among Kidney Transplant Recipients: Data From the Scientific Registry of Transplant Recipients. Transplantation 2021; 105:2104-2111. [PMID: 33449609 PMCID: PMC8273213 DOI: 10.1097/tp.0000000000003608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND With stressors of dialysis prekidney transplantation (KT) and restoration of kidney function post-KT, it is likely that KT recipients experience a decline in functional status while on the waitlist and improvements post-KT. METHODS We leveraged 224 832 KT recipients from the national registry (SRTR, February 1990-May 2019) with measured Karnofsky Performance Status (KPS, 0%-100%) at listing, KT admission, and post-KT. We quantified the change in KPS from listing to KT using generalized linear models. We described post-KT KPS trajectories using adjusted mixed-effects models and tested whether those trajectories differed by age, sex, race, and diabetes status using a Wald test among all KT recipients. We then quantified risk adverse post-KT outcomes (mortality and all-cause graft loss [ACGL]) by preoperative KPS and time-varying KPS. RESULTS Mean KPS declined from listing (83.7%) to admission (78.9%) (mean = 4.76%, 95% confidence interval [CI]: -4.82, -4.70). After adjustment, mean KPS improved post-KT (slope = 0.89%/y, 95% CI: 0.87, 0.91); younger, female, non-Black, and diabetic recipients experienced greater post-KT improvements (Pinteractions < 0.001). Lower KPS (per 10% decrease) at admission was associated with greater mortality (adjusted hazard ratio [aHR] = 1.11, 95% CI: 1.10, 1.11) and ACGL (aHR = 1.08, 95% CI: 1.08, 1.09) risk. Lower post-KT KPS (per 10% decrease; time-varying) were more strongly associated with mortality (aHR = 1.93, 95% CI: 1.92, 1.94) and ACGL (aHR = 1.84, 95% CI: 1.83, 1.85). CONCLUSIONS Functional status declines pre-KT and improves post-KT in the national registry. Despite post-KT improvements, poorer functional status at KT and post-KT are associated with greater mortality and ACGL risk. Because of its dynamic nature, clinicians should repeatedly screen for lower functional status pre-KT to refer vulnerable patients to prehabilitation in hopes of reducing risk of adverse post-KT outcomes.
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Affiliation(s)
- Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel C Brennan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara A McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Mori M, Brooks C, Dhruva SS, Lu Y, Spatz ES, Dey P, Zhang Y, Chaudhry SI, Geirsson A, Allore HG, Krumholz HM. Trajectories of Pain After Cardiac Surgery: Implications for Measurement, Reporting, and Individualized Treatment. Circ Cardiovasc Qual Outcomes 2021; 14:e007781. [PMID: 34304586 PMCID: PMC8366534 DOI: 10.1161/circoutcomes.120.007781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative pain after cardiac surgery is a significant problem, but studies often report pain value as an average of the study cohort, obscuring clinically meaningful differences in pain trajectories. We sought to characterize heterogeneity in postoperative pain experiences. METHODS We enrolled patients undergoing a cardiac surgery at a tertiary care center between January 2019 and February 2020. Participants received an electronically-delivered questionnaire every 3 days for 30 days to assess incision site pain level. We evaluated the variability in pain trajectories over 30 days by the cohort-level mean with confidence band and latent classes identified by group-based trajectory model. Group-based trajectory model estimated the probability of belonging to a specific trajectory of pain. RESULTS Of 92 patients enrolled, 75 provided ≥3 questionnaire responses. The cohort-level mean showed a gradual and consistent decline in the mean pain level, but the confidence bands covered most of the pain score range. The individual-level trajectories varied substantially across patients. Group-based trajectory model identified 4 pain trajectories: persistently low (n=9, 12%), moderate declining (initially mid-level, followed by decline; n=26, 35%), high declining (initially high-level, followed by decline; n=33, 44%), and persistently high pain (n=7, 9%). Persistently high pain and high declining groups did not seem to be clearly distinguishable until approximately postoperative day 10. Patients in persistently low pain trajectory class had a numerically lower median age than the other 3 classes and were below the lower confidence band of the cohort-level approach. Patients in the persistently high pain trajectory class had a longer median length of hospital stay than the other 3 classes and were often higher than the upper confidence band of the cohort-level approach. CONCLUSIONS We identified 4 trajectories of postoperative pain that were not evident from a cohort-level mean, which has been a common way of reporting pain level. This study provides key information about the patient experience and indicates the need to understand variation among sites and surgeons and to investigate determinants of different experience and interventions to mitigate persistently high pain.
