Survey of postoperative pain control in different types of hospitals: a multicenter observational study

Michał Borys, Klaudia Zyzak, Agata Hanych, Michał Domagała, Piotr Gałkin, Katarzyna Gałaszkiewicz, Agata Kłaput, Kai Wróblewski, Justyna Miękina, Dariusz Onichimowski, Mirosław Czuczwar, Michał Borys, Klaudia Zyzak, Agata Hanych, Michał Domagała, Piotr Gałkin, Katarzyna Gałaszkiewicz, Agata Kłaput, Kai Wróblewski, Justyna Miękina, Dariusz Onichimowski, Mirosław Czuczwar

Abstract

Background: Current pain assessment and treatment does not address every patient's requirements. Although the Polish national guidelines for post-operative pain management have been published, many patients experience severe pain in the postoperative period. The main goal of our study was to assess pain severity among patients from different types of hospitals (primary, secondary, and tertiary centers) after similar types of surgeries. We also aimed to determine if there were any differences in pain severity associated with anesthesia technique, type of surgery, and the patient's age and sex.

Methods: This was a prospective, observational study. A questionnaire form was used to collect demographic data, type of hospital, surgery, anesthesia, and patient satisfaction of pain control in the postoperative period. The visual analogue scale (VAS) was used to measure pain severity at four time points after surgery (4, 8, 12, and 24 h).

Results: The study was conducted from November 2015 to June 2016 in seven hospitals in Eastern Poland, and 269 women and 293 men participated. At the 4-h measurement, 39.32% of patients assessed the pain as moderate and 19.75% as severe. A difference was found in pain intensity between patients treated in primary and secondary hospitals. Vascular surgery patients had the lowest pain intensity (19 (13-26)), especially in comparison to those undergoing thoracic surgery (30 (27-33)). A sudden elevation in pain severity among patients anesthetized with single-shot spinal technique was observed. Only 4.9% of participants received strong opioids during the first 24 h after surgery.

Conclusions: Postoperative pain control seems to be unexpectedly poor after single-shot subarachnoid anesthesia. Despite concerns, the use of analgesics may be insufficient in some groups of patients. Our study indicates new variables that influence the severity of pain, such as operated region, anesthetic technique, and type of surgical department. The results obtained in our study are in discrepancy with recommendations presented by the national guidelines for post-operative pain management.

Keywords: Analgesia; Analgesics; Multimodal analgesia; Postoperative pain management.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for this study (permit number KE-0254/282/2015) was provided by Medical University of Lublin Ethics Committee (Chairperson – Prof. Olajossy) on 29 October 2015. All participants provided written informed consent in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Legend: VAS results in millimeters during the first day after surgery in different types of hospitals. VAS are presented as means and confidence intervals
Fig. 2
Fig. 2
Legend: Pain intensity measured by VAS in millimeters during the first day after surgery according to operated region. VAS are presented as means and confidence intervals. H&N – head&neck; LL – lower limb; LA – lower abdomen; UL – upper limb; Ch – chest; upper abdomen
Fig. 3
Fig. 3
Legend: Pain intensity measured by VAS in millimeters during the first day after surgery according to surgical ward. VAS are presented as means and confidence intervals. VS – vascular surgery, GYN – gynecology; LAR – laryngology; NU – neurosurgery; OBS – obstetrics; GS – general surgery; UR – urology; OR – orthopedic surgery; TS – Thoracic surgery
Fig. 4
Fig. 4
Legend: Pain intensity measured by VAS in millimeters during the first day after surgery in different types of anesthesia. VAS are presented as means and confidence intervals
Fig. 5
Fig. 5
Legend: Pain intensity measured by VAS in millimeters during the first day after surgery according to sex. VAS are presented as means and confidence intervals

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