Postoperative Pain Experience Research Articles

Patients’ experience of pain and pain relief following hip replacement surgery

The aim of this study was to describe patients' experience of pain and pain relief following hip replacement surgery. Annually, many patients undergo hip replacement surgery. Previous research has focused largely on the long-term effects on pain for patients who undergo hip replacement surgery and to a lesser degree on their subjective, early postoperative pain experience. A descriptive qualitative design was used. The study was carried out in an orthopaedic ward at a hospital in Sweden during 2006. Qualitative interviews were conducted with 15 patients who had undergone hip replacement surgery. Data were analysed by means of qualitative content analysis. The postoperative pain experience was characterised in terms of interrelated contexts of time, various bodily activities and postoperative pain intensity. The postoperative pain intensity was characterised in terms of intensive and worst imaginable, strange feelings and fear and a feeling of faintness. Easing of postoperative pain was related to professional care features, such as nursing staff, pharmacological pain relief and technical aids. Self-care features were related to relieving body positions, endurance and looking ahead. Although the development of total hip replacement surgery has been very successful, there are issues that need to be addressed in relation to postoperative pain management. The findings in this study show that there are reasons for making a more concerted effort to develop postoperative pain management, particularly during the first few days after surgery. The results provide some indication that pain management for this group of patients in the early postoperative period needs to be improved to reduce the fear of moving and improve the process of regaining independence. Devoting more attention to the patients during the initial postoperative phase may be the key to improve the training and making it even more effective.

Predicting Postoperative Pain Based on Preoperative Pain Perception

Predicting Postoperative Pain Based on Preoperative Pain Perception

Prediction of Postoperative Pain

Quantitative testing of a patient's basal pain perception before surgery has the potential to be of clinical value if it can accurately predict the magnitude of pain and requirement of analgesics after surgery. This review includes 14 studies that have investigated the correlation between preoperative responses to experimental pain stimuli and clinical postoperative pain and demonstrates that the preoperative pain tests may predict 4-54% of the variance in postoperative pain experience depending on the stimulation methods and the test paradigm used. The predictive strength is much higher than previously reported for single factor analyses of demographics and psychologic factors. In addition, some of these studies indicate that an increase in preoperative pain sensitivity is associated with a high probability of development of sustained postsurgical pain.

Women’s postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesarean section

The aim was to evaluate a new anaesthetic routine and to study the effect of spinal opioids for caesarean section on postoperative pain, expectations of pain, satisfaction with pain treatment, breastfeeding, infant care and length of hospital stay. Inadequate postoperative pain relief is a problem among hospitalised patients. Women undergoing caesarean section have been shown to experience high levels of pain during the first days after operation. Women are expected to breastfeed and care for their newborn while recovering from major abdominal surgery and sufficient pain relief are of importance. Comparative patient survey. Data were collected through a questionnaire distributed to two independent samples of women undergoing elective and emergency caesarean section before and after the introduction of an additive of opioids in obstetric spinal anaesthesia. Chi-square tests were performed, and risk ratios were used for bivariate analysis. Logistic regression modelling was used for multivariate analysis. The group of women undergoing caesarean section with opioids added to the spinal anaesthesia reported significantly lower levels of experienced pain. High pain levels irrespective of mode of caesarean section affected breastfeeding and infant care. Length of hospital stay for caesarean women was shortened and the consumption of analgesics was reduced. Women receiving an additive of opioids in spinal anaesthesia experienced lower levels of pain. Low pain levels facilitate breastfeeding and infant care and are of relevance for financial considerations. The results of this study indicate that spinal opioids for women undergoing caesarean section have a positive effect on the postoperative pain experience. Women undergoing caesarean section and have high pain levels are in special need of attention and care because of a higher risk of a decreased ability to breastfeed and to take care of their newborn.

Pain after surgery: Can protective analgesia reduce pain? A randomised clinical trial

Aim To improve the patients postoperative pain experience using protective analgesia for patients undergoing third molar surgery under day case general anaesthesia. Material and methods Patients were randomly allocated to a protective analgesia (1.6 g modified release ibuprofen) or conventional analgesia (400 mg conventional ibuprofen) orally 2 h preoperatively. Surgical model was third molar surgery. Postoperative outcomes of interest were pain intensity at 30 min, 1, 6, 24 and 48 h. The time to rescue analgesia, overall assessment of pain control, safety and tolerability profiles were also recorded. Results 122 patients entered the study providing 98 evaluable patients for analysis. Patients in the protective analgesia group reported more pain than those in the conventional group at 30 min, 1, 6 and 48 h following surgery, although this difference was only statistically significant at the 30 min time point. 62.2% of patients required rescue analgesia within 6 h after surgery. The median time for patients who had to take rescue analgesia was 3.1 h. Patients in the protective analgesia group reported a longer time to rescue analgesia compared with those in conventional analgesia group. Overall, 91.7% of patients were at least satisfied with their pain control. Conclusion There was no difference in the protective analgesia group compared with conventional analgesia group in improving postoperative pain experience. A different protective analgesia regime may be necessary, which employs a more aggressive and multimodal strategy for postoperative pain management.

