Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
| Autor: | Mauricio Polanco-García, Margarita M. Puig, Jaume García-Lopez, Neus Fàbregas, Windfried Meissner |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Analgesic Cohort Studies Tertiary Care Centers Postoperative pain 03 medical and health sciences Dolor postoperatori Opioid consumption 0302 clinical medicine Patient satisfaction 030202 anesthesiology Pain assessment Surveys and Questionnaires Postoperative analgesia medicine Humans Pain Management Registries Dolor crònic - Cirurgia Pain Measurement Pain Postoperative business.industry Chronic pain Postoperative outcomes Middle Aged medicine.disease 3. Good health Analgesics Opioid Hospitalization Treatment Outcome Anesthesiology and Pain Medicine Neurology Opioid Spain Anesthesia Orthopedic surgery Female Neurology (clinical) Analgesia Chronic Pain Patient Participation Pre-surgical chronic pain business 030217 neurology & neurosurgery Abdominal surgery medicine.drug Cohort study |
| Zdroj: | The Journal of Pain. 18:1237-1252 |
| ISSN: | 1526-5900 |
| DOI: | 10.1016/j.jpain.2017.05.006 |
| Popis: | Pain after surgery remains a problem worldwide, although there are no published data on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The aims were to: assess postoperative outcomes and anesthetic/analgesic management in Orthopedics (ORT) and General Surgery (GEN) patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management according to surgical procedure. Mean worst pain and percentage of patients in severe pain were 5.6 (on a numeric rating scale of 0-10) and 39.4%, respectively, slightly lower than those reported in Western countries (range, 5.0-8.4 and 33-55%). Patients' pain assessment (83.1%) and information were high (63.3%), but participation in decision-making (4.8) was lower than in the United States (7.0) and Europe (Germany, France, Norway, and Denmark; mean, 5.9). Patients after orthopedic surgery had the worst outcomes. General anesthesia was more frequent in GEN patients, whereas regional (central and peripheral) was more frequent in ORT surgery patients. Mean opioid consumption (20.2 mg per patient per 24 hours, oral morphine equivalents), was lower than reported and decreased >50% after regional analgesia. Intravenous morphine patient-controlled analgesia was seldom used (6.2%). Acute opioid treatments were associated with worsened outcomes whereas multimodal analgesia (mainly antipyretic analgesics-nonsteroidal anti-inflammatory drugs-opioids) were associated with improved results. Epidurals in abdominal surgery (16.7%) were also associated with better outcomes. Presurgical chronic pain (>7) and/or chronic opioid consumption, were associated with worsened pain outcomes; the latter with a 50% increase in postoperative opioid requirements. Tibia/fibula and foot surgeries (ORT), and gastric, small intestine, and anterior abdominal wall procedures (GEN) were the most painful. Rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve postoperative outcomes. PERSPECTIVE: We analyzed postoperative outcomes and analgesic management in patients from tertiary care Spanish hospitals. The study serves as a point of comparison with other Western countries and shows that pain intensity outcomes and opioid consumption were slightly better in the Spanish population. Chronic pain before surgery (numeric rating scale score >7) and/or chronic opioid consumption, were associated with worsened pain outcomes, suggesting that rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve outcomes. Patients' pain participation in decision-making was inadequate and should be improved in Spanish hospitals. The PAIN OUT project was funded by the European Commission 7th Framework Programme, Call HEALTH-2007- 3.1 4: Improving Clinical Decision-Making, and endorsed by the International Association for the Study of Pain |
| Databáze: | OpenAIRE |
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