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Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.)
| | - Cornell Brooks
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT
| | - Sanket S Dhruva
- Department of Medicine, University of California San Francisco School of Medicine (S.S.D.).,San Francisco VA Medical Center, CA (S.S.D.)
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.)
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine (E.S.S.), Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.)
| | - Pranammya Dey
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT
| | - Yawei Zhang
- Department of Environmental Health Sciences, Yale School of Public Health, Department of Surgery (Y.Z.), Yale School of Medicine, New Haven, CT
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine (S.I.C.), Yale School of Medicine, New Haven, CT
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT
| | - Heather G Allore
- Section of Geriatrics, Department of Internal Medicine (H.G.A.), Yale School of Medicine, New Haven, CT.,Department of Biostatistics (H.G.A.), Yale School of Public Health, New Haven, CT
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT
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Abstract
OBJECTIVE Define and contrast acute pain trajectories vs. the aggregate pain measurements, summarize appropriate linear and nonlinear statistical analyses for pain trajectories at the patient level, and present methods to classify individual pain trajectories. Clinical applications of acute pain trajectories are also discussed. SETTING In 2016, an expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society (APS), and American Academy of Pain Medicine (AAPM) established an initiative to create a pain taxonomy, named the ACTTION-APS-AAPM Pain Taxonomy (AAAPT), for the multidimensional classification of acute pain. The AAAPT panel commissioned the present report to provide further details on analysis of the individual acute pain trajectory as an important component of comprehensive pain assessment. METHODS Linear mixed models and nonlinear models (e.g., regression splines and polynomial models) can be applied to analyze the acute pain trajectory. Alternatively, methods for classifying individual pain trajectories (e.g., using the 50% confidence interval of the random slope approach or using latent class analyses) can be applied in the clinical context to identify different trajectories of resolving pain (e.g., rapid reduction or slow reduction) or persisting pain. Each approach has advantages and disadvantages that may guide selection. Assessment of the acute pain trajectory may guide treatment and tailoring to anticipated symptom recovery. The acute pain trajectory can also serve as a treatment outcome measure, informing further management. CONCLUSIONS Application of trajectory approaches to acute pain assessments enables more comprehensive measurement of acute pain, which forms the cornerstone of accurate classification and treatment of pain.
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Affiliation(s)
- Emine O Bayman
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA.,Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA
| | - Jacob J Oleson
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Jennifer A Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA.,Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington, USA
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Chandrababu R, Ramesh J, Sanatombi Devi E, Nayak BS, George A. Effectiveness of music on anxiety and pain among cardiac surgery patients: A quantitative systematic review and meta-analysis of randomized controlled trials. Int J Nurs Pract 2021; 27:e12928. [PMID: 33759286 DOI: 10.1111/ijn.12928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to evaluate the effectiveness of music on anxiety and pain among patients following cardiac surgery. BACKGROUND Cardiac surgery affects patients physically, psychologically and socially. Anxiety and pain are the usual problems among patients following cardiac surgery. DESIGN The study design is a systematic review and meta-analysis. DATA SOURCES The Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica database (EMBASE) and Web of Science databases were searched for randomized controlled trials from January 2000 to December 2017. REVIEW METHODS The Cochrane collaboration guidelines were followed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to summarize the quality of evidence. RESULTS Fourteen studies were included in systematic review and 13 in meta-analysis. The meta-analysis revealed that there was a significant reduction in anxiety and pain among patients who received musical intervention compared with those who did not. CONCLUSION Music has positive benefits on anxiety and pain. However, well-designed and high-quality trials are needed to generate higher quality evidence.
