INTENSE POSTOPERATIVE PAIN — RISK FACTORS AND PREVENTION: PROSPECTIVE, COHORT STUDY
Keywords:
acute postoperative pain, risk factorsAbstract
Introduction. Inadequate management of postoperative pain (POP) is a widespread phenomenon, that affects the patient both in the short and long term of surgery, and the intense postoperative pain (IPOP) is known to be a risk factor for chronification of pain. The ability to accurately assess and forecast the risk of developing an IPOP, would allow us а preemptive approach of this problem. IPOP was associated with female gender, age < 55 years, pain and use of analgesics in preoperative, psychoemotional condition. In this study, there was investigated the quality of risk factor of a number of new proposed parameters (eg., night surgery, postponing the intervention, environmental factors such as artificial or natural illumination in the postoperative period, etc.). Material and methods. Prospective, observational, cohort study. Research Ethics Committee and eligible patient’s agreement — obtained. There were enrolled adult patients, ASA I–II. Complete data of 292 cards of patients were analyzed. There recorded anthropometric parameters, type of intervention, duration of anesthesia, duration of intervention and a set of hypothetical parameters, tested as risk factors for IPOP — factors (preoperative, intraoperative and postoperative) that are directly related to the patient or the medical act itself and the administered medication. Statistical software were used: GraphPad Prism, version 6 (Graph Pad Software Inc., CA, USA). Results. Studied surgical population — homogeneous in terms of body mass, height, duration of anesthesia and surgical intervention; gender (predominantly women) and by type of surgery (44.9% laparoscopic cholecystectomies). Risk factors for IPOP: psychoemotional condition (depression (RR=4.9; [95% CI: 2.0–11.7], p=0.0093), preoperative anxiety (RR=6.6; [95% CI: 3.3–13.2], p<0.0001), pessimism (RR=6.4; [95% CI: 2.9–13.8], p=0.001), fear of pain (RR=3.0; [95% CI: 1.4–6.4], p=0.0043), hypervigilance personality (PCS=27), (RR=5.0; [95% CI: 1.7–14.8], p=0.0033); intense preoperative pain (RR=5.1; [95% CI: 2.4–10.6]; use of analgesics in preoperative (RR=5.5; [95% CI: 2.2–14.2], p=0.0156); intense pain on waking from anesthesia (RR=4.6; [95% CI: 2.2–9.5], p=0.0003); postoperative anxiety (RR=5.0; [95 Cl: 2.2–11.2], p=0.0037); acute neuropathic pain following surgery (RR=5.0; [95% CI: (1.2–5.2); p=0.0225); postoperative vomiting (RR=4.4; [95% CI: 1.8–10.9], p=0.0130); intestinal paresis = 48 hours (RR=7.8; [95% CI: 3.5–17.8], p=0.0050); postoperative sleepiness (RR=2.6; [95% CI: 1.1–5.95], p=0.0414); postoperative insomnia (RR=8.1; [95% CI: 4.1–15.9], p<0.0001) and fever = 38°C (RR=4.9; [95% CI: 2.0–11.8], p=0.0092). Conclusions. Patient’s altered psycho-emotional status, intense pre-operative pain, preoperative analgesic use, and IPOP at awakening from anesthesia, are risk factors for IPOP. The long-term intervention, which involves a comparatively higher consumption of opioids, precipitates in specific adverse events, including the induction of hyperalgesia and IPOP.
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