Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients

Roth, W.; Kling, J.; Gockel, I.; Rümelin, A.; Hessmann, M.H.; Meurer, A.; Gillitzer, R.; Jage, J.

doi:10.1016/j.acpain.2005.05.001

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Volume 7, Issue 2 , Pages 75-83, August 2005

Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients

W. Roth
- Clinic of Anesthesiology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Visceral Surgery, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Corresponding author. Tel.: +49 6131 17 3911.
J. Kling
- Clinic of Anesthesiology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
I. Gockel
- Clinic of Visceral Surgery, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
A. Rümelin
- Clinic of Anesthesiology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
M.H. Hessmann
- Clinic of Traumatology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
A. Meurer
- Clinic of Orthopedic Surgery, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
R. Gillitzer
- Clinic of Orthopedic Surgery, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
J. Jage
- Clinic of Anesthesiology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany
- Clinic of Urology, University Hospital, Johannes Gutenberg-University, Langenbeckstr. 1, 55131 Mainz, Germany

Received 26 March 2004; received in revised form 30 April 2005; accepted 3 May 2005.

Summary

A total number of 1071 patients was investigated using a modified questionnaire of the American Pain Society to evaluate the pain profile and satisfaction/dissatisfaction on the second post-operative day after different types of surgery (abdominal, traumatic, orthopaedic, urologic, gynaecologic, ENT). Patients were either treated with non-standardized pain management (no measurement of pain intensities, no regular administration of analgesics) (non-APS; n=575) under responsibility of surgical specialties or with standardized pain management (regular assessment of pain and dose adaptation with i.v. PCA or epidurals) (APS; n=496) by an anaesthesiology-based acute pain service.

Patients with a non-standardized pain management gave answers expressing higher pain intensities and breakthrough pain compared with APS-patients as a sign of their analgesic undertreatment (p≤0.05). The differences between the non-APS and APS groups were also significant after major surgery (abdominal, urologic, traumatic, orthopaedic), showing the benefit of using i.v. PCA or epidurals. Furthermore, it could be demonstrated that patients in the APS treatment group were satisfied with their pain management to a significantly higher degree than patients in the non-APS group. 27.3% of non-APS versus 1.1% of APS-patients (p≤0.05) were dissatisfied with their pain management. The majority of these patients did not want to experience the same management again.

The stepwise multivariate regression to estimate influencing variables on dissatisfaction (e.g. pain intensity, breakthrough pain, pain service, age, type of surgery) had yielded the surprising result that the most important factor for dissatisfaction was the patient's feeling that a complaint about pain had been taken seriously.

Our data has shown the necessity to improve pain management after surgery under the responsibility of surgical specialties, in order to avoid undertreatment and to increase patient's satisfaction. As a consequence of this prospective study, an interdisciplinary standardized pain management was introduced at the University Hospital. A repetition of this audit is planned.

Keywords: Post-operative pain, Pain management, Dissatisfaction