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Pre- and post-surgical factors that predict the provision of rescue analgesia following hysterectomy

Lookup NU author(s): Professor Vera Araujo-SoaresORCiD

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Abstract

Background: To better manage post-surgical pain, standardized analgesic protocols allow for rescue analgesia (RA). This study seeks to determine which pre- and post-surgical clinical and patient-related factors, in addition to post-surgical pain, may influence health care professional decisions on RA administration. Methods: A consecutive sample of 185 women, submitted to hysterectomy for benign disorders, was assessed 24 h before (time 1; T1) and 48 h after (time 2; T2) surgery. At T1, baseline demographic, clinical and psychological predictors were assessed and at T2, post-surgical pain, anxiety and RA administration were recorded. Results: After controlling for post-surgical acute pain intensity, logistic regression results revealed several pre-surgical (T1) and surgical factors associated with post-surgical RA: having other previous pain states [odds ratio (OR), 4.551; 95% confidence interval (CI), 1.642–12.611, p = 0.004], being anaesthetized with only general or loco-regional anaesthesia (OR, 5.349; 95% CI, 1.976–14.483, p = 0.001) and pre-surgical fear of immediate consequences of surgery (OR, 1.306; 95% CI, 1.031–1.655, p = 0.027). Concerning post-surgical variables, higher pain intensity (OR, 1.591; 95% CI, 1.353–1.871, p < 0.001) and post-surgical anxiety (OR, 1.245; 95% CI, 1.084–1.430, p = 0.002) were significantly associated with RA provision. Conclusions: Health care decision making to administer RA might be influenced not only by post-surgical pain intensity but also by pre-surgical and surgical clinical factors, such as previous pain and type of anaesthesia. Patient-related psychological characteristics, such as pre-surgical fear and post-surgical anxiety, may also play a role in decision making on RA provision. Implications for practice are discussed.

Publication metadata

Author(s): Pinto PR, McIntyre T, Fonseca C, Almeida A, Araújo-Soares V

Publication type: Article

Publication status: Published

Journal: European Journal of Pain

Year: 2013

Volume: 17

Issue: 3

Pages: 423-433

Print publication date: 14/08/2012

ISSN (print): 1090-3801

ISSN (electronic): 1532-2149

Publisher: John Wiley & Sons Ltd.

URL: http://dx.doi.org/10.1002/j.1532-2149.2012.00205.x

DOI: 10.1002/j.1532-2149.2012.00205.x

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