Application of preoperative assessment of pain induced by venous cannulation in predicting postoperative pain in patients under laparoscopic nephrectomy: a prospective observational study

Abstract

Background: Postoperative pain is the most prominent concern among surgical patients. It has previously been reported that venous cannulation-induced pain (VCP) can be used to predict postoperative pain after laparoscopic cholecystectomy within 90 mins in the recovery room. Its potential in predicting postoperative pain in patients with patient-controlled intravenous analgesia (PCIA) is worth establishing. The purpose of this prospective observational study was to investigate the application of VCP in predicting postoperative pain in patients with PCIA during the first 24 h after laparoscopic nephrectomy. Methods: One hundred twenty patients scheduled for laparoscopic nephrectomy were included in this study. A superficial vein on the back of the hand was cannulated with a standard-size peripheral venous catheter (1.1 × 3.2 mm) by a nurse in the preoperative areas. Then the nurse recorded the VAS score associated with this procedure estimated by patients, and dichotomized the patients into low response group (VAS scores < 2.0) or high response group (VAS scores ≥2.0). After general anesthesia and surgery, all the patients received the patient-controlled intravenous analgesia (PCIA) with sufentanil. The VAS scores at rest and on coughing at 2 h, 4 h, 8 h, 12 h, 24 h, the effective number of presses and the number of needed rescue analgesia within 24 h after surgery were recorded. Results: Peripheral venous cannulation-induced pain score was significantly correlated with postoperative pain intensity at rest (r s = 0.64) and during coughing (r s = 0.65), effective times of pressing (r s = 0.59), additional consumption of sufentanil (r s = 0.58). Patients with venous cannulation-induced pain intensity ≥2.0 VAS units reported higher levels of postoperative pain intensity at rest (P < 0.0005) and during coughing (P < 0.0005), needed more effective times of pressing (P < 0.0005) and additional consumption of sufentanil (P < 0.0005), and also needed more rescue analgesia (P = 0.01) during the first 24 h. The odds of risk for moderate or severe postoperative pain (OR 3.5, 95% CI 1.3-9.3) was significantly higher in patients with venous cannulation-induced pain intensity ≥2.0 VAS units compared to those <2.0 VAS units.

Effect of injection pain and withdrawal movement of propofol and rocuronium in the induction of anaesthesia on postoperative pain outcomes in gynaecological laparoscopic surgery: a prospective observational study

“…Peng et al .’s study reported that preoperative pain induced by venous cannulation and propofol infusion predicted postoperative pain after laparoscopic cholecystectomy. [ 10 ] In their study, patients with venous cannulation-induced pain with a VAS score ≥2.0 showed greater and earlier postoperative pain, and had a higher consumption of opioids as compared to those with a VAS score <2.0. The difference between the present study and Peng et al’s study[ 10 ] is the inclusion of both subjective and objective measures of pain for PIP and RIWM in the former.…”

“…The exclusion criteria were: (a) patients with muscular disorders, difficult venous access on the forearm, history of allergy to propofol or rocuronium, or neuromuscular diseases, (b) patients who declined to participate in this study, (c) patients who received analgesics or sedatives within the previous 24 h, and (d) menopausal patients (to exclude the hormonal effect on pain). [ 10 ]…”