A Prospective Study of Pain at Rest: Incidence and Characteristics of an Unrecognized Symptom in Surgical and Trauma versus  Medical Intensive Care Unit Patients

Abstract

We read with interest the investigation by Dr. Wan et al. 1 of postoperative impairment of cognitive function in rats. We would like to ask whether the investigators believe there was an adequate control group with which to compare the results of their surgical intervention. In addition to the neuroleptic analgesia group alone, it may have been advantageous to include a sham surgical group that received a similar skin incision to the splenectomized group of rats with postoperative treatment of bupivacaine infiltration. This may have permitted an assessment of the contribution of a surgical incision alone with wound infiltration of 0.25% bupivacaine, because, contrary to the suggestion by the authors, the two groups of rats may not have received identical anesthetic regimens, i.e., there was no assessment of the contribution of the local anesthetic infiltration. Bupivacaine has been shown on its own to suppress systemic cytokine activation when given locally or systemically. 2 The investigators suggest the neuroinflammatory changes are related solely to the splenectomy surgical injury and not to other factors, such as the development of postoperative infection, which may or may not have been recognized in these rats. Splenectomized animals would more likely develop postoperative infections, and that by itself may alter neurocytokine levels. 3 In addition, surgical healing and its potential impairment of full ambulation in the rats after splenectomy may have also contributed to their difficulty in completing the learning maze, which may or may not have been related to neurocognitive impairment. A few animals with postoperative infection or impairment in their ambulation may have skewed the results on days 1 and 3 after surgery and may explain the large range of learning abilities seen in the Y-maze testing on those days. It would be interesting to note whether there were individual animal correlates of increased neuroinflammation with increased learning times in the maze.We appreciate the work presented by Dr. Wan et al. because they raise important issues with regard to postoperative cognitive impairment and the role of inflammatory changes in the central nervous system.

Pain Assessment in INTensive care (PAINT): an observational study of physician‐documented pain assessment in 45 intensive care units in the United Kingdom

“…This is despite evidence indicating that medical ICU patients report higher pain scores when compared with surgical patients 1. Furthermore, over three quarters of patients with an airway device in situ failed to have a pain assessment documented.…”

“…Pain is common among patients admitted to intensive care units (ICUs), with a prevalence of 40–77% 1, 2, 3, 4. Failure to conduct appropriate pain assessment hinders adequate pain management, and pain can lead to deleterious acute and chronic physiological and psychological consequences 5.…”

Behavioral Pain Assessment Tool for Critically Ill Adults Unable to Self-Report Pain

“…Assessment of the need for medication and of the effect of the medication is a central tenet of medication administration that guides initiation, escalation, and discontinuation of therapy. However, systematic assessment of pain in critically ill patients remains infrequent and is done CVICU may have thought that most patients had pain related to procedures and incision sites 28 and routinely administered preemptive analgesics. Possibly CPOT implementation enabled nurses to better detect the presence or absence of pain and to titrate administration of analgesics accordingly.…”

Sedation in intensive care units

“…Procenjuje se da je bol velikog intenziteta prisutan kod oko 50% pacijenata u hirurškim i nehirurškim JIL 10 . Pored bola koji nastaje kao posledica hirurške intervencije, traume, opekotine ili karcinoma, i koji bolesnici osećaju u stanju mirovanja, lečenje u JIL neretko prati pojava proceduralnog bola usled različitih intervencija kojima se bolesnik izlaže.…”