Prevalence and Predictors of Postoperative Pain After Ear, Nose, and Throat Surgery

Sommer, Michael; Geurts, José W. J. M.; Stessel, Björn; Kessels, Alfons G.H.; Peters, Madelon L.; Patijn, Jacob; Kleef, Maarten van; Kremer, Bernd; Marcus, Marco A. E.

doi:10.1001/archoto.2009.3

Cited by 112 publications

(117 citation statements)

References 38 publications

(60 reference statements)

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“…Although it is well known that rhinosurgery is much more painful than septoplasty, and in a broader sense any kind of surgery on the external nose and nasal skeleton could be signiWcantly painful, there is lack of prospective studies assessing early postoperative pain following rhinoplasty or septorhinoplasty [6,12,13]. The present prospective investigation conWrmed moderate, but therapy-relevant postoperative, pain on the Wrst day after septorhinoplasty, as a mean NRS value of 3.77 for maximal pain was estimated.…”

Section: Discussionmentioning

confidence: 52%

“…Although rhinoplasty without and with septoplasty are common procedures of plastic surgery, there is a lack of knowledge about pain and speciWc pain management after rhinoplasty [6]. If at all any speciWc recommendation is given in guidelines for postoperative pain management, rhinoplasty is subsumed insuYciently under head and neck surgery [7].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative pain assessment after septorhinoplasty

Wittekindt

Schneider

et al. 2011

Eur Arch Otorhinolaryngol

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Postoperative pain after septorhinoplasty and its optimal management has not been described in detail. Fifty-two adult septorhinoplasty patients were included in a prospective cohort single center study. Patients' and surgical characteristics were evaluated. Outcome and process parameters were analyzed using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Management (QUIPS) on the first postoperative day. Pain during the first operative day after septorhinoplasty was moderate. Pain management predominately consisted of remifentanil intraoperatively, metamizole in the recovery room, in combination with piritramide in one-third of the patients, and metamizole on ward. Patients younger than 31 years were less satisfied with pain management (P = 0.018). Open rhinoplasty was associated with less satisfaction with pain management (P = 0.007). Use of rib grafts led to more mobility, breathing, sleeping and mood disturbances (P = 0.003, 0.047; 0.047; 0.022, respectively). Preoperative pain counseling was followed by higher satisfaction, less breathing and mood disturbances after surgery (P = 0.021; 0.004; 0.046, respectively). Opioids in the recovery room in addition to non-opioids and treatment with non-opioids on ward led to less maximal pain (P = 0.027 and 0.040, respectively). We conclude that QUIPS is an easy tool to evaluate the quality of postoperative pain management following rhinoplasty. Preoperative pain counseling, specific care for patients with rib grafts, consequent use of opioids in the recovery room in addition to non-opioids, and use of non-opioids on ward seem to be effective to improve pain management after septorhinoplasty.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Postoperative pain assessment after septorhinoplasty

Wittekindt

Schneider

et al. 2011

Eur Arch Otorhinolaryngol

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“…First, one limitation was that perioperative pain and pain management-related parameters were assessed only once and within the first 24 h after surgery. Depending on the type of HNC surgery, significant pain peaks at day 1 or 2 after surgery, but some patients experience pain even throughout 1 week after surgery [21]. Second, only Caucasian patients in a German hospital were measured.…”

Section: Discussionmentioning

confidence: 99%

Pain on the first postoperative day after head and neck cancer surgery

Inhestern

Schuerer

Illge

et al. 2014

Eur Arch Otorhinolaryngol

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Postoperative pain within the first 24 h after head and neck cancer (HNC) surgery was assessed. Factors influencing postoperative pain were identified. In a prospective cohort single center study 145 HNC patients rated their pain on the first postoperative day using questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0-10) for the determination of patient's pain on ambulation, his maximal and minimal pain. QUIPS allowed a standardized assessment of patients' characteristics and pain-related parameters. The influence of these parameters on the patients' postoperative pain was estimated by univariate and multivariate statistical analysis. One-third had already pain prior to the surgical intervention. Overall, the mean pain on ambulation, maximal pain and minimal pain were 2.55 ± 2.36, 3.18 ± 2.86, and 1.38 ± 2.86 (NRS), respectively. 53 % of the patients had maximal pain scores >3. Multivariate analysis revealed independent predictors for more postoperative pain on ambulation: intensity of chronic preoperative pain, usage of non-opioids on ward, and existence of pain documentation on ward. Intensity of chronic preoperative pain and usage of non-opioids on ward were independent risk factors for more maximal pain. Intensity of chronic preoperative pain was independently associated to more minimal pain. Concerning pain management side effects, the risk for drowsiness increased with longer time of surgery. Postoperative pain after HNC surgery is highly variable and seems often to be unnecessarily high. Many patients seem to receive less analgesia than needed or ineffective analgesic drug regimes.

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“…The most consistent finding in the literature thus far has been that the presence of current pain (either preoperative or acute postsurgical pain) predicts future pain [4,[9][10][11][12]. Other factors such as younger age [3,14], female gender [9,15], the presence of anxiety [9,16], pain catastrophizing [17], and other psychological variables such as emotional numbing [18] have been shown to predict the development ofpostsurgical pain after a variety of surgical procedures [4]. We must continue efforts to determine which aspects of the perioperative pain experience are predictive of the transition to pain chronicity: qualities specific to the pain itself (e.g.…”

Section: Introductionmentioning

confidence: 98%