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Pain following Surgery: Management, Outcome, and Prediction

Rudin, Åsa LU (2006)
Abstract
Despite advances in the treatment of postoperative pain, nearly 30% of patients experience moderate to severe pain following major surgery. The present thesis includes four studies intended to evaluate important aspects of postoperative pain.



In studies I and II, patient-controlled epidural analgesia (PCEA, n = 1,670), using local anesthetics and morphine, was associated with significantly lower pain ratings than intravenous patient-controlled analgesia (PCA, n = 1,026) using morphine following major surgery. Respiratory depression, sedation, confusion, hallucinations, and nightmares were more frequently observed in the PCA group, while technical difficulties leading to insufficient analgesia were more frequent in the... (More)
Despite advances in the treatment of postoperative pain, nearly 30% of patients experience moderate to severe pain following major surgery. The present thesis includes four studies intended to evaluate important aspects of postoperative pain.



In studies I and II, patient-controlled epidural analgesia (PCEA, n = 1,670), using local anesthetics and morphine, was associated with significantly lower pain ratings than intravenous patient-controlled analgesia (PCA, n = 1,026) using morphine following major surgery. Respiratory depression, sedation, confusion, hallucinations, and nightmares were more frequently observed in the PCA group, while technical difficulties leading to insufficient analgesia were more frequent in the PCEA group.



In study III, morphine pharmacokinetics were studied in patients undergoing major liver resection (n = 15) in comparison with a group undergoing colon surgery (n = 15). Liver resection was associated with higher plasma concentrations of morphine indicating a decrease in morphine clearance, compared to controls. Sedation scores were higher in patients undergoing liver resection than in controls.



In study IV, the predictive potential of psychometric variables and preoperative responses to experimental heat stimuli were evaluated in patients scheduled for a laparoscopic sterilization procedure (n = 59). Pre-surgical pain and preoperative heat pain sensitivity were important predictors of postoperative pain, while psychometric estimates of vulnerability, anxiety, and depression only contributed to a lesser degree. The prediction model accounted for 29-43% of the total variance in postoperative movement-related pain.



Optimum pain management requires careful consideration regarding surgical procedure, analgesic technique, pharmacokinetics, and risk factors in the development of postoperative pain. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • MD, PhD Segerdahl, Märta, Department of anaesthesiology, Institution of Clinical science, intervention and technology, Karolin
organization
publishing date
type
Thesis
publication status
published
subject
keywords
intensivvård, Epidural analgesia, Outcome, Prediction., Anaesthesiology, intensive care, Anestesiologi, Postoperative pain, Patient controlled analgesia
pages
142 pages
publisher
Department of Anaesthesiology and Intensive Care, Lund
defense location
Konferenslokalen, BMC, House D, Sölvegatan 19, Lund, Sweden
defense date
2006-06-16 09:00:00
ISBN
978-91-85559-82-4
language
English
LU publication?
yes
additional info
P Flisberg, Å Rudin, R Linnér and CJF Lundberg. 2003. Pain relief and safety after major surgery. A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiol Scand, vol 47 pp 457-65.
Å Rudin, P Flisberg, J Johansson, B Walther and CJF Lundberg. 2005. Thoracic epidural analgesia or intravenous morphine analgesia after thoracoabdominal esophagectomy: a prospective follow-up of 20 patients. Journal of Cardiothoracic and Vascular Anesthesia, vol 19 pp 350-7.
Å Rudin, JF Lundberg, M Hammarlund-Udenäs, P Flisberg and MU Werner. 2007. Morphine metabolism after major liver surgery. Anesthesia and Analgesia, vol 104 (accepted)
Å Rudin, P Wölner-Hansen, M Hellbom and MU Werner. . Prediction of postoperative pain after a laparoscopic sterilization procedure. (submitted)
id
613d9802-416c-455e-98c6-6c1ec9204666 (old id 548883)
date added to LUP
2016-04-01 15:36:26
date last changed
2018-11-21 20:35:21
@phdthesis{613d9802-416c-455e-98c6-6c1ec9204666,
  abstract     = {{Despite advances in the treatment of postoperative pain, nearly 30% of patients experience moderate to severe pain following major surgery. The present thesis includes four studies intended to evaluate important aspects of postoperative pain.<br/><br>
<br/><br>
In studies I and II, patient-controlled epidural analgesia (PCEA, n = 1,670), using local anesthetics and morphine, was associated with significantly lower pain ratings than intravenous patient-controlled analgesia (PCA, n = 1,026) using morphine following major surgery. Respiratory depression, sedation, confusion, hallucinations, and nightmares were more frequently observed in the PCA group, while technical difficulties leading to insufficient analgesia were more frequent in the PCEA group.<br/><br>
<br/><br>
In study III, morphine pharmacokinetics were studied in patients undergoing major liver resection (n = 15) in comparison with a group undergoing colon surgery (n = 15). Liver resection was associated with higher plasma concentrations of morphine indicating a decrease in morphine clearance, compared to controls. Sedation scores were higher in patients undergoing liver resection than in controls.<br/><br>
<br/><br>
In study IV, the predictive potential of psychometric variables and preoperative responses to experimental heat stimuli were evaluated in patients scheduled for a laparoscopic sterilization procedure (n = 59). Pre-surgical pain and preoperative heat pain sensitivity were important predictors of postoperative pain, while psychometric estimates of vulnerability, anxiety, and depression only contributed to a lesser degree. The prediction model accounted for 29-43% of the total variance in postoperative movement-related pain.<br/><br>
<br/><br>
Optimum pain management requires careful consideration regarding surgical procedure, analgesic technique, pharmacokinetics, and risk factors in the development of postoperative pain.}},
  author       = {{Rudin, Åsa}},
  isbn         = {{978-91-85559-82-4}},
  keywords     = {{intensivvård; Epidural analgesia; Outcome; Prediction.; Anaesthesiology; intensive care; Anestesiologi; Postoperative pain; Patient controlled analgesia}},
  language     = {{eng}},
  publisher    = {{Department of Anaesthesiology and Intensive Care, Lund}},
  school       = {{Lund University}},
  title        = {{Pain following Surgery: Management, Outcome, and Prediction}},
  year         = {{2006}},
}