Prevalence and predictors of postoperative pain after ear, nose, and throat surgery.

OBJECTIVE To determine postoperative pain in different types of ear, nose, and throat (ENT) surgery and their psychological preoperative predictors. DESIGN Prospective cohort study. SETTING Academic hospital. PATIENTS A total of 217 patients undergoing ENT surgery. INTERVENTIONS All ENT, neck, and salivary gland surgery. MAIN OUTCOME MEASURES Postoperative pain and predictors for postoperative pain. RESULTS Fifty percent of the patients undergoing surgery on the oral, pharyngeal, and laryngeal region and on the neck and salivary gland region had a visual analog scale score higher than 40 mm on day 1. In the patients who underwent oropharyngeal region operations the VAS score remained high on all 4 days. A VAS pain score higher than 40 mm was found in less than 30% of patients after endoscopic procedures and less than 20% after ear and nose surgery. After bivariate analysis, 6 variables--age, sex, preoperative pain, expected pain, short-term fear, and pain catastrophizing--had a predictive value. Multivariate analysis showed only preoperative pain, pain catastrophizing, and anatomical site of operation as independent predictors. CONCLUSIONS Differences exist in the prevalence of unacceptable postoperative pain between ENT operations performed on different anatomical sites. A limited set of variables can be used to predict the occurrence of unacceptable postoperative pain after ENT surgery.

[1]  M. van Kleef,et al.  The prevalence of postoperative pain in a sample of 1490 surgical inpatients , 2008, European journal of anaesthesiology.

[2]  M. van Kleef,et al.  The Prevalence of Postoperative Pain in a Cross-sectional Group of Patients After Day-case Surgery in a University Hospital , 2007, The Clinical journal of pain.

[3]  M. van Kleef,et al.  Somatic and Psychologic Predictors of Long-term Unfavorable Outcome After Surgical Intervention , 2007, Annals of surgery.

[4]  E. Zimmer,et al.  Pain catastrophizing, response to experimental heat stimuli, and post-cesarean section pain. , 2007, The journal of pain : official journal of the American Pain Society.

[5]  Timothy T Houle,et al.  Multifactorial Preoperative Predictors for Postcesarean Section Pain and Analgesic Requirement , 2006, Anesthesiology.

[6]  H. Gramke,et al.  Sublingual Piroxicam for Postoperative Analgesia: Preoperative Versus Postoperative Administration: A Randomized, Double-Blind Study , 2006, Anesthesia and analgesia.

[7]  D. Jiang,et al.  Day-case major ear surgery: is it viable? , 2005, The Journal of Laryngology & Otology.

[8]  C. Chen,et al.  Predicting Postoperative Pain by Preoperative Pressure Pain Assessment , 2005, Anesthesiology.

[9]  M. Granot,et al.  The Roles of Pain Catastrophizing and Anxiety in the Prediction of Postoperative Pain Intensity: A Prospective Study , 2005, The Clinical journal of pain.

[10]  M. Sullivan,et al.  Catastrophizing: A Risk Factor For Postsurgical Pain , 2005, The Clinical journal of pain.

[11]  Gurminder Singh,et al.  Readmission and overstay after day case nasal surgery , 2004, BMC ear, nose, and throat disorders.

[12]  R. Fillingim,et al.  Catastrophizing as a mediator of sex differences in pain: differential effects for daily pain versus laboratory-induced pain , 2004, Pain.

[13]  M. van Kleef,et al.  The quest for new devices to improve postoperative pain control. , 2004, Anesthesia and analgesia.

[14]  A. Forster,et al.  Are there reliable predictors of postoperative pain? , 2004, Acta anaesthesiologica Scandinavica.

[15]  H. Kehlet,et al.  Prediction of Postoperative Pain by Preoperative Nociceptive Responses to Heat Stimulation , 2004, Anesthesiology.

[16]  G. Bonsel,et al.  Preoperative prediction of severe postoperative pain , 2003, Pain.

[17]  M. Jensen,et al.  Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. , 2003, The journal of pain : official journal of the American Pain Society.

[18]  Lars Arendt-Nielsen,et al.  Quantitative Sensory Testing and Human Surgery: Effects of Analgesic Management on Postoperative Neuroplasticity , 2003, Anesthesiology.

[19]  P. Laippala,et al.  Fear and anxiety in patients at different time-points in the coronary artery bypass process. , 2002, International journal of nursing studies.

[20]  J. Bland,et al.  Effectiveness of acute postoperative pain management: I. Evidence from published data. , 2002, British journal of anaesthesia.

[21]  A. Nigam,et al.  Anticipated absence from work ('sick leave') following routine ENT surgery: are we giving the correct advice? A postal questionnaire survey. , 2001, Clinical otolaryngology and allied sciences.

[22]  Jacob Rosenberg,et al.  Characteristics and prediction of early pain after laparoscopic cholecystectomy , 2001, Pain.

[23]  B. Sjöström,et al.  Assessment of pain experiences after elective surgery. , 2000, Journal of pain and symptom management.

[24]  M. Jensen,et al.  Do beliefs, coping, and catastrophizing independently predict functioning in patients with chronic pain? , 2000, Pain.

[25]  J. P. Lund,et al.  Differences between the sexes in post-surgical pain , 2000, Pain.

[26]  H. Boshuizen,et al.  Multiple imputation of missing blood pressure covariates in survival analysis. , 1999, Statistics in medicine.

[27]  S. Paul,et al.  Anesthesia-based pain services improve the quality of postoperative pain management , 1999, Pain.

[28]  M. Armstrong,et al.  ON WHICH DAY IS PAIN WORST FOLLOWING ADULT TONSILLECTOMY? , 1998, International journal of clinical practice.

[29]  F. Mosteller,et al.  The Comparative Effects of Postoperative Analgesic Therapies on Pulmonary Outcome: Cumulative Meta-Analyses of Randomized, Controlled Trials , 1998, Anesthesia and analgesia.

[30]  C. Robinson,et al.  Prediction and assessment of the severity of post-operative pain and of satisfaction with management , 1998, Pain.

[31]  H. McQuay,et al.  The visual analogue pain intensity scale: what is moderate pain in millimetres? , 1997, PAIN.

[32]  G. Alarcón,et al.  Coping strategies predict disability in patients with primary fibromyalgia , 1996, Pain.

[33]  A. Davis,et al.  Pain after tonsillectomy. , 1996, Clinical otolaryngology and allied sciences.

[34]  M. Bridger,et al.  Post-tonsillectomy pain: the first ten days , 1995, The Journal of Laryngology & Otology.

[35]  D. N. Buckley,et al.  Epidural morphine reduces the riskof postoperative myocardial ischaemia in patients with cardiac risk factors , 1993, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[36]  D B Rubin,et al.  Multiple imputation in health-care databases: an overview and some applications. , 1991, Statistics in medicine.

[37]  J. Gerbert.  Postoperative pain and its management. , 1973, Journal of the American Podiatry Association.

[38]  O. Zagólski,et al.  [Pain in patients undergoing day-case ENT surgery]. , 2005, Wiadomosci lekarskie.

[39]  P. Myles,et al.  Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. , 2000, British journal of anaesthesia.

[40]  I. Clarke.  Management of postoperative pain. , 1993, Lancet.