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Affiliation(s)
- Ramesh Chandrababu
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyothi Ramesh
- Udupi College of Nursing, Shree Krishna Educational Trust, Manipal, Karnataka, India
| | - Elsa Sanatombi Devi
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Baby S Nayak
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anice George
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Smith CR, Baharloo R, Nickerson P, Wallace M, Zou B, Fillingim RB, Crispen P, Parvataneni H, Gray C, Prieto H, Machuca T, Hughes S, Murad G, Rashidi P, Tighe PJ. Predicting long-term postsurgical pain by examining the evolution of acute pain. Eur J Pain 2021; 25:624-636. [PMID: 33171546 PMCID: PMC8628519 DOI: 10.1002/ejp.1698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/08/2020] [Indexed: 09/13/2023]
Abstract
BACKGROUND Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage. METHODS We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX-based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other. RESULTS This single-centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the 'None' and 'Severe' outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe-to-severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6. CONCLUSIONS Clinically, these results suggest that individual pain-state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient- and surgery-specific factors may help indicate which patients are at increased risk of PPP. SIGNIFICANCE Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.
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Affiliation(s)
- Cameron R Smith
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Raheleh Baharloo
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
| | - Paul Nickerson
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Margaret Wallace
- Center for NeuroGenetics, University of Florida, Gainesville, FL, USA
| | - Baiming Zou
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Paul Crispen
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hari Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Chancellor Gray
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hernan Prieto
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
| | - Tiago Machuca
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Gregory Murad
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Parisa Rashidi
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, USA
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
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7
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Alameri R, Dean G, Castner J, Volpe E, Elghoneimy Y, Jungquist C. Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study. Pain Manag Nurs 2020; 21:314-322. [PMID: 31734151 DOI: 10.1016/j.pmn.2019.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/18/2019] [Accepted: 09/16/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery. AIM The aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain. METHOD A randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication. RESULTS The findings of this study indicate that foot massage significantly (p < .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group. CONCLUSION Providing non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants' satisfaction.
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Affiliation(s)
- Rana Alameri
- Department of Fundamental Nursing, College Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Grace Dean
- School of Nursing, The State University of New York, Buffalo, New York, USA
| | - Jessica Castner
- School of Nursing, The State University of New York, Buffalo, New York, USA
| | - Ellen Volpe
- School of Nursing, The State University of New York, Buffalo, New York, USA
| | - Yasser Elghoneimy
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Carla Jungquist
- School of Nursing, The State University of New York, Buffalo, New York, USA
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Shanthanna H, Turan A, Vincent J, Saab R, Shargall Y, O'Hare T, Davis K, Fonguh S, Balasubramaniam K, Paul J, Gilron I, Kehlet H, Sessler DI, Bhandari M, Thabane L, Devereaux PJ. N-Methyl-D-Aspartate Antagonists and Steroids for the Prevention of Persisting Post-Surgical Pain After Thoracoscopic Surgeries: A Randomized Controlled, Factorial Design, International, Multicenter Pilot Trial. J Pain Res 2020; 13:377-387. [PMID: 32104059 PMCID: PMC7024793 DOI: 10.2147/jpr.s237058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose We conducted a feasibility 2×2 factorial trial comparing N-methyl-D-aspartate (NMDA) antagonists (intravenous ketamine and oral memantine) versus placebo and intravenous steroids versus placebo, in patients having elective video-assisted thoracic surgery lobectomies, at St. Joseph's