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Research article
Characterization of self-anticipated surgical pain prior to general anesthesia - a prospective observational study
Yu-Chuan Tsai
E-Da Hospital
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.
Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.
Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (P<0.001). Higher anticipated pain scores (preoperative NRS³4) were associated with higher actual postoperative pain levels (P=0.032) in the PACU and higher total equivalent opioid use (P=0.001) for acute pain management during the perioperative period.
Conclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.
Keywords
numerical rating scale, pain expectation, pre-anesthesia assessment, post-anesthesia care unit, surgery-related pain
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Editor invited
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Editorial decision: Major revision
On 17 Nov, 2020
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On 14 Nov, 2020
Editor invited
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Editorial decision: Major revision
On 01 Sep, 2020
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Received 31 Aug, 2020
Reviewer #1 agreed
On 03 Aug, 2020
Reviewers invited
Invitations sent on 27 Jul, 2020
Editor assigned
On 14 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
No comments provided
Editorial decision: Major revision
On 20 May, 2020
Review #1 received
Received 19 May, 2020
Review #2 received
Received 05 May, 2020
Reviewer #2 agreed
On 28 Apr, 2020
Reviewer #1 agreed
On 27 Apr, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
First submitted
On 12 Mar, 2020
Editor assigned
On 12 Mar, 2020
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On 11 Mar, 2020
Editor invited
On 11 Mar, 2020
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Characterization of self-anticipated surgical pain prior to general anesthesia - a prospective observational study
Yu-Chuan Tsai
E-Da Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 11 Jan, 2021
No community comments so far
Reviewer #1 agreed
On 03 Jan, 2021
Review #1 received
Received 03 Jan, 2021
Reviewers invited
Invitations sent on 28 Dec, 2020
Editor assigned
On 27 Dec, 2020
Submission checks complete
On 27 Dec, 2020
Editor invited
On 27 Dec, 2020
No comments provided
Editorial decision: Major revision
On 17 Nov, 2020
Editor assigned
On 14 Nov, 2020
Submission checks complete
On 14 Nov, 2020
Editor invited
On 14 Nov, 2020
No comments provided
Editorial decision: Major revision
On 01 Sep, 2020
Review #1 received
Received 31 Aug, 2020
Reviewer #1 agreed
On 03 Aug, 2020
Reviewers invited
Invitations sent on 27 Jul, 2020
Editor assigned
On 14 Jul, 2020
Submission checks complete
On 13 Jul, 2020
Editor invited
On 13 Jul, 2020
No comments provided
Editorial decision: Major revision
On 20 May, 2020
Review #1 received
Received 19 May, 2020
Review #2 received
Received 05 May, 2020
Reviewer #2 agreed
On 28 Apr, 2020
Reviewer #1 agreed
On 27 Apr, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
First submitted
On 12 Mar, 2020
Editor assigned
On 12 Mar, 2020
Submission checks complete
On 11 Mar, 2020
Editor invited
On 11 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Current postoperative pain management principles are primarily based on the type and extent of surgical interventions. This clinical study measured patient’s self-anticipated pain score before surgery and compared the scores with the pain levels and analgesic requirements after surgery.
Methods: This prospective observational study recruited consecutive patients who received general anesthesia for elective surgeries in E-Da Hospital (Taiwan) between June and August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numerical rating scale, NRS 0-10) for their scheduled surgical intervention during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0-10) experienced by the patient in the post-anesthesia care unit (PACU) and the total dose of opioids administered during the perioperative period were recorded. Pain scores ³4 on the NRS were regarded as being unacceptable levels of anticipated or postoperative pain.
Results: A total of 857 patients were included in the study. The final database included 49.2% males, and 73.7% of them have had previous operations. The mean anticipated pain score was 4.9±2.5 and 72.2% of the patients reported an anticipated NRS ³4 before their operations. Females anticipated significantly higher overall pain intensities than male patients (adjusted odds ratio 1.695, 95% confidence interval 1.252-2.295; P=0.001). Patients over 40 years of age reported significantly lower overall anticipated NRS scores (4.78±2.49 vs 5.36±2.50; P=0.003). Patients scheduled to receive more invasive surgical procedures were more likely to anticipate high pain intensity in the preoperative period (P<0.001). Higher anticipated pain scores (preoperative NRS³4) were associated with higher actual postoperative pain levels (P=0.032) in the PACU and higher total equivalent opioid use (P=0.001) for acute pain management during the perioperative period.
Conclusion: This observational study found that females, younger patients (£40 years), and patients scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and management of exaggerated pain expectation in these patients are necessary to improve the quality of anesthesia delivered and patient’s satisfaction.
Figure 1
Figure 2