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Postoperative pain management in Spanish hospitals. A cohort study using the PAIN-OUT registry.

J Pain. 2017 Jun 12;:

Authors: Polanco-García M, García-Lopez J, Fàbregas N, Meissner W, Puig MM, PAIN-OUT-Spain Consortium

Abstract
Pain after surgery remains a problem worldwide, though there is no published data on postoperative outcomes in Spain. We evaluated 2922 patients in the first day after surgery in thirteen tertiary care Spanish Hospitals, using the PAIN-OUT questionnaire. Aims were to: assess postoperative outcomes, and anesthetic/analgesic management in orthopedics (ORT) and general (GEN) surgery patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management by surgical procedure. Mean worst-pain and % patients in severe pain were 5.6 (NRS 0-10) and 39.4%, slightly lower than those reported in Western countries (range 5.0-8.4 and 33%-55%). Patients’ pain assessment (83.1%) and information were high (63.3%), but participation in decision-making (4.8) was lower than in the US (7.0) and Europe (Germany, France, Norway and Denmark, mean 5.9). Patients after ORT had worst outcomes. General anesthesia was more frequent in GEN, while regional (central and peripheral) in ORT. Mean opioid consumption (20.2 mg·patient(-1)·24h(-1), oral morphine equivalents), was lower than reported and decreased >50% after regional analgesia. Intravenous morphine-PCA was seldom used (6.2%). Acute opioids were associated with worsened outcomes while multimodal analgesia (mainly Antipyretic Analgesics-NSAIDs-Opioids) with improved results. Epidurals in abdominal surgery (16.7%) also associated with better outcomes. Pre-surgical chronic pain (>7) and/or chronic opioid consumption, were associated with worsened pain-outcomes; the latter with a 50% increase in postoperative opioid requirements. Tibia/fibula and foot surgeries (ORT), and gastric, small intestine and anterior abdominal wall procedures (GEN) were the most painful. Rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve postoperative outcomes.
PERSPECTIVE: We analyzed postoperative outcomes and analgesic-management in patients from tertiary care Spanish Hospitals. The study serves as a point of comparison with other Western countries and shows that pain intensity outcomes and opioid consumption were slightly better in the Spanish population. Chronic pain before surgery (NRS >7) and/or chronic opioid consumption, were associated with worsened pain-outcomes, suggesting that rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve outcomes. Patients’ pain participation in decision-making was inadequate and should be improved in Spanish hospitals.

PMID: 28619696 [PubMed – as supplied by publisher]