Hamilton, Canada, and Cleveland Clinic, Cleveland, USA. Our feasibility objectives were: 1) recruitment rate/week; 2) recruitment of ≥90% of eligible patients; and 3) >90% follow-up. Secondary objectives were incidence and intensity of persistent post-surgical pain (PPSP) and other clinical and safety outcomes. Methods Using computerized randomization, patients were allocated to one of four groups: NMDA active with steroid placebo; NMDA placebo with steroid active; both NMDA and steroid active; both NMDA and steroid placebo. Patients, health providers, and data analysts were blinded to allocation. Patients were followed for 3 months after randomization. Results The trial was initiated in May 2017 at Hamilton and, after subsequent regulatory and ethics approval, in April 2018 at Cleveland. The trial had to be stopped after only 1 month of recruitment in Cleveland because the packaged study medications (memantine) expired and we were unable to procure the dosage required. Among 41 eligible patients, 27 (66%) were randomized. The recruitment rate/week was 0.63, 95% confidence interval (CI): 0.47-0.79 in Hamilton; and 1, 95% CI: 0.83-1.17 in Cleveland. Follow-up was complete for all 24 patients (100%) in Hamilton, and 3 of 4 patients in Cleveland. In total, only 4 patients (15%), and 2 patients (7%) had persistent pain at rest and with movement, respectively. There were no significant differences between groups for other outcomes. Conclusion The trial had to be stopped prematurely due to non-availability of study medications. Trial feasibility objectives of recruiting 90% of eligible patients and recruiting at least one patient/week per site were not met. Consideration for protocol changes will be necessary for the full trial. Trial Registration NCT02950233.
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Affiliation(s)
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Remie Saab
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yaron Shargall
- Department of Surgery, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Turlough O'Hare
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Kimberly Davis
- Acute Pain Service, St. Joseph Healthcare Hamilton, Hamilton, ON, Canada
| | | | | | - James Paul
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Ian Gilron
- Departments of Anesthesiology and Perioperative Medicine, Biomedical and Molecular Sciences, Centre for Neuroscience Studies and School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Henrik Kehlet
- Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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9
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Okamoto A, Yamasaki M, Yokota I, Mori M, Matsuda M, Yamaguchi Y, Yamakita S, Ueno H, Sawa T, Taguchi T, Hosokawa T, Amaya F. Classification of acute pain trajectory after breast cancer surgery identifies patients at risk for persistent pain: a prospective observational study. J Pain Res 2018; 11:2197-2206. [PMID: 30323654 PMCID: PMC6179582 DOI: 10.2147/jpr.s171680] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Predictive value and accuracy of the acute pain trajectory were compared with those of pain intensity at 1 day after the surgery for pain prevalence at 6 months after the surgery. Materials and methods Female patients scheduled for breast cancer surgery were eligible for this study. Patients were questioned about pain intensity daily during the 7 days after surgery. Presence of pain, its location, and intensity as well as the Japanese version of the quality of the recovery-40 (QOR-40) were determined in an interview prior to and at 6 months after the surgery. Acute pain trajectory was determined by a group-based trajectory modeling analysis that was based on the pain intensity at 1–7 days after surgery. Predictive value of the acute pain trajectory for the presence of pain at 6 months after the surgery was assessed by a logistic regression model. The predictive value was compared with pain intensity at 1 day after the surgery. Results A total of 123 participants completed the 6-month follow-up. The three-cluster model (mild, moderate, and severe pain) was considered to be the most statistically appropriate model for the acute pain trajectory. After 6 months, 51.2% and 8.9% of participants reported pain and severe pain, respectively. Presence of pain at 6 months after the surgery was associated with poor recovery. The severe pain cluster was significantly associated with the presence of pain at 6 months after the surgery (adjusted odds ratio, 9.40; P<0.001 vs mild pain cluster). Conclusion Classification of patients according to the acute pain trajectory, when compared with the classification according to pain intensity at 1 day after the surgery, made it possible to predict with better precision those patients who will develop persistent postsurgical pain.
