Independent Predictors of Postoperative Severe Pain Among Patients Undergoing Gynecological Surgeries

• Main Author: Tabish Hussain
• Format: Article
• Language: English
• Published: Rawalpindi Medical University 2015-03-01
• Series: Journal of Rawalpindi Medical College
• Subjects: Postoperative pain; Gynaecological Surgeries
• Online Access: https://www.journalrmc.com/index.php/JRMC/article/view/303

Background: To determine independent predictors for postoperative severe pain in Post Anesthesia Care Unit (PACU) among patients who underwent general anesthesia for lower abdominal gynecological surgery. Methods: A prospective observational study was conducted from January 2013 to July 2014 in the 2500 beds Tongji Hospital, Tongji Medical College, Hua Zhong University of Science and Technology Wuhan China. The NRS (Numerical Rating Scale) ranging from 0 “no pain at all’ to 10(unbearable pain) was used on arrival postoperatively in PACU. NRS score NRS ≥7 was common break point for defining severe pain. We assessed also the preoperative information, medical treatment, intra-operative events and their role on postoperative severe pain (POSP). Patients were grouped labeled as either with postoperative severe pain POSP, and the non-POSP category. Results: Out of 1020, 18% experienced NRS≥7 showing severe unbearable pain. Using a univariate analysis, age, invasive surgeries, the duration of the surgical procedure, anesthesia maintenance, intra-operative fluid load and loss, blood loss, postoperative nausea and vomiting (PONV) prophylaxis, patients-controlled analgesia (PCA),malignancy and intra-operative analgesia were significant predictors for the POSP. Multivariate conditional regression modelling was also used to determine independent predictors for postoperative severe pain. Using multi-variate analysis, malignancy, operative time period, invasive nature of procedure and use of analgesic drugs found to be significantly independent predictor for POSP. Patients with cancer experienced more severe pain with OR (odds ratio) of 1.66, Invasive surgery OR=1.671, operation duration more than 2 hours with OR=1.774 and nonsteroidal anti-inflammatory drugs (NSAIDs) use before emergence was OR=3.648.Other factors were not considered because of their non significance. Conclusion: Patients with malignancies, undergoing invasive surgery, operative duration greater than 2 hours and NSAID use before emergence were significantly independent predictors for POSP. It was affecting on PACU discharge, hospital length of stay and additional health expenses.