The use of powerful synthetic opioids, such as sufentanil and remifentanil, during surgery is linked to a subsequent poor ‘pain experience’ – a composite of emotional, cognitive, and physical aspects of pain.
That is a key finding of a research paper published in the open access journal Regional Anesthesia & Pain Medicine today (26 February).
The findings highlight the need to reassess intraoperative pain relief strategies to reduce complications after surgery and improve the quality of patient care, says a team of eight researchers based in France.
The paper’s first author is Professor Axel Maurice-Szamburski, from the Department of Anaesthesiology and Intensive Care Medicine at the University Hospital Centre Nice Pasteur Hospital in Nice.
Most patients experience moderate to severe pain after surgery, which is not only unpleasant for them, but can also hinder their recovery and increase their chances of subsequent complications, explain the researchers.
Analysing people’s ‘pain experience’
Recent research suggests that the experience of pain encompasses more than intensity alone, and includes emotional and cognitive dimensions, they add.
To identify factors potentially associated with poor ‘pain experience’ after surgery they carried out a secondary analysis of a clinical trial aimed at evaluating the effectiveness of sedatives given before surgery on the entire surgical experience.
The trial involved 1,062 adults under the age of 70 at five French teaching hospitals. They had been randomly assigned the day before surgery to receive either lorazepam (sedative), nothing, or a dummy drug.
Preoperative anxiety was assessed using a validated scale (APAIS), which measures anxiety about anaesthesia and surgery as well as the patient’s desire for information about the procedure.
Pain, sleep quality, and wellbeing were assessed using the visual analogue scale (VAS), which measures the frequency and intensity of pain, while patient experience and satisfaction were measured the day after surgery using the EVAN-G questionnaire, which covers 26 items across dimensions.
Nearly 1,000 patients included in analysis
For the current study, 971 patients with EVAN-G scale scores were included in the analysis. This showed that 271 (28 per cent) reported a poor pain experience on the first day after surgery.
Influential factors included age, an APAIS score above 11, VAS scores for pain, sleep quality and wellbeing, tobacco use, long term opioid use and type of surgery.
‘These findings underscore the need to reassess intraoperative analgesic strategies to reduce postoperative complications and improve patient care [Axel Maurice-Szamburski et al]‘
But the use of strong opioids, such as remifentanil or sufentanil, during general anaesthesia was strongly and independently linked to postoperative pain experience, with these patients almost 27 times as likely to report a poor one.
Patients given postoperative drugs to treat anxiety and those who reported amnesia were, respectively, eight times and 58 per cent more likely to have a poor pain experience the day after surgery, while higher VAS acute pain, and lower wellbeing, scores on day one were also predictive.
Older age was associated with a lower likelihood of poor pain experience as were no preoperative sedative use and orthopaedic surgery – 51 per cent and 71 per cent lower, respectively – seriously ill patients with an ASA 3 score, as defined by the American Society of Anesthesiologists, were five times more likely to report poor pain experience.
Caveats and conclusions
As the study was observational in nature, cause cannot be established. Professor Maurice-Szamburski and his team acknowledge the lack of standardised anaesthesia and pain relief protocols across the different hospitals, which may limit the generalisability of the findings.
Professor Maurice-Szamburski and his colleagues suggest that their study ‘demonstrates that intraoperative use of remifentanil and sufentanil is independently associated with poorer postoperative pain outcomes’.
They add: ‘Amnesia and postoperative anxiolytic use were also identified as predictors of adverse pain experiences. These findings underscore the need to reassess intraoperative analgesic strategies to reduce postoperative complications and improve patient care.
‘Further research is required to confirm these associations and to develop optimized perioperative pain management protocols focused on enhancing patient outcomes.’
To access the full version of the article – titled Factors associated with poor pain experience after surgery Doi: 10.1136/rapm-2024-106095 – see: https://rapm.bmj.com/lookup/doi/10.1136/rapm-2024-106095
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