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Affiliation(s)
- Akiko Okamoto
- Department of Endocrinological and Breast Surgery.,Department of Pain Management and Palliative Care Medicine
| | | | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | | | | | - Hiroshi Ueno
- Department of Pain Management and Palliative Care Medicine
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10
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The Fifth Vital Sign: Postoperative Pain Predicts 30-day Readmissions and Subsequent Emergency Department Visits. Ann Surg 2017; 266:516-524. [PMID: 28657940 DOI: 10.1097/sla.0000000000002372] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We hypothesized that inpatient postoperative pain trajectories are associated with 30-day inpatient readmission and emergency department (ED) visits. BACKGROUND Surgical readmissions have few known modifiable predictors. Pain experienced by patients may reflect surgical complications and/or inadequate or difficult symptom management. METHODS National Veterans Affairs Surgical Quality Improvement data on inpatient general, vascular, and orthopedic surgery from 2008 to 2014 were merged with laboratory, vital sign, health care utilization, and postoperative complications data. Six distinct postoperative inpatient patient-reported pain trajectories were identified: (1) persistently low, (2) mild, (3) moderate or (4) high trajectories, and (5) mild-to-low or (6) moderate-to-low trajectories based on postoperative pain scores. Regression models estimated the association between pain trajectories and postdischarge utilization while controlling for important patient and clinical variables. RESULTS Our sample included 211,231 surgeries-45.4% orthopedics, 37.0% general, and 17.6% vascular. Overall, the 30-day unplanned readmission rate was 10.8%, and 30-day ED utilization rate was 14.2%. Patients in the high pain trajectories had the highest rates of postdischarge readmissions and ED visits (14.4% and 16.3%, respectively, P < 0.001). In multivariable models, compared with the persistently low pain trajectory, there was a dose-dependent increase in postdischarge ED visits and readmission for pain-related diagnoses, but not postdischarge complications (χ trend P < 0.001). CONCLUSIONS Postoperative pain trajectories identify populations at risk for 30-day readmissions and ED visits, and do not seem to be mediated by postdischarge complications. Addressing pain control expectations before discharge may help reduce surgical readmissions in high pain categories.
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Nickerson P, Tighe P, Shickel B, Rashidi P. Deep neural network architectures for forecasting analgesic response. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2966-2969. [PMID: 28268935 DOI: 10.1109/embc.2016.7591352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Response to prescribed analgesic drugs varies between individuals, and choosing the right drug/dose often involves a lengthy, iterative process of trial and error. Furthermore, a significant portion of patients experience adverse events such as post-operative urinary retention (POUR) during inpatient management of acute postoperative pain. To better forecast analgesic responses, we compared conventional machine learning methods with modern neural network architectures to gauge their effectiveness at forecasting temporal patterns of postoperative pain and analgesic use, as well as predicting the risk of POUR. Our results indicate that simpler machine learning approaches might offer superior results; however, all of these techniques may play a promising role for developing smarter post-operative pain management strategies.
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Tighe PJ, King CD, Zou B, Fillingim RB. Time to Onset of Sustained Postoperative Pain Relief (SuPPR): Evaluation of a New Systems-level Metric for Acute Pain Management. Clin J Pain 2016; 32:371-9. [PMID: 26247416 DOI: 10.1097/ajp.0000000000000285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Prior work on postoperative pain trajectories has examined pain score changes over time using daily averages of pain scores. However, little is known about the time required until patients consistently report minimal postoperative pain. MATERIALS AND METHODS We conducted a retrospective cohort study of surgical case data from 7293 adult patients to examine the impact of age, sex, and the type of surgery on the time to sustained postoperative pain relief (SuPPR). We defined SuPPR as the time required until a patient reports the first of multiple (2, 3, 4, or 5 sequential measurements; eg, SuPPR-2, SuPPR-3), uninterrupted, mild pain scores (≤4/10). RESULTS Overall, SuPPR times ranged from 3 minutes for SuPPR-2 and 9 minutes for SuPPR-5 to 160.1 hours for SuPPR-2 and 183.1 hours for SuPPR-5. For the SuPPR-2 outcome, the median time to event was 10.9 hours (interquartile range, 3 to 26.1 h) after surgery. For the SuPPR-5 outcomes, the median time to event was 31.5 hours (interquartile range, 17.8 to 54.2 h) after surgery. The peak median difference between 2 sequential SuPPR definitions was between SuPPR-3 and SuPPR-2 at 9 hours, with subsequent decreases to 6.5 hours between SuPPR-4 and SuPPR-3, and 5.2 hours between SuPPR-5 and SuPPR-4. There were statistically different differences across SuPPR-2 through SuPPR-5 definitions by age, sex, and type of surgery. DISCUSSION Although additional analyses are necessary, SuPPR may represent a novel method for evaluating acute pain service performance.
