Quality of Postoperative Pain Management Following Thoracic Surgery

Quality of Postoperative Pain Management Following Thoracic Surgery: a Prospective Observational Study.

The purpose of this study is to assess the quality of postoperative pain management in a Canadian teaching hospital following thoracic surgery.

Hypothesis: Postoperative pain management following thoracotomy or thoracoscopy is still suboptimal despite the evidence that adequate pain relief improves outcome.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain
• Intervention / Treatment: Other: Assessment of pain using the Brief Pain Questionnaire; Other: Assessment of pain relief using a Verbal Numeric Scale (VNS); Other: Assessment of patient' satisfaction with pain relief; Other: Nurse's satisfaction with patient's pain relief and recovery

Detailed Description

Pain is an expected outcome of surgery. However, many patients experience suboptimally managed postoperative pain. Benefits of adequate analgesia no longer need to be demonstrated. Optimal analgesia leads to faster recovery, reduces the risk of postoperative complications, enhances patient's satisfaction and quality of life following surgery.

Currently, approximately 1000 thoracic surgeries are performed in our hospital annually. Many of these surgeries that previously required a thoracotomy incision are now performed under Video-Assisted Thoracoscopy Surgery (VATS). Although VATS is known to be less invasive and causes less pain than thoracotomy, some patients still experience considerable pain following thoracoscopy especially during the first hours following surgery.

Thoracic epidural has emerged as the preferred pain control technique following thoracotomy. However, the role of epidural analgesia after thoracoscopy remains debatable. The ideal postoperative analgesia regimen for the short-duration but intense pain related to thoracoscopy has not been elucidated. Paravertebral blockade is an alternative to epidural analgesia. However, the duration of pain relief associated with this technique may vary from 4 to 48 hours. Systemic opioids given through patient-controlled devices may be used after thoracic surgery but the analgesic effect can be limited and undesirable side-effects may occur.

This prospective observational study will investigate the quality of pain management following thoracic surgery and assess patient's and nurse's satisfaction regarding pain relief in a teaching hospital.

Methods:

Patients scheduled for elective thoracic surgery to be performed by thoracotomy or thoracoscopy will be considered for this prospective observational study.

The surgical approach and pain management plan will not be modified by the patient's participation to the study. According to standard practice in our hospital, pain will be assessed using a Verbal Numeric Scale from 0 to 10.

Type of analgesic technique, consumption of opioid and non-opioid drugs, type and duration of surgery will be noted. Side-effects attributable to analgesia and associated treatment will be recorded. Length of stay in the recovery room, step-down unit and in the hospital will also be recorded. Postoperative complications will be assessed.

Patients will be invited to complete the short form of the "Brief Pain Inventory". They will be asked to grade their satisfaction with pain relief using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied). Nurses will be asked to provide their opinion on patient's pain relief, ability to move and collaboration.

• Study Type: Observational
• Enrollment (Actual): 250

Contacts and Locations

Study Locations

• Canada
  • Quebec
    • Montréal, Quebec, Canada, H2L 4M1
      • Centre Hospitalier de l'Universite de Montreal

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients undergoing elective thoracotomy or thoracoscopy in a teaching hospital over a one year period will be considered for this study

Description

Inclusion Criteria:

• Consenting patients aged 18-80 years
• ASA physical status 1-3
• Patients undergoing elective thoracic surgery (thoracotomy/thoracoscopy)

Exclusion Criteria:

• Current regular use of drugs belonging to the class of opioids
• Presence of a coexisting chronic pain syndrome
• The inability to understand a verbal numeric pain scale (VNS) despite previous instruction
• Patient refusal

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Patients undergoing thoracic surgery; Assessment of postoperative pain management in patients undergoing elective thoracoscopy or thoracotomy in a teaching hospital

Other: Assessment of pain using the Brief Pain Questionnaire; Patients will complete this questionnaire daily from surgery until discharge from the hospital; Other: Assessment of pain relief using a Verbal Numeric Scale (VNS); Patients will assess their pain daily from surgery until discharge from the hospital using the VNS; Other: Assessment of patient' satisfaction with pain relief; Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied); Other: Nurse's satisfaction with patient's pain relief and recovery; Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Pain relief according to analgesic technique	From surgery (Day 0) until discharge from the hospital (Day 5)

Secondary Outcome Measures

Outcome Measure	Time Frame
Consumption of analgesics	From surgery (Day 0) until discharge from the hospital (Day 5)
Interference of pain on daily activities	From surgery (Day 0) until discharge from the hospital (Day 5)
Patient's satisfaction with pain relief	From surgery (Day 0) until discharge from the hospital (Day 5)
Nurse's satisfaction with patient's pain relief, mobility and collaboration	From surgery (Day 0) until discharge from the hospital (Day 5)
Length of stay in the recovery room	From arrival (Day 0) until discharge from the recovery room (Day 0)
Length of stay in the step-down unit	From arrival (Day 0) until discharge from the step-down unit (Day 1)
Length of stay in the hospital	From surgery (Day 0) until discharge from the hospital (Day 5)
Side-effects attributable to analgesia	From surgery (Day 0) to discharge from the hospital (Day 5)
Presence of postoperative complications	From surgery (Day 0) until discharge from the hospital (Day 5)

Collaborators and Investigators

• Sponsor: Centre hospitalier de l'Université de Montréal (CHUM)
• Investigators: Principal Investigator: Daniel Boudreault, MD, FRCPC, Centre Hospitalier de l'Universite de Montreal (CHUM)

Study record dates

Study Major Dates

• Study Start: September 1, 2012
• Primary Completion (ACTUAL): September 1, 2013
• Study Completion (ACTUAL): September 1, 2013

Study Registration Dates

• First Submitted: June 7, 2012
• First Submitted That Met QC Criteria: June 8, 2012
• First Posted (ESTIMATE): June 11, 2012

Study Record Updates

• Last Update Posted (ESTIMATE): September 16, 2013
• Last Update Submitted That Met QC Criteria: September 12, 2013
• Last Verified: September 1, 2013

More Information

Terms related to this study

• Keywords: thoracic surgery; analgesia
• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Pain; Neurologic Manifestations; Pain, Postoperative
• Other Study ID Numbers: DB 2012-001