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Langford R, Pogatzki-Zahn EM, Morte A, Sust M, Cebrecos J, Vaqué A, Ortiz E, Fettiplace J, Adeyemi S, López-Cedrún JL, Bescós S, Gascón N, Plata-Salamán C. Co-crystal of Tramadol-Celecoxib Versus Tramadol or Placebo for Acute Moderate-to-Severe Pain After Oral Surgery: Randomized, Double-Blind, Phase 3 Trial (STARDOM1). Adv Ther 2024; 41:1025-1045. [PMID: 38183526 PMCID: PMC10879371 DOI: 10.1007/s12325-023-02744-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Co-crystal of tramadol-celecoxib (CTC) is the first analgesic co-crystal for acute pain. This completed phase 3 multicenter, double-blind trial assessed the efficacy and safety/tolerability of CTC in comparison with that of tramadol in the setting of moderate-to-severe pain up to 72 h after elective third molar extraction requiring bone removal. METHODS Adults (n = 726) were assigned randomly to five groups (2:2:2:2:1): orally administered twice-daily CTC 100 mg (44 mg rac-tramadol hydrochloride/56 mg celecoxib; n = 164), 150 mg (66/84 mg; n = 160) or 200 mg (88/112 mg; n = 160); tramadol 100 mg four times daily (n = 159); or placebo four times daily (n = 83). Participants in CTC groups also received twice-daily placebo. The full analysis set included all participants who underwent randomization. The primary endpoint was the sum of pain intensity differences over 0 to 4 h (SPID0-4; visual analog scale). Key secondary endpoints included 4-h 50% responder and rescue medication use rates. Safety endpoints included adverse events (AEs), laboratory measures, and Opioid-Related Symptom Distress Scale (OR-SDS) score. RESULTS All CTC doses were superior to placebo (P < 0.001) for primary and key secondary endpoints. All were superior to tramadol for SPID0-4 (analysis of covariance least squares mean differences [95% confidence interval]: - 37.1 [- 56.5, - 17.6], - 40.2 [- 59.7, - 20.6], and - 41.7 [- 61.2, - 22.2] for 100, 150, and 200 mg CTC, respectively; P < 0.001) and 4-h 50% responder rate. Four-hour 50% responder rates were 32.9% (CTC 100 mg), 33.8% (CTC 150 mg), 40.6% (CTC 200 mg), 20.1% (tramadol), and 7.2% (placebo). Rescue medication use was lower in the 100-mg (P = 0.013) and 200-mg (P = 0.003) CTC groups versus tramadol group. AE incidence and OR-SDS scores were highest for tramadol alone. CONCLUSIONS CTC demonstrated superior pain relief compared with tramadol or placebo, as well as an improved benefit/risk profile versus tramadol. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02982161; EudraCT number, 2016-000592-24.
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Affiliation(s)
| | | | | | | | | | - Anna Vaqué
- ESTEVE Pharmaceuticals, Barcelona, Spain
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Riecke J, Zerth SF, Schubert AK, Wiesmann T, Dinges HC, Wulf H, Volberg C. Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data. BMJ Open 2023; 13:e069977. [PMID: 37156592 PMCID: PMC10173966 DOI: 10.1136/bmjopen-2022-069977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Surgical fear is one of the most important psychological risk factors for postoperative pain, but less is known about the contribution of protective factors. This study investigated somatic and psychological risk and resilience factors of postoperative pain and validated the German version of the Surgical Fear Questionnaire (SFQ). SETTING University Hospital of Marburg, Germany. DESIGN Single-centre observational study and cross-sectional validation study. PARTICIPANTS Data for validating the SFQ were obtained from a cross-sectional observational study (N=198, mean age 43.6 years, 58.8% female) with persons undergoing different kinds of elective surgery. A sample of N=196 (mean age 43.0 years, 45.4% female) undergoing elective (orthopaedic) surgery was analysed to investigate somatic and psychological predictors of relevant acute postsurgical pain (APSP). OUTCOME MEASURES Participants completed preoperative and postoperative assessments at postoperative days 1, 2 and 7. Presurgical pain, age, gender, pain expectation, surgical setting, physical status, anaesthesia, surgical fear, pain catastrophising, depression, optimism and self-efficacy were examined as predictors. RESULTS Confirmatory factor analysis confirmed the original two-factor structure of the SFQ. Correlation analyses indicated good convergent and divergent validity. Internal consistency (Cronbach's α) was between 0.85 and 0.89. Blockwise logistic regression analyses for the risk of APSP revealed outpatient setting, higher preoperative pain, younger age, more surgical fear and low dispositional optimism as significant predictors. CONCLUSIONS The German SFQ is a valid, reliable and economical instrument with which the important psychological predictor surgical fear can be assessed. Modifiable factors that increase the risk of postoperative pain were higher pain intensity before surgery and being fearful about negative consequences of the surgery whereas positive expectations seem to buffer against postsurgical pain. TRIAL REGISTRATION NUMBERS DRKS00021764 and DRKS00021766.