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Affiliation(s)
- Patrick J Tighe
- *Pain Research and Intervention Center of Excellence (PRICE), University of Florida Departments of †Anesthesiology ‡Biostatistics, University of Florida College of Medicine, Gainesville, FL
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Lindberg MF, Miaskowski C, Rustøen T, Rosseland LA, Paul SM, Lerdal A. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty. PLoS One 2016; 11:e0161681. [PMID: 27583551 PMCID: PMC5008744 DOI: 10.1371/journal.pone.0161681] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 08/10/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. METHODS Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. RESULTS Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. DISCUSSION Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.
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Affiliation(s)
- Maren Falch Lindberg
- Department of Surgery, Lovisenberg Diakonale Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Anners Lerdal
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway
- * E-mail:
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Connor LO. Developing 'subject matter experts': an improvement methodology programme for acute postoperative pain with patients post major surgery. J Clin Nurs 2016; 25:2629-38. [PMID: 27334830 DOI: 10.1111/jocn.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine the effectiveness of an improvement methodology initiative, directed at refining the quality of acute pain management of patients in the first 24 hours post major surgery using the Revised American Pain Society Patient Outcome Questionnaire, pre- and post development of a 'subject matter experts' acute pain programme. BACKGROUND Accurately measuring effectiveness of acute pain management post major surgery is intertwined with measuring overall patient satisfaction. A critical element of quality evaluation is obtaining direct feedback from patients about the here-and-now pain experiences post major surgery. METHODS A prospective cross-sectional, observational study was conducted in a large university hospital in Ireland. The questionnaire was completed with patients within 24 hours post major surgery, i.e., cardiothoracic, breast, gynaecological, gastrointestinal and urology surgery. The nurse participants were selected based on their commitment to play a key role in acute pain management. The study consisted of: a pre programme phase (n = 100 patients), an intervention phase - 'subject matter experts' acute pain programme (n = 24 nurses) and a postprogramme phase (n = 100 patients). RESULTS Over a quarter of patients were in severe pain for long periods in the first 24 hours post major surgery. These findings were linked not only to ineffective analgesia from some pain drug therapies but also to contradictory messages from nurses. Over half of the patients' pre- and postintervention reported satisfaction with acute pain management, whereas the remainder were dissatisfied and some sought answers to their suboptimum pain status. The 'subject matter experts' had a noteworthy impact on the patients' pain beliefs. CONCLUSIONS The findings revealed that a 'subject matter experts' acute pain programme can have a positive impact on pain management in the immediate phase post major surgery. RELEVANCE TO CLINICAL PRACTICE The role making of 'subject matter experts' in acute pain is a tactical approach towards achieving optimum patient pain control in the immediate phase post major surgery.
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Affiliation(s)
- Laserina O Connor
- Mater Misericordiae University Hospital, St Vincent's Health Care Group, University College Dublin, Dublin, Ireland.
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Postoperative pain documentation in a hospital setting: A topical review. Scand J Pain 2016; 11:77-89. [DOI: 10.1016/j.sjpain.2015.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/17/2015] [Accepted: 12/20/2015] [Indexed: 11/17/2022]
Abstract
Abstract
Background and aims
Nursing documentation supports continuity of care and provides important means of communication among clinicians. The aim of this topical review was to evaluate the published empirical studies on postoperative pain documentation in a hospital setting.
