Acute postoperative pain in 23 procedures of gynaecological surgery analysed in a prospective open registry study on risk factors and consequences for the patient

Abstract

Effective perioperative pain management is essential for optimal patient recovery after surgery and reduces the risk of chronification. However, in clinical practice, perioperative analgesic treatment still needs to be improved and data availability for evidence-based procedure specific analgesic recommendations is insufficient. We aimed to identify procedures related with high pain scores, to evaluate the effect of higher pain intensity on patients and to define patient and intervention related risk factors for increased pain after standard gynaecological and obstetrical surgery. Therefore, we performed a prospective cross-sectional study based on the German registry for quality in postoperative pain (QUIPS). A cohort of 2508 patients receiving surgery between January 2011 and February 2016 in our tertiary referral centre (university departments of gynaecology and obstetrics, respectively) answered a validated pain questionnaire on the first postoperative day. Maximal pain intensity was measured by means of a 11-point numeric rating scale (NRS) and related to procedure, perioperative care as well as patient characteristics. The interventions with the highest reported pain scores were laparoscopic removal of ovarian cysts (NRS of 6.41 ± 2.12) and caesarean section (NRS of 6.98 ± 2.08). Factors associated with higher pain intensity were younger age (OR 1.75, 95% CI 1.65–1.99), chronic pain (OR 2.08, 95% CI 1.65–2.64) and surgery performed outside the regular day shift (OR 1.67, 95% CI 1.09–2.36). Shorter duration of surgery, peridural or local analgesic and preoperative sedation reduced postoperative pain. Patients reporting high pain scores (NRS ≥ 5) showed relevant impairment of daily activities and reduced satisfaction. Caesarean section and minimal invasive procedures were associated with the highest pain scores in the present ranking. Pain management of these procedures has to be reconsidered. Younger age, receiving surgery outside of the regular shifts, chronic pain and the surgical approach itself have a relevant influence on postoperative pain intensity. When reporting pain scores of 5 or more, patients were more likely to have perioperative complications like nausea or vomiting and to be impaired in mobilisation. Registry-based data are useful to identify patients, procedures and critical situations in daily clinical routine, which increase the risk for elevated post-intervention pain. Furthermore, it provides a database for evaluation of new pain management strategies.

Following Evidence-Based Recommendations for Perioperative Pain Management after Cesarean Section Is Associated with Better Pain-Related Outcomes: Analysis of Registry Data

“…Cesarean section (CS) is the most common major surgical procedure in women of childbearing age [ 1 ]. Multi-center observational studies demonstrate that the incidence of severe pain after CS is high, even when compared with other gynecologic surgical procedures [ 2 , 3 ]. It is well described that after CS, moderate-to-severe post-operative pain and interference with function are associated with short- and long-term negative consequences for mother and child [ 4 , 5 , 6 ].…”

The effects of Kinesio taping and breathing exercises on pain management after gynaecological abdominal surgery: A randomized controlled study

“…Standard surgical procedures performed in gynaecology and obstetrics can be associated with severe postoperative pain. Furthermore, pain management in female patients may be more complex than in male patients (Cruz et al, 2021).…”

“…Standard surgical procedures performed in gynaecology and obstetrics can be associated with severe post‐operative pain. Furthermore, pain management in female patients may be more complex than in male patients (Cruz et al, 2021). Post‐operative pain management is an important component of post‐operative care; especially following abdominal surgery, pain limits physical functions such as coughing, breathing, movement, sleep and self‐care (Mizrak Sahin et al, 2021).…”

The “WWHow” Concept for Prospective Categorization of Post-operative Severity Assessment in Mice and Rats

“…It is known from human studies that minimally invasive procedures reduce cutaneous hypersensitivity but do not contribute significantly to the overall reduction of post-operative pain ( 44 , 45 ). This may be due to the minimally invasive procedure limiting the surgeon's vision and leading to additional tissue trauma (e.g., surgical neuropathy by nerve injury), directly impacting severity.…”