Pain scores in the management of postoperative rotator cuff surgery (SS-51)

Abstract

Recent public opinion has focused on the lay perception that postoperative pain control is often inadequate. JCAHO has attempted to address this by mandating pain scores as part of the postoperative pain assessment. No studies exist to validate these scores in orthopedics. Methods: 99 patients over a 12-month period undergoing routine arthroscopic rotator cuff repair were followed and multivariate analysis assessed in regard to pain scores, objective physiologic correlates, complications, patient satisfaction, and MMPI scores. Results: All procedures were virtually identical, with 3 to 5 portals and 1 to 2 anchors. No correlation existed between the number of portals, anchors, and pain scores. Wide variability existed in pain scores despite the fact that the procedures were virtually identical. No correlation existed between pain scores and any physiological correlate of pain. There was a trend toward patient satisfaction and pain scores. Higher pain scores resulted in an increase in complications, specifically postoperative nausea (P < .01) and increased recovery room stay (P < .05). Pain scores correlated strongly with MMPI results. Discussion: While pain scores have been mandated as a measure of adequacy of postoperative care, they correlated poorly with physiologic manifestations of pain, and varied widely in patients undergoing virtually the same procedure. Excessive treatment of those patients whose pain scores fall outside the 25th percentile increases complications postoperatively. Pain scores correlate better with MMPI indices involving depression and self-esteem than the operative procedure. Considerations of treatment of postoperative pain based solely on pain scores must be tempered by the lack of physiologic correlates and increased complications. Recent public opinion has focused on the lay perception that postoperative pain control is often inadequate. JCAHO has attempted to address this by mandating pain scores as part of the postoperative pain assessment. No studies exist to validate these scores in orthopedics. Methods: 99 patients over a 12-month period undergoing routine arthroscopic rotator cuff repair were followed and multivariate analysis assessed in regard to pain scores, objective physiologic correlates, complications, patient satisfaction, and MMPI scores. Results: All procedures were virtually identical, with 3 to 5 portals and 1 to 2 anchors. No correlation existed between the number of portals, anchors, and pain scores. Wide variability existed in pain scores despite the fact that the procedures were virtually identical. No correlation existed between pain scores and any physiological correlate of pain. There was a trend toward patient satisfaction and pain scores. Higher pain scores resulted in an increase in complications, specifically postoperative nausea (P < .01) and increased recovery room stay (P < .05). Pain scores correlated strongly with MMPI results. Discussion: While pain scores have been mandated as a measure of adequacy of postoperative care, they correlated poorly with physiologic manifestations of pain, and varied widely in patients undergoing virtually the same procedure. Excessive treatment of those patients whose pain scores fall outside the 25th percentile increases complications postoperatively. Pain scores correlate better with MMPI indices involving depression and self-esteem than the operative procedure. Considerations of treatment of postoperative pain based solely on pain scores must be tempered by the lack of physiologic correlates and increased complications.