Abstract
Assessment and treatment of postoperative pain can be challenging as objective examination techniques to detect and quantify pain are lacking. We aimed to investigate changes of exhaled volatile organic compounds (VOCs) in patients with postoperative pain before and after treatment with opioid analgesics. In an observational study in 20 postoperative patients, we monitored for postoperative pain, hemodynamic parameters, and catecholamines before and during treatment. VOCs in the patients were determined by direct real-time proton transfer reaction time-of-flight mass spectrometry prior (0 min) and after piritramide application (15 min as well as 30 min). Cardiovascular variables changed and norepinephrine levels decreased during treatment. The VOCs acetonitrile (<0.001), acetaldehyde (p = 0.002), benzopyran (p = 0.004), benzene (p < 0.001), hexenal (p = < 0.001), 1-butanethiol (p = 0.004), methanethiol (p < 0.001), ethanol (p = 0.003), and propanol (p = < 0.001) changed significantly over time. Patients with Numeric Rating Scale (NRS) < 4 showed a significantly lower concentration of hexenal compared to patients with NRS > 4 at the time points 15 min (45.0 vs. 385.3 ncps, p = 0.047) and 30 min (38.3 vs. 334.6 ncps, p = 0.039). Breath analysis can provide additional information for noninvasive monitoring for analgesic treatment in postoperative patients.
Highlights
Pain is a complex sensation with multiple definitions: The International Association for the Study of Pain (IASP) defines it as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”, whereas McCaffery describes pain as “whatever the person experiencing it says it is, and exists whenever the person experiencing it says it does” [1,2,3]
With this prospective observational study, we examined whether changes of volatile organic compounds (VOCs) might be helpful in determining and quantifying pain in postoperative patients undergoing analgesic treatment
As its release may be related to bronchial circulation [17], it is possible that bronchial vasoconstriction was related to a decreased ethanol output
Summary
Pain is a complex sensation with multiple definitions: The International Association for the Study of Pain (IASP) defines it as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”, whereas McCaffery describes pain as “whatever the person experiencing it says it is, and exists whenever the person experiencing it says it does” [1,2,3]. Improvements in pain treatment could be achieved in the past, patients frequently suffer from postoperative pain [5,6]. Due to the subjective nature of pain, assessment and treatment can be challenging for physicians. For the assessment of pain, intensity scores such as the Verbal Rating Scale (VRS), Visual Analogue Scale (VAS), and Numerical Rating Scale (NRS) are used regularly [7]. These unidimensional and subjective means reflect rather the subjectivity of pain and the patients’ individual sensation than
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