Journal of Korean Biological Nursing Science

Korean society of Biological Nursing Science (한국기초간호학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors and Level of Acute Post-Operative Pain in Surgical Patients During the First 48 Hours after Surgery

수술 후 첫 48시간 동안의 수술후 통증에 영향을 미치는 요인

  • Received : 2014.05.25
  • Accepted : 2014.08.08
  • Published : 2014.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This prospective study was designed to investigate the incidence of acute postoperative pain (APP) ${\geq}4$ and the risk factors of APP${\geq}$ for the first 48 hours after surgery. Methods: Data from 531 surgical patients were collected from November, 2009 to May, 2010. APP was assessed from the time of arrival at the Post Anesthetic Care Unit (PACU) to the end of the post-operative 48 hours. Risk factors of APP${\geq}$ were analyzed by logistic regression analysis. Results: The incidence of APP ${\geq}4$ was 58.8% for the first postoperative 4 hours; 33.5%, 24 hours; 11.1%, 48 hours. The score of pain was 5.55, the highest on arriving at PACU; 5.03 at postoperative 30 minutes; 4.03 at 1 hour; 3.96 at 4 hours; 2.76 at 24 hours; 1.44 at 48 hours Risk factors for APP ${\geq}4$ were females (Odds ratio [OR], 1.94; p=.013), general anesthesia (OR, 4.29; p<.001) and patient controlled analgesia (PCA) (OR, 2.83; p<.001) at 4 hours after operation; body mass index (BMI) ${\geq}25$ (OR, 1.80; p=.009), duration of surgery ${\geq}1$ hour (OR, 2.87; p=.037), general anesthesia (OR, 3.99; p<.001) and PCA (OR, 6.23; p<.001) at 24 hours; general anesthesia (OR, 3.53; p=.003) and PCA (OR, 3.01; p=.013) at 48 hours. Conclusion: Surgical patients with BMI ${\geq}25$, PCA and general anesthesia seem to have a higher incidence of pain ${\geq}4$ through the first postoperative 48 hours.