Anxiety and Pain in Children undergoing Elective Surgical Procedures: A Systematic Review

Anxiety and Pain in Children undergoing Elective Surgical Procedures: A Systematic Review

A pilot randomised controlled trial comparing the post-operative pain experience following vitrectomy with a 20-gauge system and the 25-gauge transconjunctival system

Aims:To compare post-operative pain following 25-gauge (25G) and 20-gauge (20G) vitrectomy in the first week following surgery.Methods:The study was a pilot randomised controlled trial with patients masked to the treatment...

Évaluation de la douleur chez le bébé de moins de 36 mois : application du modèle de Rasch

This study has used an Item Response Theory model (IRT model), specifically the Rasch model, to construct a new observational scale for the assessment of pain in infants less than 36 months old. Results showed that the Rasch model is ideally suited to building an assessment instrument for postoperative pain in this particular age group. Indeed, based on this methodology 21 dichotomous items have been selected that fit to the assessment of postoperative pain in infants aged three to 24 months. Despite some limitations, this study makes a convincing case for the use of Rasch model in instrument design and allowed us to highlight some developmental and behavioral dimensions of the postoperative pain experience in infants.

Effet des anesthésiques locaux sur la réponse inflammatoire postopératoire

Current knowledge suggests that peripheral inflammation following surgery activates and sensitizes both peripheral and central nervous system. These phenomena involved in the maintenance of the inflammatory response lead to hypersensibility, hyperalgesia and allodynia. Hyperalgesia participates in the general experience of postoperative pain and ALo in the development of chronic pain. A correlation between the ability of treatments to reduce areas of hypersensitivity surrounding the wound after surgery and their ability to reduce the incidence of chronic pain has been shown. For a long time, local anaesthetics have been used for their capacity to block nociceptive input. They can ALo modulate the inflammatory response following a surgical trauma. By inhibiting the nervous conductivity at the site of the trauma, local anesthetics attenuate the sensitization of the nervous system and therefore the inflammatory phenomena. They ALo exert intrinsic anti-inflammatory properties by modulating the local and systemic liberation of inflammatory mediators. The mechanisms involved are not clearly elucidated. Local, systemic, and spinal inflammatory mechanisms may be influenced by local anesthetics through multiple different mechanisms. The therapeutic implications of effects of local anesthetics on local, systemic, and spinal inflammatory responses merit further study.

Prediction of postoperative pain after radical prostatectomy

BackgroundThere is a belief that the amount of pain perceived is merely directly proportional to the extent of injury. The intensity of postoperative pain is however influenced by multiple factors aside from the extent of trauma. The purpose of the study was to evaluate the relationship between preoperative factors that have been shown to predict postoperative pain and the self-reports of pain intensity in a population of 155 men undergoing radical prostatectomy (RP), and also to investigate if previous pain score could predict the subsequent pain score.MethodsThe correlation between potential pain predictors and the postoperative pain experiences during three postoperative days was tested (Pitmans' test). By use of a logistic regression analysis the probability that a Visual Analogue Scale (VAS) score at one occasion would exceed 30 mm or 70 mm was studied, depending on previous VAS score, age, depression and pain treatment method.ResultsAge was found to be a predictor of VAS > 30 mm, with younger patients at higher risk for pain, and preoperative depression predicted VAS > 70 mm. The probability that VAS would exceed 30 mm and 70 mm was predicted only by previous VAS value. Day two however, patients with epidural analgesia were at higher risk for experiencing pain than patients with intrathecal or systemic opioid analgesia.ConclusionThe results show that it would be meaningful to identify RP patients at high risk for severe postoperative pain; i.e. younger and/or depressive patients who might benefit from a more aggressive therapy instituted in the very early postoperative period.