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Affiliation(s)
- Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Simon Felix Zerth
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Ann-Kristin Schubert
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | | | - Hanns-Christian Dinges
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
| | - Christian Volberg
- Department of Anesthesiology & Intensive Care Medicine, Philipps University Marburg Faculty of Medicine, Marburg, Germany
- Research Group Medical Ethics, University of Marburg, Marburg, Germany
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Individualized multidisciplinary analgesia to prevent persistent postsurgical pain. Curr Opin Anaesthesiol 2022; 35:380-384. [PMID: 35671029 DOI: 10.1097/aco.0000000000001140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Persistent postsurgical pain as outcome of surgery has reached more attention in the past years. In the first place because of related disability, long-term use of (opioid)analgesics and impact on the quality of life of individual patients. In addition, the individual and societal socio-economic burden of PPSP is high and increasing in the light of increasing numbers of surgery world-wide. RECENT FINDINGS Actual studies identified risk factors for persistent postsurgical pain in relevant patient populations. Astonishingly, most of predicting factors seem unrelated to surgery. SUMMARY Future perioperative practice will have to focus on identifying patients at risk for PPSP before surgery and develop/offer suitable individually tailored preventive interventions.
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Stjernberg M, Schlichting E, Rustoen T, Valeberg BT, Småstuen M, Raeder JC. Postdischarge pain, nausea and patient satisfaction after diagnostic and breast-conserving ambulatory surgery for breast cancer: A cross-sectional study. Acta Anaesthesiol Scand 2022; 66:317-325. [PMID: 34888855 DOI: 10.1111/aas.14015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aims of this study were to assess first day postdischarge pain, nausea and patient satisfaction in ambulatory breast cancer surgical patients, after diagnostic and breast conserving procedures. METHODS A total of 781 women, aged 18-85 years were included in this prospective, cross-sectional study. All patients received standardized multimodal pain prophylaxis with paracetamol, COX-II inhibitor, dexamethasone and wound infiltration with local anaesthetics. Nausea prophylaxis was provided with ondansetron. Most patients received general anaesthesia with propofol and remifentanil. Data were collected using a validated questionnaire during telephone follow-up on the first postoperative day. RESULTS The response rate was 94.5%. NRS ≥ 4 was reported by 5.3% at rest, by 17% during activity and by 30.7% as the worst pain score. Young age was strongly associated with more pain both at rest, during activity and regarding worst pain since discharge. Postdischarge nausea was present in 17.8%, and vomiting in 1.2%. High pain score during activity and higher level of worst pain, were associated with nausea. There was no association between nausea and age, type of anaesthesia, surgical procedure or pain at rest. Patient satisfaction was high (97.8%-99.7%) regarding information, time for discharge and overall satisfaction. CONCLUSION Pain scores and incidence of nausea were generally low on the day after surgery. Young age was a strong predictor for postdischarge pain. A high worst pain score and high pain score during the activity were associated with postdischarge nausea. Patient satisfaction was high.
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Affiliation(s)
- Mi Stjernberg
- Division of Emergencies and Critical Care Department of Research and Development Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Ellen Schlichting
- Department of Breast and Endocrine Surgery Oslo University Hospital Oslo Norway
| | - Tone Rustoen
- Division of Emergencies and Critical Care Department of Research and Development Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Berit T. Valeberg
- Department of Nursing and Health Promotion Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Milada C. Småstuen
- Division of Emergencies and Critical Care Department of Research and Development Oslo University Hospital Oslo Norway
- Department of Nursing and Health Promotion Faculty of Health Sciences Oslo Metropolitan University Oslo Norway
| | - Johan C. Raeder
- Faculty of Medicine University of Oslo Oslo Norway
- Division of Emergencies and Critical Care Department of Anaesthesiology Oslo University Hospital Oslo Norway
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Stessel B, Hendrickx M, Pelckmans C, De Wachter G, Appeltans B, Braeken G, Herbots J, Joosten E, Van de Velde M, Buhre WFFA. One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial. PLoS One 2021; 16:e0245774. [PMID: 33497408 PMCID: PMC7837485 DOI: 10.1371/journal.pone.0245774] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
Background/Objectives This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR. Methods/Design This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test. Results Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups. Conclusions The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile. Trial registration European Union Clinical Trials Register 2015-003987-35.