Keywords

References

  1. Argoff, C. E. (2013). Recent management advances in acute postoperative pain. Pain Practice. 2013 Aug 15. [Epub ahead of print]. http://dx.doi.org/10.1111/papr.12108
  2. Aubrun, F., Valade, N., Coriat, P., & Riou, B. (2008). Predictive factors of severe postoperative pain in the postanesthesia care unit. Anesthesia and Analgesia, 106(5), 1535-1541. http://dx.doi.org/10.1213/ane.0b013e318168b2ce
  3. Boldt, J., Thaler, E., Lehmann, A., Papsdorf, M., & Isgro, F. (1998). Pain management in cardiac surgery patients: comparison between standard therapy and patient- controlled analgesia regimen. Journal of Cardiothoracic and Vascular Anesthesia, 12(6), 654-658. https://doi.org/10.1016/S1053-0770(98)90237-3
  4. Crowe, L., Chang, A., Fraser, J. A., Gaskill, D., Nash, R., & Wallace, K. (2008). Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain. International Journal of Evidence-Based Healthcare, 6(4), 396-430. http://dx.doi.org/10.1111/j.1744-1609.2008.00113.x
  5. Freeman, L. J., Rahmani, E. Y., Al-Haddad, M., Sherman, S., Chiorean, M.V., Selzer, D. J., et al. (2010). Comparison of pain and postoperative stress in dogs undergoing natural orifice transluminal endoscopic surgery, laparoscopic, and open oophorectomy. Gastrointestinal Endoscopy, 72(2), 373-380. http://dx.doi.org/10.1016/j.gie.2010.01.066
  6. Grass, J. A. (2005). Patient-controlled analgesia. Anesthesia and Analgesia, 101(5 Suppl), S44-61. https://doi.org/10.1213/01.ANE.0000177102.11682.20
  7. Gust, R., Pecher, S., Gust, A., Hoffmann, V., Bohrer, H., & Martin, E. (1999). Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Critical Care Medicine, 27(10), 2218-2223. https://doi.org/10.1097/00003246-199910000-00025
  8. Harsten, A., Kehlet, H., & Toksvig-Larsen, S. (2013). Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial. British Journal of Anaesthesia, 111(3), 391-399. http://dx.doi.org/10.1093/bja/aet104
  9. Ip, H. Y., Abrishami, A., Peng, P. W., Wong, J., & Chung, F. (2009). Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology, 111(3), 657-677. http://dx.doi.org/10.1097/ALN.0b013e3181aae87a
  10. Katz, J., Poleshuck, E. L., Andrus, C. H., Hogan, L. A., Jung, B. F., Kulick, D. I., et al. (2005). Risk factors for acute pain and its persistence following breast cancer surgery. Pain, 119(1-3), 16-25. https://doi.org/10.1016/j.pain.2005.09.008
  11. Kim, H. Y., & Yoon, H. S. (2006). The effects of ketamine preemptive analgesia on postoperative pain in patients undergoing a hysterectomy. Taehan Kanho Hakhoe Chi, 36(1), 114-126.
  12. Liu, S. S., Buvanendran, A., Rathmell, J. P., Sawhney, M., Bae, J. J., Moric, M., et al. (2012). Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. International Orthopaedics, 36(11), 2261-2267. http://dx.doi.org/10.1007/s00264-012-1623-5
  13. Lockwood, G. (2010). Theoretical context-sensitive elimination times for inhalation anaesthetics. British Journal of Anaesthesia, 104(5), 648-655. http://dx.doi.org/10.1093/bja/aeq051
  14. Macintyre, P. E. (2001). Safety and efficacy of patient-controlled analgesia. British Journal of Anaesthesia, 87(1), 36-46. https://doi.org/10.1093/bja/87.1.36
  15. McGrath, B., Elgendy, H., Chung, F., Kamming, D., Curti, B., & King, S. (2004). Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Canadian Journal of Anaesthesia, 51(9), 886-891. https://doi.org/10.1007/BF03018885
  16. Oh, S. H., Kim, I. H, Choi, S. R., & Chung, C. J. (2005). Causes of patient dissatisfaction with anesthetic care. Korean Journal of Anesthesiology, 48(4), 387-392. https://doi.org/10.4097/kjae.2005.48.4.387
  17. Pasqualucci, A., de Angelis, V., Contardo, R., Colo, F., Terrosu, G., Donini, A., et al. (1996). Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology, 85(1), 11-20. https://doi.org/10.1097/00000542-199607000-00003
  18. Pearse, E. O., Caldwell, B. F., Lockwood, R. J., & Hollard, J. (2007). Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. Journal of Bone and Joint Surgery. British Volume, 89(3), 316-322.
  19. Peters, M. L., Sommer, M., de Rijke, J. M., Kessels, F., Heineman, E., Patijn, J., et al. (2007). Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Annals of Surgery, 245(3), 487-494. http://dx.doi.org/10.1097/01.sla.0000245495.79781.65
  20. Phillips, D. M. (2000). JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations. JAMA, 284(4), 428-429. https://doi.org/10.1001/jama.284.4.428
  21. Rajpal, S., Gordon, D. B., Pellino, T. A., Strayer, A. L., Brost, D., Trost, G. R., et al. (2010). Comparison of perioperative oral multimodal analgesia versus IV PCA for spine surgery. Journal of Spinal Disorders Techniques, 23(2), 139-145. http://dx.doi.org/10.1097/BSD.0b013e3181cf07ee
  22. Ratrout, H. F., Hamdan-Mansour, A. M., Seder, S. S., & Salim, W. M. (2013). Patient satisfaction about using patient controlled analgesia in managing pain post surgical intervention. Clinical Nursing Research. 2013 May 30. [Epub ahead of print]
  23. Shahraki, A. D., Jabalameli, M., & Ghaedi, S. (2012). Pain relief after Cesarean section: Oral methadone vs intramuscular pethidine. Journal of Research in Medical Sciences, 17(2), 143-147.
  24. Smith, K. S., Wilson, T. C., Luces, L., Stevenson, A. A., Hajhosseini, B., & Siram, S. M. (2013). Pneumoperitoneum 48 days after laparoscopic hysterectomy. Journal of the Society of Laparoendoscopic Surgeons, 17(4), 661-664. http://dx.doi.org/10.4293/108680813X13794522666446
  25. Sommer, M., de Rijke, J. M., van Kleef, M., Kessels, A. G., Peters, M. L., Geurts, J. W., et al. (2010). Predictors of acute postoperative pain after elective surgery. Clinical Journal of Pain, 26(2), 87-94. http://dx.doi.org/10.1097/AJP.0b013e3181b43d68
  26. Soylemez, H., Penbegul, N., Atar, M., Bozkurt, Y., Sancaktutar, A. A., & Altunoluk, B. (2012). Comparison of laparoscopic and microscopic subinguinal varicocelectomy in terms of postoperative scrotal pain. Journal of the Society of Laparoendoscopic Surgeons, 16(2), 212-217. https://doi.org/10.4293/108680812X13427982376220
  27. Taylor, S., Voytovich, A. E., & Kozol, R. A. (2003). Has the pendulum swung too far in postoperative pain control? American Journal of Surgery, 186(5), 472-475. https://doi.org/10.1016/j.amjsurg.2003.07.021
  28. Woolf, C. J., & Chong, M. S. (1993). Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesthesia and Analgesia, 77(2), 362-379. https://doi.org/10.1213/00000539-199377020-00026
  29. Yang, Z., Yang, Z., Arheart, K. L., Morris, R., Zhang, Y., Rodriguez, Y., et al. (2012). CYP2D6 poor metabolizer genotype and smoking predict severe postoperative pain in female patients on arrival to the recovery room. Pain Medicine, 13(4), 604-609. http://dx.doiorg/10.1111/j.1526-4637.2012.01296.x
  30. Zevin, S., & Benowitz, N. L. (1999). Drug interactions with tobacco smoking. An update. Clinical Pharmacokinetics, 36(6), 425-438. https://doi.org/10.2165/00003088-199936060-00004

Cited by

  1. Effects of Korean Hand Acupressure on Pain and Abdominal Bloating of Patients Receiving Laparoscopic Hysterectomy vol.18, pp.1, 2015, https://doi.org/10.7587/kjrehn.2015.20
  2. Effects of PCA (Patient Controlled Analgesics) Education Program including Practicum on Post-op Pain of Gynecologic Laparoscopic Surgery Patients vol.17, pp.3, 2015, https://doi.org/10.7586/jkbns.2015.17.3.253
  3. Nurses' Evidence-Based Pain Management Knowledge, Performance and EBP Attitude in Small-medium Sized Hospitals vol.3, pp.4, 2015, https://doi.org/10.15205/kschs.2015.3.4.476
  4. 간호사의 자가통증조절기 사용과 관리에 대한 지식 및 적용실태 vol.24, pp.1, 2014, https://doi.org/10.5977/jkasne.2018.24.1.5
  5. 수술 후 자가통증조절요법 중단 관련요인 vol.20, pp.4, 2014, https://doi.org/10.7586/jkbns.2018.20.4.236