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Regional anesthesia and acute pain
Factors associated with poor pain experience after surgery
  1. Axel Maurice-Szamburski1,
  2. Romain Rozier2,
  3. Victor Gridel1,
  4. Vladimir Radev1,
  5. Emmanuelle Badia1,
  6. Anderson Loundou3,
  7. Pascal Auquier4 and
  8. Xavier Capdevila5
  1. 1Department of Anaesthesiology and Intensive Care Medicine, University Hospital Centre Nice Pasteur Hospital, Nice, Provence-Alpes-Côte d'Azur, France
  2. 2Department of Anaesthesiology and Intensive Care Medicine, University Hospital Centre Nice L'Archet Hospital, Nice, Provence-Alpes-Côte d'Azur, France
  3. 3Hôpitaux Universitaires de Marseille Timone, Marseille, Provence-Alpes-Côte d'Azur, France
  4. 4Université de la Méditerranée Faculté de Médecine Secteur Timone, Marseille, Provence-Alpes-Côte d'Azur, France
  5. 5Anesthesiology and Critical Care Department, Hopital Lapeyronie, Montpellier, France
  1. Correspondence to Dr Axel Maurice-Szamburski; amszamburski{at}gmail.com

Abstract

Objective To identify factors associated with poor postoperative pain experience by examining patient-related and procedural variables.

Methods An exploratory secondary analysis was conducted on data from 971 adult patients undergoing elective surgery under general anesthesia across five French teaching hospitals. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Pain, sleep quality and well-being were measured preoperatively and postoperatively using visual analog scales (VAS). The primary endpoint was the patient experience measured by the Evaluation du Vécu de l'Anesthésie Generale (EVAN-G) questionnaire on postoperative day 1, with poor pain experience defined as a score below the 25th percentile on the EVAN-G pain dimension. Univariate and multivariate logistic regression analyses were performed to identify factors associated with poor pain experience.

Results Poor pain experience was reported by 271 patients (27.9%). Multivariate analysis identified intraoperative use of remifentanil and sufentanil as an independent predictor of poor pain experience with an OR of 26.96 (95% CI 2.17 to 334.23, p=0.01). Additionally, age (OR 0.97, p=0.003), absence of premedication (OR 0.49, p=0.035) and orthopedic surgery (OR 0.29, p=0.005) were associated with a lower likelihood of poor pain experience. Conversely, American Society of Anesthesiologists (ASA) 3 status (OR 5.09, p=0.028), postoperative anxiolytic use (OR 8.20, p<0.001), amnesia (OR 1.58, p=0.001), higher VAS pain (p<0.001) and lower well-being scores (p=0.007) on day 1 were predictors of poor pain experience.

Conclusion The intraoperative use of remifentanil and sufentanil is independently associated with poorer postoperative pain experience. These findings highlight the need to reassess intraoperative analgesic strategies to enhance patient outcomes and reduce postoperative complications.

  • Opioids
  • Anxiety
  • Pain Management
  • Pain Perception
  • Acute Pain

Data availability statement

Data are available upon reasonable request. Original data are available from the Laboratoire de Santé Publique, EA3279, 264 rue Saint Pierre, 13005, Marseille, France.

https://doi.org/10.1136/rapm-2024-106095

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    Data availability statement

    Data are available upon reasonable request. Original data are available from the Laboratoire de Santé Publique, EA3279, 264 rue Saint Pierre, 13005, Marseille, France.

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    Footnotes

    • Contributors AMS: Responsible for the overall content as the guarantor. Conception and design, acquisition of data, analysis and interpretation of data; drafting and revising and agreement to be accountable for all aspects of the work thereby ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RR: Analysis, interpretation of data and agreement to be accountable for all aspects of the work. VG: Analysis, interpretation of data and agreement to be accountable for all aspects of the work. VR: Analysis, interpretation of data and agreement to be accountable for all aspects of the work. AL: Statistical analysis, and agreement to be accountable for all aspects of the work. EB: Analysis, interpretation of data and agreement to be accountable for all aspects of the work. PA: Analysis, interpretation of data and agreement to be accountable for all aspects of the work. XC: Analysis, interpretation of data and agreement to be accountable for all aspects of the work.

    • Funding This work was supported by grant 2011-32 A-1337 from the French Institutional Clinical Hospital Research Program, Ministry of Health (awarded to Dr Maurice-Szamburski).

    • Competing interests The authors declare no competing interests related to the subject of this study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.