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Affiliation(s)
- Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Diepenbeek, Belgium
- * E-mail:
| | - Maarten Hendrickx
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium
| | - Caroline Pelckmans
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | | | - Bart Appeltans
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Geert Braeken
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Herbots
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
| | - Elbert Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marc Van de Velde
- Department of Anaesthesiology and Pain Medicine, University Hospital, Leuven, Belgium
| | - Wolfgang F. F. A. Buhre
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Callebaut I, Jorissen S, Pelckmans C, Berends N, Droogmans M, van Rossum M, Nulens M, Stessel B. Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery. Anesth Pain Med 2020; 10:e101669. [PMID: 32944560 PMCID: PMC7472168 DOI: 10.5812/aapm.101669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. Objectives The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. Methods The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. Results Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. Conclusions Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.
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Affiliation(s)
- Ina Callebaut
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Steffe Jorissen
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | | | - Noor Berends
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | | | - Maxime van Rossum
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | - Marijke Nulens
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
| | - Bjorn Stessel
- Department of Anesthesiology and Pain, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
- Corresponding Author: Department of Anesthesiology and Pain, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium.
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Booysen V, Burger JR, du Plessis JM, Cockeran M. Assessment of post-operative pain medication adherence after day case orthopaedic surgery: A prospective, cross-sectional study. Int J Orthop Trauma Nurs 2019; 36:100718. [PMID: 31585861 DOI: 10.1016/j.ijotn.2019.100718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Patients struggle to adhere to prescribed pain medication after surgery because of, inter alia, side effects, sleep disturbances and pain severity. This study aimed to determine the influence of various factors on, the extent of adherence to prescribed post-operative pain medication (POPM) measured by participant-reported pill count (PRPC) following day case orthopaedic surgery at a private South African hospital. METHODS This prospective, quantitative cross-sectional study involving 120 participants (51 males, 69 females), used a structured questionnaire completed through a telephonic survey, 4 days after orthopaedic surgery. Measurements included PRPC adherence (adherent vs. non-adherent), in relation to post-operative adherence behaviour (POAB), normal medicine adherence behaviour (NMAB), pain severity affecting sleep and mobility, treatment side effects and patient demographic characteristics. RESULTS Based on PRPC measurement 56.7% (n = 68) of participants were adherent. PRPC was significantly associated with severe pain affecting falling sleep (p = .001), pain causing awakening from sleep (p = .035) and POAB (p < .001, Cramér's V = 0.5). PRPC adherence was independent from gender (p = .140), age (p = .822), smoking status (p = 1.000), type and event of side effects (p > .300), NMAB (p = .601) and the treatment regimen (i.e. unimodal vs. bimodal or multimodal) (p = .511). CONCLUSION Non-adherence (overuse or misuse) of prescribed POPM can be a result of severe pain, influencing sleep and movement after orthopaedic surgery, indicating a need for the review of these regimens in order to optimise care.
