A Prospective Multicentre Study to Improve Postoperative Pain: Identification of Potentialities and Problems

Esther Pogatzki-Zahn, Patrick Kutschar, Nadja Nestler, Juergen Osterbrink, Esther Pogatzki-Zahn, Patrick Kutschar, Nadja Nestler, Juergen Osterbrink

Abstract

Many studies still indicate insufficient pain management after surgery, e.g., in patients after small- or medium-size operations. Yet it is still uncertain if postoperative pain based on patient-related outcomes can be improved by implementing guideline-related programmes in a multicentre approach. Adult patients in six hospitals in one German city were included in this prospective study. Data collection took place twice in each hospital, once before and once after implementation of concepts and in-house training. Pain and pain-related aspects were assessed one day after surgery and compared between the pre- and post-test group including subgroup analysis of certain surgical procedures by using Student's t-tests, Mann-Whitney U tests and chi-square tests (alphatwo-tailed = 0.05). Overall, pain at rest and during movement was slightly lower after the intervention. Significant changes were observed after thoracic surgery, small joint surgery and other minor surgical procedures. The rather moderate decrease in pain likely relates to a reasonable pre-existing pain management and to detached improvements in certain patient subgroups. Interestingly, specific analyses revealed significantly lower post-test pain as compared to pre-test pain only in patients without pre-existing chronic pain. Side effects related to pain medication were significantly lower after intervention. Our data show, for the first time, benefits of a perioperative teaching programme in a multicentre approach. Pain ratings improved mainly in specific subgroups of patients, e.g., small surgical procedures and patients without preoperative pain. Thus, general improvement is possible but special attention should be paid to the group of patients with preoperative pain.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of survey response…
Fig 1. Flow chart of survey response rates for pre- and post-test.
Fig 2. Postoperative pain ratings for those…
Fig 2. Postoperative pain ratings for those procedures with significant effects due to the intervention after a. joint surgery (s), b. thorax surgery (s, m, l) and c. tumour (skin) surgery (s).
Pain intensity distribution is displayed using boxplots and statistically tested with Mann-Whitney-U-test; proportion above NRS-cutoffs is displayed using barcharts and statistically tested with chi-square test; ** pT p<0.10.

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