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Time to Onset of Sustained Postoperative Pain Relief (SuPPR): Evaluation of a New Systems-level Metric for Acute Pain Management

Tighe, Patrick J. MD, MS; King, Christopher D. PhD; Zou, Baiming PhD; Fillingim, Roger B. PhD

The Clinical Journal of Pain: May 2016 - Volume 32 - Issue 5 - p 371–379
doi: 10.1097/AJP.0000000000000285
Original Articles

Objectives: Prior work on postoperative pain trajectories has examined pain score changes over time using daily averages of pain scores. However, little is known about the time required until patients consistently report minimal postoperative pain.

Materials and Methods: We conducted a retrospective cohort study of surgical case data from 7293 adult patients to examine the impact of age, sex, and the type of surgery on the time to sustained postoperative pain relief (SuPPR). We defined SuPPR as the time required until a patient reports the first of multiple (2, 3, 4, or 5 sequential measurements; eg, SuPPR-2, SuPPR-3), uninterrupted, mild pain scores (≤4/10).

Results: Overall, SuPPR times ranged from 3 minutes for SuPPR-2 and 9 minutes for SuPPR-5 to 160.1 hours for SuPPR-2 and 183.1 hours for SuPPR-5. For the SuPPR-2 outcome, the median time to event was 10.9 hours (interquartile range, 3 to 26.1 h) after surgery. For the SuPPR-5 outcomes, the median time to event was 31.5 hours (interquartile range, 17.8 to 54.2 h) after surgery. The peak median difference between 2 sequential SuPPR definitions was between SuPPR-3 and SuPPR-2 at 9 hours, with subsequent decreases to 6.5 hours between SuPPR-4 and SuPPR-3, and 5.2 hours between SuPPR-5 and SuPPR-4. There were statistically different differences across SuPPR-2 through SuPPR-5 definitions by age, sex, and type of surgery.

Discussion: Although additional analyses are necessary, SuPPR may represent a novel method for evaluating acute pain service performance.

*Pain Research and Intervention Center of Excellence (PRICE), University of Florida

Departments of Anesthesiology

Biostatistics, University of Florida College of Medicine, Gainesville, FL

P.J.T. is supported by a Grant from NIH (no. K23 GM102697) Bethesda, MD. The authors declare no conflict of interest.

Reprints: Patrick J. Tighe, MD, MS, Department of Anesthesiology, University of Florida College of Medicine, P.O. Box 100254, Gainesville, FL 32610 (e-mail:

Received February 13, 2015

Received in revised form August 18, 2015

Accepted July 21, 2015

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