A survey of postoperative pain experience atKing Chulalongkorn Memorial Hospital:Patients' perspective

A survey of postoperative pain experience atKing Chulalongkorn Memorial Hospital:Patients' perspective

The Evaluation of Post-Operative Pain Experience and Pain Intensity of the Hospitalized Patients

The Evaluation of Post-Operative Pain Experience and Pain Intensity of the Hospitalized Patients

747. The Evaluation of Post-Operative Pain Experience and Pain Intensity of the Hospitalized Patients

747. The Evaluation of Post-Operative Pain Experience and Pain Intensity of the Hospitalized Patients

747: The Evaluation of Post-Operative Pain Experience and Pain Intensity of the Hospitalized Patients

747: The Evaluation of Post-Operative Pain Experience and Pain Intensity of the Hospitalized Patients

Postoperative pain and self‐management: women’s experiences after cardiac surgery

This paper is a report of a study to describe women's experiences and their self-management of postoperative pain after elective cardiac surgery. Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery. Semi-structured interviews were conducted in 2004-2005 with 10 women 1-2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1-2 weeks before the interviews, providing more nuances to the experiences of pain and pain management. Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what women's expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable. Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.

Women’s descriptions of postoperative pain and pain management after discharge from cardiac surgery

To provide new insights into the postoperative pain experiences of women after coming home following cardiac surgery. Studies show that many patients experience postoperative wound discomfort after cardiac surgery and women experience more pain than men before discharge. Male experiences have shaped the accepted biomedical theories on how cardiac surgery influences the lives of women. This has led to more cardiac studies with only female respondents in the past 10 years, but few focus on pain and pain management after early discharge. The study reported here is part of a larger qualitative descriptive study. A self-developed pain diary measured pain intensity, types and amount of pain medication and its effectiveness at bedtime every day after returning home from hospital. The Brief Pain Inventory - Short Form provided a basis for comparison with the pain scores rated in the diaries from the final sample of nine women. Semi-structured interviews gave illuminating statements. The women had pain in the chest almost every day the first two weeks at home and this was expected. The pain in their neck, shoulders and back was unexpected and this pain worried them more. The women wanted to take as little medication as possible. Regular intake of pain medication resulted in more even pain scores, but not necessarily lower pain scores. The study adds new insights into how women experience postoperative pain upon returning home. Findings indicate that the women did not follow the recommended pain medication despite reporting worst pain as moderate or more during the whole period. Early discharge from hospitals gives patients more responsibility for taking care of themselves. Patients need more specific information about taking pain medication on a specified schedule to control pain.

Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh

Mild pain lasting for a few days is common following mesh inguinal hernia repair. In some patients however, severe groin pain may appear months or even years postoperatively. The aim of this study was to report our experience of late-onset persisting severe postoperative groin pain occurring years after mesh hernioplasty. In a 9-year period, 1,633 patients (1,073 men), median age 63 years (range 19-88), underwent mesh groin hernia repair. Between 1.5 and 4 years postoperatively, six patients (0.35%) presented with severe chronic groin pain unrelieved by conservative measures and surgical exploration was essential. The patients' records were retrospectively reviewed for the purpose of this study. Ilioinguinal nerve entrapment was detected in four patients. The meshes appeared to be indistinguishable from the nerve and were removed along with the stuck nerve. New meshes were properly inserted. Mesh fixation on the periostium of the pubic tubercle by a staple was found in the other two patients. The staples were removed from the periostium in both patients. Neither hernia recurrence nor chronic groin pain was persisting in all six patients during a follow-up of 6-44 months postoperatively. From the results of this study, it appears that ilioinguinal nerve entrapment and/or mesh fixation on the periostium of the pubic tubercle are the causes of late-onset severe chronic pain after inguinal mesh hernioplasty. Mesh removal, along with the stuck ilioinguinal nerve and staple detachment from the periostium, are the gold-standard techniques if conservative measures fail to reduce pain.

Postoperative Pain After Cesarean Birth Affects Breastfeeding and Infant Care

To study women's experience of postoperative pain and pain relief after cesarean birth and factors associated with pain assessment and the birth experience. Descriptive patient survey. Data were collected through a questionnaire. The outcome variables were assessments of pain using a Visual Analog Scale and women's birth experience measured on a seven-point Likert scale. Central Swedish county hospital, maternity unit. The sample consisted of 60 women undergoing cesarean birth. Women reported high levels of experienced pain during the first 24 hours. Seventy-eight percent of the women scored greater than or equal to 4 on the Visual Analog Scale, which can be seen as inadequately treated pain. There was no difference between elective and emergency cesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. The risk of a negative birth experience was 80% higher for women undergoing an emergency cesarean birth compared with elective cesarean birth. Postoperative pain negatively affected breastfeeding and infant care. There is a need for individual and adequate pain treatment for women undergoing cesarean birth, as high levels of pain interfere with early infant care and breastfeeding.