Methods
The review was conducted through a systematic search of electronic databases: Web of Science, PubMed/Medline, CINAHL, Embase, Ovid/Medline, Scopus and Cochrane Library. Ten studies were included. Study designs, documented postoperative pain information, quality of pain documentation, reported quality of postoperative pain management and documentation, and suggestions for future research and practice improvements were extracted from the studies.
Results
The most commonly used study design was a descriptive retrospective patient record review. The most commonly reported types of information were pain assessment, use of pain assessment tools, useof pain management interventions, reassessment, types of analgesics used, demographic information and pain intensity. All ten studies reported that the quality of postoperative pain documentation does not meet acceptable standards and that there is a need for improvement. The studies found that organization of regular pain management education for nurses is important for the future.
Conclusions
Postoperative pain documentation needs to beimproved. Regular educational programmes and development of monitoring systems for systematic evaluation of pain documentation are needed. Guidelines and recommendations should be based on the latest research evidence, and systematically implemented into practice.
Implications
Comprehensive auditing tools for evaluation of pain documentation can make quality assessment easier and coherent. Specific and clear documentation guidelines are needed and existing guidelines should be better implemented into practice. There is a need to increase nurses’ knowledge of postoperative pain management, assessment and documentation. Studies evaluating effectiveness of high quality pain documentation are required.
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Moscoso Loaiza LF, Bernal Cardenas CY. Cuidado y manejo del dolor en el paciente en posoperatorio de revascularización miocárdica. AVANCES EN ENFERMERÍA 2016. [DOI: 10.15446/av.enferm.v33n2.52477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>En la actualidad, se ha puesto de manifiesto la relación existente entre el dolor agudo posoperatorio y la aparición de múltiples complicaciones, que hacen necesario el manejo efectivo del dolor posquirúrgico por parte del profesional de enfermería. Objetivo: Generar una propuesta de cuidado de enfermería para el manejo del dolor en el paciente en posoperatorio de revascularización miocárdica, tras la extubación, con base en la Teoría de los Síntomas Desagradables. Metodología: A partir de la metodología del marco lógico, se socializó la importancia del manejo del dolor en el paciente en posoperatorio de revascularización miocárdica, así como la Teoría de los Síntomas Desagradables, al personal de enfermería que labora en una Unidad de Cuidado Intensivo de una Institución Prestadora de Servicios de Salud de IV Nivel en la ciudad de Bogotá. Se elaboró un formato de valoración para establecer los factores que determinaban el dolor, las características del síntoma dolor y las consecuencias del síntoma, para luego establecer la propuesta de cuidado de enfermería. Resultados: Se valoró la experiencia del dolor en nueve pacientes en posoperatorio de revascularización miocárdica, obteniendo como hallazgo que la presencia del dolor, principalmente, impedía la actividad física, la tos efectiva y el sueño, ocasionando un alto nivel de ansiedad, preocupación y cansancio. Con base en los hallazgos, se proponen ocho diagnósticos de enfermería, con sus respectivas actividades. Conclusión: La adecuada valoración y manejo del dolor postquirúrgico por parte del profesional de enfermería permite una recuperación adecuada, así como un aumento del bienestar y la comodidad en el paciente revascularizado.</p>
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Mittag O, Kampling H, Farin E, Tully PJ. Trajectories of depressive symptoms after a major cardiac event. Health Psychol Open 2016; 3:2055102915624873. [PMID: 28070385 PMCID: PMC5193273 DOI: 10.1177/2055102915624873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Depression is a common comorbidity in cardiac patients. This study sought to document fluctuations of depressive symptoms in the 12 months after a first major cardiac event. In all, 310 patients completed a battery of psychosocial measures including the depression subscale of the Symptom Check List-90-Revised. A total of 252 of them also completed follow-up measures at 3 and 12 months. Trajectories of depressive symptoms were classified as none, worsening symptoms, sustained remission, and persistent symptoms. Although the prevalence of depressive symptoms was consistent at each assessment, there was considerable fluctuation between symptom classes. Regression analyses were performed to identify predictors of different trajectories.
