Abstract
Objective. To compare Visual Analogue Scale (VAS) scores with overall postoperative pain medication requirements including cumulative dose and patterns of medication utilization and to determine whether VAS scores predict pain medication utilization. Methods. VAS scores and pain medication data were collected from participants in a randomized trial of the utility of phenazopyridine for improved pain control following gynecologic surgery. Results. The mean age of the 219 participants was 54 (range19 to 94). We did not detect any association between VAS and pain medication utilization for patient-controlled anesthesia (PCA) or RN administered (intravenous or oral) medications. We also did not detect any association between the number of VAS scores recorded and mean pain scores. Conclusion. Postoperative VAS scores do not predict pain medication use in catheterized women inpatients following gynecologic surgery. Increased pain severity, as reflected by higher VAS scores, is not associated with an increase in pain assessment. Our findings suggest that VAS scores are of limited utility for optimal pain control. Alternative or complimentary methods may improve pain management.
Highlights
Optimal postoperative pain control has been identified as a potentially important modifier of both short- and longterm surgical outcomes [1]
Post operative pain may be a major determinant of surgical wound infection, as shown with data by Akca et al [8] revealing increased subcutaneous oxygen partial pressures and perfusion to tissue in patients with better pain control than patients with inadequate pain control
Effective pain control in the early post operative period may lead to clinically important benefits for long-term recovery, including less chronic pain [9, 10]
Summary
Optimal postoperative pain control has been identified as a potentially important modifier of both short- and longterm surgical outcomes [1]. Uncontrolled post operative pain has been linked to loss of respiratory mechanics [2, 3] and cardiac morbidity through activation of the sympathetic nervous system, coagulation cascade, and surgical stress response [4, 5]. Suppression of this stress response via pain control has been suggested to decrease risk of post operative ileus through reduction of the inflammatory response to surgery [6, 7]. The association between the intensity of acute post operative pain and later development of chronic pain has been demonstrated after inguinal hernia repair [11], breast surgery [12], and thoracotomy [13]
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