The Prevalence of Postoperative Pain in a Cross-sectional Group of Patients After Day-case Surgery in a University Hospital

Although a great variety of surgical procedures are performed on an ambulatory basis, little is known about postoperative pain experience at home after ambulatory surgery. This study was performed to assess the prevalence and course of postoperative pain in the early postoperative period after ambulatory surgery. Over a period of 4 months, 648 patients who underwent day-case surgery were included in our study. Data were collected with interviews and questionnaires. Pain intensity was measured using a visual analog scale (VAS) during 4 days after surgery. Side effects of anesthesia and analgesia techniques were also recorded. On the day of the operation, 26% of the patients had moderate to severe pain (defined as mean VAS >40 mm). Mean VAS-scores were greater than 40 mm in 21% on postoperative day (POD) 1, in 13% on POD 2, in 10% on POD 3, and in 9% on POD 4. Operations of nose and pharynx, abdominal operations, plastic surgery of the breasts, and orthopedic operations were the most painful procedures during the first 48 hours. This study showed that an important number of patients still experience moderate to severe pain in the postoperative period after day-case surgery even after a 4-day period. Furthermore, the type of operation should be considered when planning postoperative analgesia for ambulatory surgery.

Commentary on He H‐G, Pölkki T, Pietilä A‐M and Vehviläinen‐Julkunen K (2005) A survey of Chinese nurses’ guidance to parents in children's postoperative pain relief. Journal of Clinical Nursing 14, 1075–1082

It has been well documented that postoperative pain can be emotionally devastating for children, and nurses should play a major role in providing appropriate and effective postoperative pain management for children. However, O’ConnerVon (2000) highlighted that, although surgical techniques and anaesthetic agents have greatly improved in recent years, nursing preparation for children undergoing surgery and their parents, including postoperative pain control, remains inadequate. There is also an increasing expectation for parents to take responsibility in caring for their child whilst in hospital, particularly in postoperative pain management. However, in a study of preparing children and family psychologically for surgery, Ellerton and Merriam (1994) revealed that most parents found it difficult to accept the role of helping their children manage the stressful experience of surgery and postoperative pain. Lack of understanding about the upcoming procedures, unfamiliarity with the hospital environment and insufficient knowledge of pain assessment and skills in alleviating postoperative pain of their child have been identified as the major factors contributing to parental stress. In this paper, He et al. (2005) emphasized that nurses are responsible in enhancing parents’ knowledge of pain assessment and management. He et al. (2005) also stressed the importance of parental involvement in the postoperative care of their child, particularly in the management of their child’s postoperative pain using non-pharmacological methods. Through participating in the nursing care, parents can not only give their child a sense of security and comfort but also take a more active role in helping their child to experience less stress and a more positive response to surgery. The benefits of using non-pharmacological methods were not mentioned in this paper but have been reported in one of the authors’ previous publication (Polkki 2002). Previous studies also failed to address what the essential components of these non-pharmacological methods are, the exact mechanism of how these methods work and why such methods results in positive outcomes. The effectiveness of using nonpharmacological methods in alleviating pain for adults has been well documented (Roykulcharoen & Good 2004); however, empirical evidence for using non-pharmacological methods in alleviating postoperative pain in children remains under-researched. Furthermore, although this paper reported nurses’ preference for providing parental guidance on different non-pharmacological methods, it is unclear which nonpharmacological methods are most effective in alleviating children’s postoperative pain. Additionally, it is unclear which of these methods are more acceptable to children and their parents. The questionnaire used in this study has been translated into Chinese and validated. However, it is not clear which questions were modified according to Chinese culture. It may not also address the different non-pharmacological methods used by parents that are not listed in the questionnaire. Some modifications were also made to the background questions, such as age, education, nursing position, professional work experience and the number of the nurses’ children. However, additional background information such as whether the nurses themselves have used non-pharmacological pain interventions and the type they have used for their own children. Such personal experiences could influence the guidance nurses provide to parents. In addition, this study did not address how cultural factors influenced the choice of guidance provided to parents by Chinese nurses, as well as the perception of pain by Chinese parents and their children as pain is susceptible to extensive cultural factors. Tsoi and Pryde (1999) highlighted that Chinese children are influenced by sociocultural values, such as obedience and social conformity and inhibition of self-expression. As a result, Correspondence: Ho Cheung William Li, The Nethersole School of Nursing, Esther Lee Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China. Telephone: (852) 26098103, E-mail: williamli@cuhk.edu.hk