Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200024
Brazilian Journal of Pain
Original Article

General anesthesia is predictive for occurrence of postoperative pain

Anestesia geral é preditiva para a ocorrência de dor pós-operatória

Thaise Loyanne Felix Dias; Amanda Paula Mendonça Costa; Celio Melo Anjos; Joanlise Marco de Leon Andrade; Mani Indiana Funez

http://dx.doi.org/10.5935/2595-0118.20200024 BrJP, vol.3, n2, p.113-117, 2020
PDF English
PDF Português
SciELO
Downloads: 0
Views: 630

Abstract

BACKGROUND AND OBJECTIVES: Pain is one of the most frequent complications in the post- anesthetic care unit. Knowing the risk variables is one strategy for its prevention. The objective of the present study was to identify the predictive variables for pain in the post anesthetic care unit, regardless of its intensity.

METHODS: This was an observational and cross-sectional study with primary data with 98 adults submitted to elective surgery. The pain was assessed using a numerical scale. The patients were divided into two groups: the presence or absence of pain. Also, pre, intra, and postoperative information were gathered. Descriptive, comparative analysis between groups and logistic regression were conducted.

RESULTS: Pain in the post anesthetic care unit was mentioned by 34.7% of the sample, classified as severe by the majority (61.8%). A significant statistical relationship was found between the presence of pain, regardless of intensity, and two preoperative variables, nine intraoperative variables, and four postoperative variables, namely: female sex; general surgery specialty; supine position; general anesthesia; greater use of intravenous opioids and lower use of intrathecal morphine in the intraoperative period; time in surgery greater than 120 minutes; and oxygen desaturation in the postoperative period. The regression analysis revealed that general anesthesia increased the probability of pain in the post anesthetic care unit by 9.5 times.

CONCLUSION: General anesthesia was identified as predictive of pain in the post-anesthetic care unit, indicating the profile of patients at higher risk.

Keywords

Anesthesia, Elective surgical procedures, Perioperative nursing, Postoperative period, Care unit

Resumo

JUSTIFICATIVA E OBJETIVOS: A dor é uma das complicações mais frequentes em sala de recuperação pós-anestésica e uma estratégia para sua prevenção é o conhecimento de variáveis de risco. O objetivo deste estudo foi identificar variáveis preditivas de dor em sala de recuperação pós-anestésica, independentemente de sua intensidade.

MÉTODOS: Estudo observacional e transversal com dados primários, com 98 pacientes adultos submetidos a cirurgia eletiva. A dor foi avaliada utilizando a escala numérica. Os pacientes foram divididos em dois grupos pela sua presença ou ausência de dor. Além disso, foram coletadas informações pré, intra e pós-operatórias. Realizou-se análise descritiva comparativa entre grupos e regressão logística.

RESULTADOS: A queixa de dor na sala de recuperação pós-anestésica foi feita por 34,7%, sendo classificada como intensa para a maioria (61,8%). Houve relação estatística significativa para sua presença, independente da intensidade, com duas variáveis pré-operatórias, nove variáveis intraoperatórias e quatro variáveis pós-operatórias, a saber: sexo feminino; especialidade cirúrgica geral; decúbito dorsal; anestesia geral; maior consumo de opioides por via endovenosa e menor uso de morfina subaracnóidea no intraoperatório; tempo de cirurgia superior a 120 minutos e dessaturação de oxigênio no pós-operatório. A análise de regressão revelou que anestesia geral aumenta em 9,5 vezes as chances de ocorrência de dor em sala de recuperação pós-anestésica.

CONCLUSÃO: A anestesia geral foi identificada como preditiva para a ocorrência de dor em sala de recuperação pós-anestésica, evidenciando o perfil de pacientes com maior risco.

References

Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10(4):2287-98.

Bisgaard T, Klarskov B, Rosenberg J, Kehlet H. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90(3):261-9.

Cruz LFD, Felix MMS, Ferreira MBG, Pires PDS, Barichello E, Barbosa MH. Influence of socio-demographic, clinical and surgical variables on the Aldrete-Kroulik Scoring System. Rev Bras Enferm. 2018;71(6):3113-9.

Ganter MT, Blumenthal S, Dübendorfer S, Brunnschweiler S, Hofer T, Klaghofer R. The length of stay in the post-anaesthesia care unit correlates with pain intensity, nausea and vomiting on arrival. Perioper Med (Lond). 2014;3(1):10.

Nunes FC, Matos SS, Mattia AL. Análise das complicações em pacientes no período de recuperação anestésica. Rev SOBECC. 2014;19(3):129-35.

Rungwattanakit P, Sondtiruk T, Nimmannit A, Sirivanasandha B. Perioperative factors associated with severe pain in post-anesthesia care unit after thoracolumbar spine surgery: a retrospective case-control study. Asian Spine J. 2019;13(3):441-9.

