| Background and ObjectivePostoperative pain is a physiological and psychological response of the body to surgical stimulation.If not adequately controlled,it will affect postoperative rehabilitation,health-related quality of life,increase the risk of complications,and may develop into postoperative chronic pain.Currently,postoperative analgesia advocates individualized pain management in order to better manage postoperative acute pain and reduce the risk of developing postoperative persistent pain.Therefore,the ability to preoperative predict who is at risk for developing moderate or severe postoperative pain might allow anesthetist to optimize pain management by offering personalized or targeted analgesic treatment regimens.Preoperative pain prediction methods are highly relevant in this regard.The prediction methods of postoperative pain include quantitative sensory testing(QST),preoperative questionnaires,and the painful procedures in preoperative routine preparation.Pain rating during local anaesthesia infiltration(performed immediately prior to the spinal anaesthetic)or peripheral venous cannulation(a mandatory procedure in any patient scheduled for surgery)is an easy to perform,rapid,point-of-care clinical test.Compared to QST and preoperative questionnaires,it does not require any additional or new equipment,requiring only a single question to be asked of patient,and is readily available in a fast-paced clinical environment.A study found that preoperative venous cannulation induced pain intensity levels can be used to predict the risk of postoperative pain within 90 minutes after laparoscopic nephrectomy.However,the postoperative pain is usually the most severe within 24 hours and gradually alleviates after two to three days.And the feasibility of peripheral venous cannulation induced pain in predicting postoperative pain intensity after surgery for patients with controlled intravenous analgesia has not been studied.Therefore,the purpose of this study was to investigate the feasibility of preoperative peripheral venous cannulation induced pain in predicting postoperative pain intensity in patients with controlled intravenous analgesia after laparoscopic nephrectomy within 24 hours.Methods120 patients scheduled for laparoscopic nephrectomy,aged 18-65 years,all genders,BMI 18-28 kg/m~2,ASA class?or?.A superficial vein on the back of the hand was cannulated with a standard-size peripheral venous catheter(1.1×3.2 mm)by a nurse in the preoperative areas.Then the nurse recorded the VAS scores associated with this procedure estimated by patients.After general anesthesia and surgery,all the patients received the patient-controlled intravenous analgesia(PCIA)with sufentanil.In the ward,patients pressed PCA when VAS scores at rest>3.0.If patients still reported pain or the VAS scores?4.0,supplemental rescue boluses of intravenous flurbiprofen axetil injection of 50 mg were administered.The complete history of continuous infusion,bolus infusion,and bolus demand for the PCIA device was downloaded after surgery.The patients'age,height,weight,gender,ASA grade,surgical approach,surgical type,duration of anesthesia,and consumption of remifentanil were recorded.The VAS scores at rest and on coughing at 2 h,4 h,8 h,12 h,24 h,the effective number of presses,the adverse reactions and the number of patients needed rescue analgesia within 24 hours after surgery were also recorded.Results1.A total of 106 patients were included in this study for statistical analysis.The median(inter-quartile range)of peripheral venous cannulation induced pain scores,postoperative maximum pain scores at rest,postoperative maximum pain scores during coughing,effective times of pressing,patient-controlled consumption of sufentanil were 1.8(1.4-2.6),3.4(3.0-3.9),5.8(5.5-6.3),1.0(0.0-5.0),3.2(0.0-12.6)?g.2.The maximum pain scores at rest and during coughing,effective number of presses,and patient-controlled consumption of sufentanil within 24h after surgery were positively correlated with preoperative peripheral venous cannulation induced pain scores(P<0.05).3.There were no significant differences in age,gender,BMI,ASA,history of surgery,type of surgery,approaches of surgery,duration of anesthesia and surgery,consumption of remifentanil and the incidence of adverse reactions between the two groups(P>0.05).Patients with venous cannulation induced pain intensity?2.0 VAS units reported higher levels of postoperative pain intensity at rest and during coughing,needed more effective times of pressing and patient-controlled consumption of sufentanil(P<0.05).Patients with venous cannulation induced pain intensity?2.0 VAS units also needed more rescue analgesia during the first 24hours(P<0.05).4.Of patients with levels of venous cannulation induced pain intensity?2.0VAS units,33.3%reported moderate or severe(?4.0 VAS units)postoperative pain.Among patients rating pain intensity on venous cannulation induced pain intensity<2.0 VAS units,12.5%reported moderate or severe postoperative pain.There was statistically significant in the proportion of moderate or severe pain between two groups(P<0.05).5.Peripheral venous cannulation induced pain intensity?2.0 VAS units is a risk factor for postoperative pain and not affected by gender or age,and the odds of risk for moderate or severe postoperative pain(OR 3.3,95%CI 1.1-9.2)was significantly higher in patients with venous cannulation induced pain intensity?2.0 VAS units compared to those<2.0 VAS units(P<0.05).ConclusionsPeripheral venous cannulation induced pain scores is positively correlated with postoperative maximum pain and patient-controlled consumption of sufentanil during the first 24 h after laparoscopic nephrectomy.Patients with venous cannulation induced pain intensity?2.0 VAS units are more likely to report higher postoperative pain scores,patient-controlled consumption of sufentanil and risk for moderate or severe postoperative pain.Peripheral venous cannulation induced pain scores can be used to predict the risk of postoperative pain following laparoscopic nephrectomy. |
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