Department of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Pain Center, Department of Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Pain Med. 2020 Apr 1;21(4):803-813. doi: 10.1093/pm/pnz156.
Multimodal pain management strategies aim to improve postoperative pain control. The purpose of this study was to analyze pain scores and risk factors for acute postoperative pain after various abdominal surgery procedures.
Data on 11 different abdominal surgery procedures were prospectively recorded. Pain intensity (rest, mobilization) and patient satisfaction at discharge were assessed using a visual analog scale (VAS; 0-10), and analgesic consumption was recorded until 96 hours postoperation. Demographic, surgery-related, and pain management-related univariate risk factors for insufficient pain control (VAS ≥ 4) were entered in a multivariate logistic regression model.
A total of 1,278 patients were included. Overall, mean VAS scores were <3 at all time points, and scores at mobilization were consistently higher than at rest (P < 0.05). Thirty percent of patients presented a prolonged VAS score ≥4 at mobilization at 24 hours, significantly higher than at rest (14%, P < 0.05). High pain scores correlated with high opioid consumption, whereas a variability of pain scores was observed in patients with low opioid consumption. The only independent risk factor for moderate and severe pain (VAS ≥ 4) was younger age (<70 years, P = 0.001). The mean satisfaction score was 8.18 ± 1.29.
Among 1,278 patients, pain was controlled adequately during the first four postoperative days, resulting in high levels of patient satisfaction. Pain levels were higher at mobilization. Younger age was the only independent risk factor for insufficient pain control. Preventive treatment in patients <70 years old and before mobilization could be evaluated for potential improvement.
多模式疼痛管理策略旨在改善术后疼痛控制。本研究旨在分析各种腹部手术后急性术后疼痛的评分和风险因素。
前瞻性记录了 11 种不同的腹部手术数据。使用视觉模拟评分（VAS；0-10）评估疼痛强度（休息时、活动时）和出院时的患者满意度，并记录术后 96 小时内的镇痛药物消耗量。将疼痛控制不足（VAS≥4）的人口统计学、手术相关和疼痛管理相关的单变量风险因素输入多变量逻辑回归模型。
共纳入 1278 例患者。总体而言，所有时间点的平均 VAS 评分均<3，活动时的评分始终高于休息时（P<0.05）。30%的患者在 24 小时活动时出现持续性 VAS 评分≥4，明显高于休息时（14%，P<0.05）。高疼痛评分与高阿片类药物消耗相关，而低阿片类药物消耗的患者疼痛评分存在差异。中度和重度疼痛（VAS≥4）的唯一独立风险因素是年龄较小（<70 岁，P=0.001）。平均满意度评分为 8.18±1.29。
在 1278 例患者中，术后前 4 天疼痛得到了充分控制，患者满意度高。活动时疼痛水平较高。年龄较小是疼痛控制不足的唯一独立风险因素。可以评估在<70 岁的患者和活动前进行预防性治疗以潜在改善疼痛控制。
