Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

Prevalence of chronic pain and its risk factors until one year after intensive care unit discharge. A single-center prospective observational study

PURPOSE

To investigate the prevalence and risk factors for long-term pain following an ICU stay.

MATERIALS AND METHODS

This prospective, single-center study included patients who stayed in the ICU for ≥3 days and could complete a questionnaire. The primary aim was to assess chronic pain incidence at 3 months and up to 1 year post-discharge and identify associated risk factors. Follow-up involved 3 phone interviews at 3, 6, and 12 months, utilizing the Brief Pain Inventory (BPI) and the Patient Health Questionnaire-2 (PHQ-2).

RESULTS

Among the 150 included patients (mean age 66 ± 17 years; 66 % male; median SAPS II 39), 71(47 %) reported pain at discharge. At 3 months, 39 % of 114 respondents had pain, and 35 % of 103 patients at one year. Significant factors for pain at 3 months included urgent surgical admission (p = 0.029), axial-skeleton bone fractures (p = 0.035), days with significant pain in ICU (p = 0.004), and opioid exposure (p = 0.014 for duration, p = 0.038 for dose). Axial skeleton fractures were independently associated with pain at 1 year (OR 5.18, p = 0.023).

CONCLUSIONS

Around one-third of ICU patients experience pain one year post-discharge, with axial-skeleton bone fractures being a significant risk factor for chronic pain.

IMPLICATIONS FOR CLINICAL PRACTICE

Management of pain and optimal opioids dose during ICU stay are crucial to limit chronic pain after ICU discharge. Special attention should be given to patients with axial-skeleton fracture.

Postoperative pain at Landspitali: A prospective study

BACKGROUND

Moderate or severe postoperative pain is common despite advances in surgical technique and perioperative analgesia. This study aimed to assess the prevalence and severity of postoperative pain following procedures requiring anaesthesia and identify factors associated with increased risk of postoperative pain.

METHODS

Surgical patients ≥18 years of age were prospectively questioned on level of current pain on a numerical rating scale (NRS) from 0 to 10 in the post-anaesthesia care unit (PACU) and on resting, active and worst pain experienced in the first 24 h postoperatively. Clinical data was obtained from medical records. Descriptive statistics were applied, and predictors of worst pain assessed as moderate/severe (NRS ≥ 5) on postoperative day one were assessed using multivariable logistic regression.

RESULTS

Of 438 included participants, moderate/severe pain occurred in 29% on the day of surgery and 70% described their worst pain as moderate/severe on postoperative day one. Procedures with the highest incidence of moderate/severe pain on the day of surgery were gynaecology-, plastic-, abdominal-, breast-, and orthopaedic procedures. On postoperative day one, patients undergoing vascular-, orthopaedic-, and abdominal operations most commonly rated their worst pain as moderate/severe. Female sex (OR = 2.15, 95% Cl 1.21-3.88, p = .010), chronic preoperative pain (OR = 4.20, 95% Cl 2.41-7.51, p < .001), undergoing a major procedure (OR = 2.07, 95% Cl 1.15-3.80, p = .017), and any intraoperative remifentanil administration (OR = 2.16, 95% Cl 1.20-3.94, p = .01) had increased odds of rating the worst pain as moderate/severe. Increased age (OR = 0.66 per 10 years (95% Cl 0.55-0.78, p < .001)) and undergoing breast-, gynaecology-, otolaryngology-, and neurosurgery (OR = 0.15-0.34, p < .038) was associated with lower odds of moderate/severe pain on postoperative day one.

DISCUSSION

In our cohort, patients rated their current pain in the PACU similarly to other studies. However, the ratio of patients rating the worst pain experienced as moderate/severe on postoperative day one was relatively high. The identified patient- and procedural-related factors associated with higher odds of postoperative pain highlight a subgroup of patients who may benefit from enhanced perioperative monitoring and pain management strategies.