Pain Intensity in the First 96 Hours After Abdominal Surgery: A Prospective Cohort Study

• Published in: Pain medicine (Malden, Mass.) Vol. 21; no. 4; pp. 803 - 813
• Main Authors: Cachemaille, Matthieu, Grass, Fabian, Fournier, Nicolas, Suter, Marc R, Demartines, Nicolas, Hübner, Martin, Blanc, Catherine
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.04.2020
• Subjects: Abdomen; Abdominal surgery; Age Factors; Aged; Analgesics; Analgesics - therapeutic use; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Anesthesia, Epidural - methods; Anesthetics, Local - therapeutic use; Bariatric Surgery; Cohort analysis; Cohort Studies; Combined modality therapy; Complications and side effects; Digestive System Surgical Procedures; Elective Surgical Procedures; Emergencies; Female; Herniorrhaphy; Humans; Ketamine - therapeutic use; Laparoscopy; Laparotomy; Lidocaine - therapeutic use; Logistic Models; Lymph Node Excision; Male; Multivariate Analysis; Narcotics; Operative Time; Opioids; Pain; Pain management; Pain Management - methods; Pain Measurement; Pain, Postoperative; Pain, Postoperative - drug therapy; Pain, Postoperative - physiopathology; Pain, Postoperative - prevention & control; Parathyroidectomy; Patient Satisfaction; Patients; Prospective Studies; Risk factors; Surgery; Thyroidectomy; Switzerland; Abdominal Surgery; Postoperative Pain; Multimodal Therapy
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnz156

Abstract Objective Multimodal pain management strategies aim to improve postoperative pain control. The purpose of this study was to analyze pain scores and risk factors for acute postoperative pain after various abdominal surgery procedures. Methods Data on 11 different abdominal surgery procedures were prospectively recorded. Pain intensity (rest, mobilization) and patient satisfaction at discharge were assessed using a visual analog scale (VAS; 0–10), and analgesic consumption was recorded until 96 hours postoperation. Demographic, surgery-related, and pain management–related univariate risk factors for insufficient pain control (VAS ≥ 4) were entered in a multivariate logistic regression model. Results A total of 1,278 patients were included. Overall, mean VAS scores were <3 at all time points, and scores at mobilization were consistently higher than at rest (P < 0.05). Thirty percent of patients presented a prolonged VAS score ≥4 at mobilization at 24 hours, significantly higher than at rest (14%, P < 0.05). High pain scores correlated with high opioid consumption, whereas a variability of pain scores was observed in patients with low opioid consumption. The only independent risk factor for moderate and severe pain (VAS ≥ 4) was younger age (<70 years, P = 0.001). The mean satisfaction score was 8.18 ± 1.29. Conclusions Among 1,278 patients, pain was controlled adequately during the first four postoperative days, resulting in high levels of patient satisfaction. Pain levels were higher at mobilization. Younger age was the only independent risk factor for insufficient pain control. Preventive treatment in patients <70 years old and before mobilization could be evaluated for potential improvement.