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Affiliation(s)
| | | | - Erik Farin
- University Medical Center Freiburg, Germany
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Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty. Pain 2015; 156:460-468. [PMID: 25599235 DOI: 10.1097/01.j.pain.0000460327.10515.2d] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal of this study was to follow a cohort of patients undergoing total knee arthroplasty over time to: (1) identify and describe the various pain trajectories beginning preoperatively and for up to 12 months after surgery, (2) identify baseline predictors of trajectory group membership, and (3) identify trajectory groups associated with poor psychosocial outcomes 12 months after surgery. One hundred seventy-three participants (female = 85 [49%]; mean age [years] = 62.9, SD = 6.8) completed pain and psychological questionnaires and functional performance tests preoperatively and 4 days, 6 weeks, and 3 and 12 months after total knee arthroplasty. Using growth mixture modeling, results showed that a 4-group model, with a quadratic slope and baseline pain data predicting trajectory group membership, best fit the data (Akaike information criterion = 2772.27). The first 3 pain trajectories represent various rates of recovery ending with relatively low levels of pain 12 months after surgery. Group 4, the constant high pain group, comprises patients who have a neutral or positive pain slope and do not show improvement in their pain experience over the first year after surgery. This model suggests that preoperative pain levels are predictive of pain trajectory group membership and moderate preoperative pain, as opposed to low or high pain, is a risk factor for a neutral or positive pain trajectory postoperatively. Consistent with previous studies, these results show that postoperative pain is not a homogeneous condition and point to the importance of examining intraindividual pain fluctuations as they relate to pain interventions and prevention strategies.
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Bjørnnes AK, Rustøen T, Lie I, Watt-Watson J, Leegaard M. Pain characteristics and analgesic intake before and following cardiac surgery. Eur J Cardiovasc Nurs 2014; 15:47-54. [PMID: 25192967 DOI: 10.1177/1474515114550441] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiac surgery is a common intervention that involves several pain-sensitive structures, and intense postoperative pain is a predictor of persistent pain. AIMS To describe pain characteristics (i.e. intensity, location, interference, relief) and analgesic intake preoperatively and across postoperative days 1 to 4 after cardiac surgery, and to explore associations between postoperative pain and demographic and clinical characteristics. METHODS Four hundred and sixteen patients (24% women) undergoing elective coronary artery bypass grafting and/or valve surgery were enrolled in a randomized controlled trial. Data were collected using standardized measures including the Brief Pain Inventory-short form. A linear mixed model analysis estimated the impact of sex, age, body mass index, analgesic intake and preoperative pain on postoperative worst pain ratings in the previous 24 hours from postoperative days 1 to 4 prior to discharge RESULTS Thirty-eight per cent of the cardiac surgery patients reported preoperative pain. Postoperative worst pain remained in the moderate to severe range for the majority of patients across day 1 (85%) to day 4 (57%), mainly around the chest incision area for the majority (70%). Mean oral morphine intake was 17 mg/24 h (day 1: 27mg; day 4: 10mg). Lower age, female sex, preoperative pain and analgesic intake had a statistically significant association with higher postoperative worst pain ratings. CONCLUSION Study findings demonstrated a high prevalence of moderate to severe pain after cardiac surgery and insufficient analgesic administration. Results indicated that patients were discharged from hospital with unrelieved pain and a potential risk for further postoperative complications.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Norway Institute of Health and Society, University of Oslo, Norway
| | - Irene Lie
- Department of Cardiothoracic Surgery, Oslo University Hospital, Ullevål, Norway
| | - Judy Watt-Watson
- Lawrence S Bloomberg Faculty of Nursing, Senior Fellow, Massey College University of Toronto, Canada
| | - Marit Leegaard
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Institute of Nursing, Norway
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