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Affiliation(s)
- Vanessa Booysen
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Johanita R Burger
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
| | - Jesslee M du Plessis
- Medicine Usage in South Africa (MUSA), School of Pharmacy, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Marike Cockeran
- Statistics, School of Computer, Statistical and Mathematical Sciences, North-West University, Potchefstroom, South Africa
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Zhang Y, Zhang R, Ding N. Investigation of analgesic dose of nalbuphine combined with remifentanil after radical gastrectomy. Exp Ther Med 2019; 18:1633-1638. [PMID: 31410119 PMCID: PMC6676188 DOI: 10.3892/etm.2019.7715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 05/28/2019] [Indexed: 11/25/2022] Open
Abstract
Clinical analgesic effect of different doses of nalbuphine combined with remifentanil on postoperative gastric cancer patients was explored. One hundred cases of gastric cancer patients treated from December 2014 to December 2016 in the Xiangyang No. 1 People's Hospital were selected and separated into group A and group B. The dose in group A was 0.2 mg/kg of nalbuphine plus 0.2 µg/kg of remifentanil, and 0.3 mg/kg of nalbuphine plus 0.1 µg/kg of remifentanil in group B. Analgesia was performed by self-controlled intravenous injection. The Visual Analogue Scale (VAS) pain scores and the Brinell Comfort Score (BCS) at 2, 6, 12, 24 and 48 h after operation, and the incidence of adverse reactions were compared between the two groups. The VAS scores in group A were higher than those in group B, but the BCS scores in group A were lower (P<0.05). Postoperative patient-controlled intravenous analgesia (PCIA) press times in group A were lower than those in group B (P<0.05); the incidence of adverse reactions such as nausea and vomiting in group A was higher than that in group B (P<0.05). The analgesic effect of intravenous analgesia scheme of 0.3 mg/kg of nalbuphine and 0.1 µg/kg of remifentanil on gastric cancer patients after operation is better than that of 0.2 mg/kg of nalbuphine and 0.2 µg/kg of remifentanil, which reduces the incidence of adverse reactions, has greater security, and can be promoted.
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Affiliation(s)
- Yang Zhang
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Rongfang Zhang
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Nannan Ding
- Department of Pharmacy, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Science, Xiangyang, Hubei 441000, P.R. China
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Vrancken D, Theunissen M, Joosten EA, Fiddelers AAA, Hoofwijk DMN, Buhre WFFA, Gramke HF, Stessel B. Procedure-Specific Pain Intensity Four Days After Day Surgery and the Relationship with Preoperative Pain: A Prospective Cohort Study. Anesth Pain Med 2019; 8:e81366. [PMID: 30719413 PMCID: PMC6347732 DOI: 10.5812/aapm.81366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/01/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
Background Identification of painful procedures is essential for the development of procedure-specific pain-treatment schedules. The aim of this study was firstly, to analyze the prevalence of acute postsurgical pain (APSP) after various types of day surgery on the fourth postoperative day, and secondly, to assess the predictive value of preoperative pain for the development of APSP after different types of surgical procedures. Methods From November 2008 to April 2010, patients scheduled for elective day surgery were enrolled in this prospective cohort study. Data were collected one week preoperatively and four days postoperatively. The 11-point Numeric Rating Scale (NRS) was used for pain measurement. Moderate pain was defined as an NRS 4 to 5, and severe pain as an NRS > 5. The predictive value of preoperative pain for development of APSP was analyzed using a univariate logistic regression, stratified for the surgical procedure. Results From a total of 1123 included patients, 182 patients experienced moderate pain (16.3%) and 136 patients experienced severe pain (12.1%) on the fourth postoperative day. A large procedure-specific variability in APSP was observed, with shoulder, anal and dental surgery associated with the highest pain levels. Overall, preoperative pain significantly predicted postoperative pain on the fourth day (OR 4.45). This predictive value showed a procedure-specific variation and was not noted after various well-defined procedures. Conclusions The prevalence of moderate to severe APSP was high four days after day surgery and showed a significant procedure-specific variation. Furthermore, there was a strong relationship between preoperative and postoperative pain, likewise characterized by a significant procedure-specific variation.
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Affiliation(s)
- Dirk Vrancken
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium. Tel: +32-479439183,
| | - Maurice Theunissen
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Elbert A. Joosten
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Audrey A. A. Fiddelers
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Daisy M. N. Hoofwijk
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wolfgang F. F. A. Buhre
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Björn Stessel
- Department of Anesthesiology and Pain Medicine, Jessa Hospital, Hasselt, Belgium
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Goldszmidt RB, Buttendorf AR, Schuldt Filho G, Souza JM, Bianchini MA. The impact of generic labels on the consumption of and adherence to medication: a randomized controlled trial. Eur J Public Health 2018; 29:12-17. [DOI: 10.1093/eurpub/cky183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rafael B Goldszmidt
- Brazilian School of Public and Business Administration, Getulio Vargas Foundation, Rio de Janeiro, Brazil
| | - André R Buttendorf
- Department of Dentistry, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Guenther Schuldt Filho
- Division of Dentistry, University of Southern Santa Catarina, Grande Florianópolis, Brazil
| | - Jose M Souza
- Department of Dentistry, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Marco A Bianchini
- Department of Dentistry, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Brazil
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