Moro ET, Silva MA, Couri MG, Issa DD, Barbieri JM. Quality of recovery from anesthesia in patients undergoing orthopedic surgery of the lower limbs. Rev Bras Anestesiol. 2016;66(6):642-50.

Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017;2(6).

Kraychete DC, Sakata RK, Lannes Lde O, Bandeira ID, Sadatsune EJ. Postoperative persistent chronic pain: what do we know about prevention, risk factors and treatment. Rev Bras Anestesiol. 2016;66(5):505-12.

Pinto PR, McIntyre T, Araújo-Soares V, Almeida A, Costa P. Psychological factors predict an unfavorable pain trajectory after hysterectomy: a prospective cohort study on chronic postsurgical pain. Pain. 2018;159(5):956-67.

Gaudard AMS, Saconato H. Controle da dor pós-operatória de pacientes submetidos à cirurgia abdominal em dois hospitais públicos de Brasília. Com Ciênc Saúde;. 2012;23(4):341-52.

Oliveira RM, Leitão IM, Silva LM, Almeida PC, Oliveira SK, Pinheiro MB. Postoperative pain and analgesia: analysis of medical charts records. Rev Dor. 2013;14(4):251-5.

Thomas T, Robinson C, Champion D, McKell M, Pell M. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain. 1998;75(2-3):177-85.

Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand. 2002;46(10):1265-71.

Joels CS, Mostafa G, Matthews BD, Kercher KW, Sing RF, Norton HJ. Factors affecting intravenous analgesic requirements after colectomy. J Am Coll Surg. 2003;197(5):780-5.

Aubrun F, Valade N, Coriat P, Riou B. Predictive factors of severe postoperative pain in the postanesthesia care unit. Anesth Analg. 2008;106(5):1535-41.

Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain. 2003;105(3):415-23.

Dahmani S, Dupont H, Mantz J, Desmonts JM, Keita H. Predictive factors of early morphine requirements in the post-anaesthesia care unit (PACU). Br J Anaesth. 2001;87(3):385-9.

Mei W, Seeling M, Franck M, Radtke F, Brantner B, Wernecke KD. Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia. Eur J Pain. 2010;14(2):149.

Cabedo N, Valero R, Alcón A, Gomar C. Prevalence and characterization of postoperative pain in the post-anaesthesia care unit. Rev Esp Anestesiol Reanim. 2017;64(7):375-83.

Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986;27(1):117-26.

Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-aphadolone. Br Med J. 1974;2(5920):656-9.

Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89-91.

Version 22.0. 2013.

Version 3.6.1.. 2014.

Storesunda A, Krukhaug Y, Olsen MV, Rygh LJ, Nilsen RM, Norekvål TM. Females report higher postoperative pain scores than males after ankle surgery. Scand J Pain. 2016;12:85-93.

Willis-Gray MG, Husk KE, Brueseke TJ, Wu JM, Dieter AA. Predictors of opioid administration in the acute postoperative period. Female Pelvic Med Reconstr Surg. 2019;25(5):347-50.

Keogh E, Herdenfeldt M. Gender, coping and the perception of pain. Pain. 2002;97(3):195-201.

Ekstein MP, Weinbroum AA. Immediate postoperative pain in orthopedic patients is more intense and requires more analgesia than in post-laparotomy patients. Pain Med. 2011;12(2):308-13.

Massicotte L, Chalaoui KD, Beaulieu D, Roy JD, Bissonnette F. Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy. Acta Anaesthesiol Scand. 2009;53(5):641-7.

Harsten A, Kehlet H, Toksvig-Larsen S. Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial. Br J Anaesth. 2013;111(3):391-9.

Naghibi K, Saryazdi H, Kashefi P, Rohani F. The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: a randomized, doubleblinded study. J Res Med Sci. 2013;18(7):543-8.

Matta JA, Cornett PM, Miyares RL, Abe K, Sahibzada N, Ahern GP. General anesthetics activate a nociceptive ion channel to enhance pain and inflammation. Proc Natl Acad Sci USA. 2008;105(25):8784-9.

Melo ARC, Soares GCM, Martins FJA, Villas Boas WW. Avaliação da dor pós-operatória em pacientes submetidos à histerectomia abdominal em um hospital de ensino. Rev Med Minas Gerais. 2016;26(Suppl 1):S4-9.

Mc Mahon SB, Koltzenburg M, Tracey M, Turk DC. Wall and Melzack´s Textbook of Pain. 2014.

Suzan E, Pud D, Eisenberg E. A crucial administration timing separates between beneficial and counterproductive effects of opioids on postoperative pain. Pain. 2018;159(8):1438-40.

Submitted date:
12/06/2019

Accepted date:
04/14/2020

5f28770d0e8825ad0f0e4939 brjp Articles
2595-3192 (Electronic) 2595-0118 (Printed)
BrJP ©2024 All rights reserved.

BrJP

Share this page
Page Sections