Prediction of Acute Postoperative Pain from Assessment of Pain Associated With Venous Cannulation

Abstract

Background It has previously been reported that venous cannulation‐induced pain (VCP) can be used to predict acute postoperative pain after laparoscopic cholecystectomy. Patients rating VCP at ≥2.0 VAS units had 3.4 times higher risk for moderate or severe pain. The purpose of this study was to evaluate if VCP scores of ≥2.0 VAS units are associated with higher risk for acute postoperative pain after various common surgical procedures. Methods In a prospective clinical observational study, 600 male and female 18‐ to 80‐year‐old patients scheduled for elective surgery were included. The primary outcome measure was the difference in maximum postoperative pain intensity between low responders (VCP < 2.0) and high responders (VCP ≥ 2.0) to VCP. Secondary outcome measures were the difference in proportion of patients with moderate or severe postoperative pain between low and high responders, and potential influence of age, gender, and preoperative habitual pain. Results Patients scoring VCP ≥2.0 VAS units reported higher acute postoperative pain intensity levels than those scoring VCP <2.0 VAS units (median 3.0 [interquartile range 0.0 to 5.0] vs. 0.2 [interquartile range 0.0 to 4.0], P = 0.001), and also had 1.7 times higher risk for moderate or severe postoperative pain (P = 0.005). Moderate or severe postoperative pain was reported by 38% of patients with VCP scores of ≥2.0 VAS units and by 26% with VCP scores of <2.0 VAS units (P = 0.005). Conclusion Scoring of VCP intensity before surgery, requiring no specific equipment or training, is useful to predict individual risks for moderate or severe postoperative pain, regardless of patient age or gender, in a setting involving different kinds of surgery.

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

“…Furthermore, the cut-off level of the VCP was found to be 2.0 VAS units in predicting postoperative pain in Persson et al Study [9]. Another study reported that 2.0 VAS units represented a more reasonable cut-off level of VCP for prediction of postoperative pain [12].…”

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

“…Carvalho et al [13] study used VCP score to predict pain during childbirth in a cohort of 50 women admitted for induction of labour and found that intense pain upon intravenous cannulation predicted an earlier request for epidural analgesia during the course of induction of labour. A recently study [12] evaluated the usefulness of VCP score in 4 categories surgery (presumed to with hardly any postoperative pain, slight, moderate and severe levels of postoperative pain) and reported that the method of VCP score was only statistically significant in the patients subjected to surgery presumed to result in moderate levels of postoperative pain.…”

Reply to: Confounding Factors in Predicting Acute Post‐Surgical Pain

“…We therefore included patients subjected to different kinds of surgery and anesthesia, well aware that this would give us a highly heterogeneous cohort and enable us to show if this test is also useful in broader perioperative clinical perspectives. 1 We adjusted for intraoperative use of regional anesthesia to take into account the potential influence on immediate postoperative pain levels, as shown in table 5, and found no predictive ability of the VCP test in patients with regional anesthesia, most likely because of their lower levels of acute postoperative pain.Their second concern is on lack of standardization of the postoperative analgesic regimen, which might have had a direct confounding effect on the primary outcome. Certainly, the treatment of postoperative pain was nonstandardized but instead adhered to current clinical practice and standards of care.…”

“…We therefore included patients subjected to different kinds of surgery and anesthesia, well aware that this would give us a highly heterogeneous cohort and enable us to show if this test is also useful in broader perioperative clinical perspectives. 1 We adjusted for intraoperative use of regional anesthesia to take into account the potential influence on immediate postoperative pain levels, as shown in table 5, and found no predictive ability of the VCP test in patients with regional anesthesia, most likely because of their lower levels of acute postoperative pain.…”

“…We have read a letter to the editor in Pain Practice entitled "Confounding factors in predicting acute post-surgical pain," in which the authors raise some methodological concerns regarding our recent study on prediction of postoperative pain. 1 First of all, we thank those authors for acknowledging our study, and we respond below to their relevant concerns regarding potential confounders.…”