Pain, Postoperative Clinical Trial
Official title:
Does Preoperative Pain Levels by Venipuncture Predict Late Postoperative Pain Levels? - a Prospective Cohort Study of Total Hip Arthroplasty Patients at Zealand University Hospital, Koege
This study wishes to investigate if pain by peripheral venous cannulation (PVC) preoperatively, will predict pain levels after 24 h postoperatively. Furthermore, to investigate moderate/severe pain at the postoperatively at the post-anaesthesia care unit (PACU) is associated with increased late (24h) pain. Additionally, if the PACU nurse is able to predict if the patient will be a high pain responder, by using a clinical judgement. Finally to evaluate the patient's pain-levels at home after discharge and investigate for associations between postoperative pain and post-discharge pain.
Postoperative pain remains insufficiently treated in clinically relevant proportions of
patients across procedures, but with varying incidences. Preoperative identification of
patients at risk for increased postoperative pain may result in stratification of
perioperative analgesic protocols, aiming at reducing pain in high-risk patients while
avoiding over-treatment in those at low-risk.
Several potential patient-related factors have been suggested as associated with an increased
risk of higher postoperative pain levels. Studies indicate a positive correlation between
postoperative pain levels and e.g. preoperative pain levels, gender, age and
socioeconomically and psychological variables. The Pain Catastrophizing Scale (PCS), has been
used to look for associations between psychological variables and levels of early and late
pain as well. However, no firm data exist for a clinically useful identification of
individual high pain responders.
Preoperative sensory testing of patient's nociception has the potential to predict
postoperative pain levels. However, a review dealing with the prediction of postoperative
pain based on experimental pain studies demonstrated that quantitative sensory testing was
only able to predict 4 - 54% of the variance of the postoperative pain of individual
patients. Another recent study of clinically applicable tests suggested that relevant
sensitivity and specificity can be achieved, but this has not been translated into clinical
practice or confirmed. Thus, no preoperative testing method has proven clinically relevant or
useful until now.
A newer pragmatic clinical study indicated that the pain intensity associated with peripheral
venous cannulation (PVC) could be used as a simple predictor of the magnitude of early pain
levels at one hour postoperatively at the post-anaesthesia care unit (PACU). That study,
however, did not test the possible association between venepuncture related pain and later
pain levels at 24h.
Another simple method for early identification of those with an intensified need of pain
treatment after PACU discharge could be to investigate if higher pain levels early
postoperatively at the PACU are associated with higher levels of late postoperative pain.
Especially, we find it relevant at the individual patient level to investigate if NRS below 3
(moderate/severe pain) in the early postoperative phase at the PACU is associated with NRS
levels above 3 late postoperatively.
Also, it could be relevant to investigate if the PACU-nurses, based on their clinical
evaluation, are able to predict if the patient would experience an increased risk of
moderate/severe pain after PACU discharge. Such a simple clinical tool of staff's judgement
of risk of postoperative pain levels has never been tested before.
The hypothesis is that levels of early and late pain are associated and with a simple
clinical related tool it could be possible to identify patients with increased pain levels at
24-hours postoperatively.
With updated fast-track perioperative patient causes, patients often are discharged quickly
after the surgical procedure. Often there may be a lack of knowledge on how they manage to
return to daily living. Pain can be a major problem for the patients, possibly also at home.
Even though one cannot be certain that patients with severe pain, will contact the hospital
after discharge. Not only can pain delay rehabilitation it can also be a major factor for
developing chronic pain.
Therefore, it is relevant to monitor the patient`s pain-levels, quality of sleep, mood, as
well as analgesic use and side-effects at home, using a diary from discharge until 5 days
postoperatively. Especially, to investigate if patients with higher postoperative pain levels
also experience excess pain-related problems after discharge.
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