Experience of moderate or even severe postoperative pain has remained a clinical problem despite major progress in pain assessment and management. The aim of the present study was to assess any association between different pre- as well as postoperative factors, actual pain experiences in the postoperative period, and the overall patient satisfaction with the pain management. A random sample of surgical patients (n =191) responded to pre- and postoperative questionnaires detailing presence of preoperative baseline pain, expected and actually experienced postoperative pain levels and perceived adequacy of the pain relief provided. Patient satisfaction was assessed and factors of importance for satisfaction/dissatisfaction were analysed. It was found that 88% of the patients had previously undergone surgical procedures and that 53% of these patients claimed to have experienced moderate or severe pain at that time. Current pain prior to the present surgical procedure was reported by 61% of the patients. Most patients (91%) expected pain of moderate to severe intensity and 76% reported to have experienced such pain levels. In spite of this 81% of the patients claimed to be satisfied with the pain management while only 8% were dissatisfied. Sex, age, pre-operative expectation and actual experience of pain relief, and the overall pain experience were found to be factors associated with the probability of being satisfied/dissatisfied. Main characteristics of the dissatisfied patient were a younger age and female sex. It is concluded that patients commonly expect moderate to severe pain in the postoperative period and that the actual pain experience is mainly in accordance with the pre-operative expectations. Therefore, the validity of patient satisfaction as an optimal outcome variable in quality assurance processes of postoperative pain management may be questioned.

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Pain in the postoperative period has remained a clinical problem in spite of major progress in pain assessment and management. The aim of the present study was to describe in detail the time course of pain experiences of surgical patients (n=200) following elective surgical procedures. Visual analogue scale (VAS, 0-100 mm) was used for pain intensity ratings at 4, 24, 48, and 72 hours after surgery. Interviews were carried out to assess the occurrence of intermittent worst pain episodes during each 24-hour period and to relate such experiences to clinical events. At 4, 24, 48, and 72 hours postoperatively, 39%, 43%, 27%, and 16% of the patients, respectively, experienced moderate or even severe pain (VAS > or =40 mm) at rest. During the first 24 hours after surgery, 88% of the patients had experienced moderate or severe pain at some time (VAS > or =40 mm). Corresponding figures for the following 24 hour periods were 81% and 72%, respectively. Spontaneous pain breakthrough and movement/mobilization were identified as reasons for the worst pain episodes during the first 72-hour period after surgery. The probability of pain intensity of VAS >40 mm was calculated from individual regression functions. The probability was found to be much higher for patients receiving parenteral analgesics than for patients receiving prolonged epidural analgesia. Despite major improvements in pain assessment and management, postoperative patients often experience moderate to severe pain, and worst pain episodes occur even in the late postoperative phase. The present study emphasizes that in the clinical routine management of pain, further quality assurance efforts are necessary.

The present study emphasizes a need for definition of more precise strategies for clinical postoperative pain assessment which better take into consideration the pain experiences and needs of individual patients.

The extent of cellular metabolic deterioration and its reversibility was studied on human skeletal muscle needle biopsies during operations in bloodless field. The tissue levels of high energy phosphates and glycolytic metabolites were analyzed after various times of tourniquet ischemia and compared to contralateral control extremity levels. In the ischemic extremity the phosphocreatine (CrP) levels decreased by 40% within 30-60 min and after 60-90 min a 60% reduction was found. No significant ATP changes occurred. Lactate levels increased by 225% after 30-60 min and by 300% after 60-90 min. The glucose and G-6-P levels increased slightly and indicated glycogenolysis. The rate of the metabolic changes decreased with ischemia time. In the control leg no significant metabolic changes could be seen. After the release of the tourniquet there was a rapid restoration of the phosphagen content and clearance of lactate in the ischemic leg. Near control levels of these substances were seen already after 5 min. The present results show that clinical tourniquet ischemia of up to 90 min duration produces less pronounced metabolic alterations than those seen in working muscle.