Predictors of postoperative pain and analgesic requirements following abdominal hysterectomy: an observational study

Predicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study

OBJECTIVES

This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery.

DESIGN

In a single-center prospective observational pilot study, the authors obtained validated measures of negative affect and opioid-related phenotype preoperatively and collected opioid use and opioid misuse-related outcomes at 30-day postoperative follow-up.

SETTING

Quaternary medical center.

PARTICIPANTS

The final dataset included 30 adult patients undergoing elective cardiac surgery procedures between August 19, 2022, and August 29, 2023.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Opioid outcomes included: (1) total inpatient postoperative opioid use (in milligram morphine equivalents), (2) self-reported number of days that prescribed outpatient opioids were used during the 30-day follow-up period (Timeline Followback method), and (3) number of opioid misuse-related behaviors (Current Opioid Misuse Measure-9) at 30-day follow-up. Generalized linear model analyses using a Poisson distribution indicated that greater preoperative depression, anxiety, anger, pain catastrophizing, and opioid misuse risk (indexed by the Screener and Opioid Assessment for Patients with Pain- Revised) were all significantly (p < 0.002) associated with greater inpatient and outpatient postoperative opioid use, as well as more opioid misuse-related behaviors at 30-day follow-up (p < 0.001).

CONCLUSIONS

Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post-cardiac surgery.

Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. The authors conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on posthysterectomy recovery.

METHODS

This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to 27 July 2023. The authors identified RCTs involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery scores.

RESULTS

Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 h following hysterectomy, as well as postoperative opioid consumption within 24 h and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration posthysterectomy.

CONCLUSION

Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

The Effect of Preoperative Fear of Pain on Postoperative Pain Levels and the Amount of Analgesic Consumption

BACKGROUND

Preoperative fear of pain can increase the surgical stress response along with anxiety, increasing postoperative pain and the amount of analgesia consumption.

AIMS

To determine the effect of preoperative fear of pain on postoperative pain level and analgesic consumption.

DESIGN

A descriptive, cross-sectional design was used.

METHODS

A total of 532 patients who were scheduled for a variety of surgical procedures in a tertiary hospital were included in the study. Data were collected using Patient Identification Information Form and Fear of Pain Questionnaire-III.

RESULTS

86.1% of the patients thought that they would experience postoperative pain, and 70% of the patients reported moderate-to-severe postoperative pain. The examination of the postoperative first 24-hour pain levels indicated that there was a significant positive correlation between patients' pain levels within 0-2 hours and their mean scores on the fear of severe and minor pain sub-dimensions and the total scale and between pain experienced within 3-8 hours and their scores on the fear of severe pain sub-dimension (p <.05). Also, a significant positive correlation was found between patients' mean scores on the total fear of pain scale and the amount of nonopioid (diclofenac sodium) consumption (p <0.05).

CONCLUSIONS

The fear of pain increased patients' postoperative pain levels, and thus the amount of analgesic consumption. Therefore, patients' fear of pain should be determined in the preoperative period, and pain management practices should be initiated in this period. As a matter of fact, effective pain management will positively affect patient outcomes by reducing the amount of analgesic consumption.

Kidney Donor Perspectives on Acute Postoperative Pain Management

This study employed a qualitative descriptive approach to examine living kidney donor's experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study. Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor's experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor's past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain. Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor's motivation might mediate their pain experience is needed.

Predictors of postoperative pain, opioid consumption, and functionality after arthroscopic shoulder surgery: A prospective observational study

PURPOSE

This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols.

STUDY DESIGN

Observational cohort study.

METHODS

One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1 h, 6 h, 12 h, 24 h, 72 h, 1 week and 1 month after surgery.

RESULTS

Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24 h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24 h, 72 h, and 1 week and lower functionality at 1 week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption.

CONCLUSION

Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.

Factors Contributing to Lingering Pain after Surgery: The Role of Patient Expectations

BACKGROUND

Pain that lingers beyond the early weeks after the acute postoperative period is an important risk factor for chronic postsurgical pain. This study examined the hypothesis that patients' expectations about their postsurgical pain would be independently associated with lingering postsurgical pain.

METHODS

The study included 3,628 patients who underwent diverse surgeries between February 2015 and October 2016 in a single U.S. tertiary hospital and participated in the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) observational study. Preoperatively, patients were asked about their expectations about pain 1 month after surgery. Patients were considered to have lingering postsurgical pain if they endorsed having pain in the area related to their surgeries during a follow-up survey obtained 1 to 3 months postoperatively. The independent associations between preselected perioperative variables and lingering postsurgical pain were evaluated.

RESULTS

Of the cohort, 36% (1,308 of 3,628) experienced lingering postsurgical pain. Overall, two thirds (2,414 of 3,628) expected their postsurgical pain to be absent or improved from baseline, and 73% of these had their positive expectations fulfilled. A total of 19% (686 of 3,628) expected new, unabated, or worsened pain, and only 39% (257 of 661) of these had their negative expectations fulfilled. Negative expectations were most common in patients with presurgical pain unrelated to the reason for surgery, undergoing surgeries not typically performed to help alleviate pain. Endorsing negative expectations was independently associated with lingering postsurgical pain (odds ratio, 1.56; 95% CI, 1.23 to 1.98; P < 0.001). Additional major factors associated with lingering postsurgical pain included recollection of severe acute postoperative pain (odds ratio, 3.13; 95% CI, 2.58 to 3.78; P < 0.001), undergoing a procedure typically performed to help alleviate pain (odds ratio, 2.18; 95% CI, 1.73 to 2.75; P < 0.001), and preoperative pain related to surgery (odds ratio, 1.91; 95% CI, 1.52 to 2.40; P < 0.001).

CONCLUSIONS

Lingering postsurgical pain is relatively common after diverse surgeries and is associated with both fixed surgical characteristics and potentially modifiable factors like pain expectations and severe acute postoperative pain.

EDITOR’S PERSPECTIVE

Predicting Pain Levels Following Vaginal Reconstructive Surgery: Who Is at Highest Risk?

OBJECTIVES

An ability to anticipate individuals at increased risk of postoperative pain would improve coordination of care and patient satisfaction. We sought to describe predictive factors of postoperative pain following vaginal reconstructive surgery.

METHODS

This institutional review board-approved, retrospective study used previously collected data from research performed at 1 center from 2009 to 2015. Eligible trials enrolled subjects undergoing vaginal reconstructive surgery for pelvic organ prolapse. All studies used a validated visual analog scale (VAS) for pain on postoperative day 1. Other information collected included pain medication use, medical and surgical history, and demographics. Linear regression analyses, multiple regression analyses, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze the relationship between VAS scores and other variables.

RESULTS

Six studies were analyzed with a total of 364 patients. The median age was 60 years (interquartile range, 16 years), and the median pain score on postoperative day 1 was 35 mm on a 100-mm VAS. Patients younger than 60 years (P < 0.001), those who used tobacco (P = 0.014), those who used pain medication prior to surgery (P = 0.007), and those who did not have a concomitant midurethral sling (P = 0.018) had significantly higher pain scores postoperatively. A trend was also noted with operating times greater than 210 minutes (P = 0.057) and preexisting history of depression (P = 0.065). Multiple regression was performed, and age, depression, tobacco use, and concomitant sling were found to be independent factors predictive of postoperative pain scores.

CONCLUSIONS

Age, depression, tobacco use, and concomitant midurethral sling are significant independent factors predictive of postoperative pain following vaginal reconstructive surgery.