Incidence of severe postoperative pain after cancer surgery despite intraoperative anticipation: a case controlled study

Abstract

Anticipating postoperative pain is a routine practice in our institution. As part of a quality assurance program we used our computerized anesthetic record system database to evaluate incidence of patients having very severe postoperative pain (grade 4 on a subjective pain scale ranging from 0 to 4) in the Post Anesthetic Care Unit during a two year period. These patients were compared to a control group matched on age, type and date of surgery. Demographic characteristics, type and duration of the surgery, preoperative and intra-operative medications were compared between groups. 78 patients out of 12,510 (0.6%) with a pain score of 4 were compared to another group of 78. No significant difference was observed with regards of demographic characteristics, duration, type of surgery, and operative pain medications. Pain scores and morphine consumption were significantly higher in the cases study group in comparison to the controlled group, 4 vs 1.6+/-1.1, (p<0.05) and 13.2+/-6 vs. 6.9+/-7mg (p<0.05). Patients in the cases study group had significantly more preoperative psychoactive medication: antidepressant and benzodiazepine 13 vs. 2, (p<0.05). The incidence of severe postoperative pain scores were less than 1% in our institution. In patients with preoperative opioid treatment, adaptation of analgesic treatment has probably prevented the occurrence of severe pain. Multimodal anticipation of postoperative pain should remain mandatory while efforts should focus to identify such patients before surgery.