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Can we define patients, which are at risk for post-operative pain after day case surgery?: A-43

Gramke, H.-F.; de Rijke, J. M.; van Kleef, M.; Marcus, M. A.E.

European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 12
Ambulatory Anaesthesia

Department of Anesthesiology, University Hospital Maastricht, Maastricht, The Netherlands

Background and Goal of Study: Despite an ongoing increase of ambulatory surgery, we know little which patients are at risks to have more pain after day case surgery. Postoperative pain not only causes discomfort and suffering, but also prevents the patient from resuming his daily activities. Severe postoperative pain may even have a negative impact on perioperative morbidity. These are important reasons for measuring post-operative pain. But most of the published papers on pain after ambulatory surgery lack a reasonable time for follow-up or did only measure a sub-group of this patient population. For future quality improvement, predictive factors, and course of post-operative pain is of the utmost importance. The purpose of our study was to assess the prevalence and intensity of postoperative pain during the first four days after the operation.

Materials and Methods: During a four-month period we enrolled 648 patients having ambulatory surgery at the day care unit of the university hospital of Maastricht, the Netherlands. A wide variety of operations were performed (general surgery, orthopedics, ophthalmology, gynecology, plastic surgery, ear-nose-throat, urology). Exclusion criteria were: age below 18 years, acute surgery, limitations of self-expression, and severe visual dysfunction. Using a visual analogue score (VAS) we evaluated postoperative pain before and up to four days postoperatively. Evaluations were made by direct questioning in hospital and using a pain diary after discharge from hospital.

Results and Discussions: Logistic regression analysis revealed that patients having pain with VAS >40 mm on the day of the operation were more likely to have pain with VAS >40mm during the following days. The younger age group (18-45 years) was more prone to have a VAS >40mm than older patients. Preoperative presence of pain and preoperative expectation of pain were other predictive values for postoperative pain in our population.

Conclusion(s): In conclusion, special attention should be given to operations which are more likely to cause postoperative pain.

© 2005 European Society of Anaesthesiology