Article

Predictors of Postoperative Pain and Analgesic Consumption: A Qualitative Systematic Review

Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Anesthesiology (Impact Factor: 5.88). 09/2009; 111(3):657-77. DOI: 10.1097/ALN.0b013e3181aae87a
Source: PubMed

ABSTRACT

Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest.

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    • "More than 50% of patients experience chronic and acute pain ranging from moderate to severe intensity during hospitalization (Couceiro, Valença, Luciana Cavalcanti Lima, de Menezes, & Raposo, 2009; Gianni et al., 2010; Sommer Pain Management Nursing, Vol -, No -(--), 2014: pp 1-12 Strohbuecker, Mayer, Evers, & Sabatowski, 2005; Wadensten, Fr€ ojd, Swenne, Gordh, & Gunningberg, 2011). Patient pain is influenced by physiologic, psychological, social, chronobiologic, ethnic, and cultural factors, as well as circadian rhythms (Nielsen & Lautenbacher, 2004; Bond & Simpson, 2006; Engel, 1977; International Association for the Study of Pain, 2001; Strain, Lautenbacher, Galfe, & Holzl, 1989; Vivian, Abrishami, Peng, Wong, & Chung, 2009). Nurses are highly involved in acute pain assessment and management practices (De Silva, 2008; Dihle, Bjolseth, & Helseth, 2006; Manias, Bucknall, & Botti, 2005). "
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    • "Such multiple causes of pain were also found in other settings, for instance, in patients seen by a specialised pain consultation service of a university hospital [18,19]. Pre-existing chronic pain is a risk factor for both increased acute and chronic post-operative pain [20,21]. Whether similar relationships influence pain management in cancer patients or patients at the end of life is an important question with potential therapeutic implications. "
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    • "We must hence carry out a thorough treatment of dynamic postoperative pain, as it is not enough to only treat pain at rest, and to avoid other predicting factors, such as pain more than one month prior to the intervention, aggressive or repeated surgery, associated nerve injury or prior psychopathological factors [10]. Moreover, factors predisposing patients to a greater postoperative pain are young age and the type of surgery, such as orthopaedic surgery (due to the involvement of periosteum, which has a very low pain sensitivity threshold) and thoraco-abdominal surgery (due to the large involvement of the functions of the corresponding organs) [10]. The concept of pre-emptive analgesia is based on the administration, prior to surgical incision, of an analgesic in order to mitigate or prevent central hypersensitivity phenomena, aiming to reduce analgesic consumption in the postoperative period and chronic pain. "
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