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Severity and impact of pain after day-surgery

Abstract

Purpose

To assess the intensity, duration and impact of pain after day-surgery interventions. Predictors of pain severity were also evaluated along with the quality of analgesic practices and patient satisfaction.

Methods

Eighty-nine consecutive day-surgery patients completed self-administered questionnaires before leaving the hospital and at 24, 48 hr and seven days after discharge. The survey instrument was composed of 0–10 pain intensity scales, selected items of the Brief Pain Inventory, of the Patient Outcome Questionnaire and of the Barriers Questionnaire. Analgesic intake in hospital and at home was recorded along with the use of other pain control methods.

Results

Forty percent of the patients reported moderate to severe pain during the first 24 hr after hospital discharge. The pain decreased with time but it was severe enough to interfere with daily activities in a substantial number of patients. The best predictor of severe pain at home was inadequate pain control during the first few hours following the surgery. More than 80% of the participants were satisfied with their pain treatment. However, one patient in four (25%) needed contact with a health care provider because of pain at home. Many patients (33% to 51 %) reported that instructions about pan control were either unclear or non-existent on several aspects. Medication use was low overall. Thirty-two percent of the patients did not take any pain medication during the first 24 hr after discharge although almost half of them (46%) rated their pain ≥4. The most common concerns patients had about using pain medication were fear of drug addiction and side effects.

Conclusion

The severity and duration of pain after day-surgery should not be underestimated. Aggressive analgesic treatment during the hospital stay should be provided along with take-home analgesia protocols and comprehensive patient education programs.

Résumé

But

Évaluer l’intensité, la durée et l’impact de la douleur à la suite de chirurgies d’un jour. Les facteurs pouvant prédire la sévérité de la douleur ont également été évalués de même que la qualité des pratiques analgésiques et la satisfaction des patients.

Méthodes

Quatre-vingt neuf patients admis pour des chirurgies d’un jour ont complété des questionnaires avant de quitter l’hôpital, à 24 et 48 hr de même qu à sept jours après leur congé. Les instruments de mesure comprenaient des échelles de douleur de 0 à 10 et des items du Brief Pain Inventory, du Patient Outcome Questionnaire et du Barriers Questionnaire. La consommation analgésique à l’hôpital et à la maison a aussi été comptabilisée.

Résultats

Quarante pour-cent des patients ont rapporté des douleurs modérées à sévères durant les 24 hr suivant leur congé. La douleur diminuait avec le temps mais elle était assez sévère pour gêner les activités quotidiennes chez un nombre substantiel de patients. Le facteur prédisant le mieux une douleur sévère à la maison était une analgésie insuffisante à l’hôpital. Plus de 80% des patients se sont dits satisfaits du traitement de la douleur. Toutefois, un patient sur quatre a communiqué avec un professionnel de la santé à cause de douleur à la maison. Un bon nombre de patients (33% à 51 %) a rapporté que les instructions concernant le contrôle de la douleur n’étaient pas claires ou inexistantes. Les patients faisaient peu usage de médicaments contre la douleur; 32% d’entre eux n’ont pris aucun médicament la première journée alors que presque la moitié (46%) cotaient leur douleur à ≥4. La crainte de développer une dépendance au médicament ou de ressentir des effets secondaires étaient les principales préoccupations des patients.

Conclusion

La sévérité et la persistance de la douleur après une chirurgie d’un jour ne devraient pas être sousestimées. Le traitement analgésique devrait se faire agressif durant le séjour hospitalier alors que des protocoles d’analgésie pour la maison devraient être fournis de concert avec des programmes d’enseignement pour les patients.

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Author information

Correspondence to Lucie Beauregard or Manon Choinière.

Additional information

This work was supported by the Department of Surgery of the Pavillon Hôtel-Dieu and by the Fondation pour la recherche en chirurgie de Montréal.

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Beauregard, L., Pomp, A. & Choinière, M. Severity and impact of pain after day-surgery. Can J Anaesth 45, 304 (1998). https://doi.org/10.1007/BF03012019

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Keywords

  • Ambulatory Surgery
  • Average Pain
  • Knee Arthroscopy
  • Analgesic Medication
  • Brief Pain Inventory