British Journal of Anaesthesia, 2002, Vol. 89, No. 3 409-423
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Effectiveness of acute postoperative pain management: I. Evidence from published data
1 Pain Clinic, St Richard’s Hospital, Chichester PO19 4E, UK. 2 Department of Anaesthesia, St. George’s Hospital, London SW17 0QT, UK. 3 Department of Public Health Sciences, St George’s Hospital Medical School, London SW17 0RE, UK*Corresponding author
Background. This review examines the evidence from published data concerning the incidence of moderate-severe and of severe pain after major surgery, with three analgesic techniques; intramuscular (i.m.) analgesia, patient controlled analgesia (PCA), and epidural analgesia.
Methods. A MEDLINE search of the literature was conducted for publications concerned with the management of postoperative pain. Over 800 original papers and reviews were identified. Of these 212 papers fulfilled the inclusion criteria but only 165 provided usable data on pain intensity and pain relief. Pooled data on pain scores obtained from these studies, which represent the experience of a total of nearly 20 000 patients, form the basis of this review.
Results. Different pain measurement tools provided comparable data. When considering a mixture of three analgesic techniques, the overall mean (95% CI) incidence of moderate-severe pain and of severe pain was 29.7 (26.4–33.0)% and 10.9 (8.4–13.4)%, respectively. The overall mean (95% CI) incidence of poor pain relief and of fair-to-poor pain relief was 3.5 (2.4–4.6)% and 19.4 (16.4–22.3)%, respectively. For i.m. analgesia the incidence of moderate-severe pain was 67.2 (58.1–76.2)% and that of severe pain was 29.1 (18.8–39.4)%. For PCA, the incidence of moderate-severe pain was 35.8 (31.4–40.2)% and that of severe pain was 10.4 (8.0–12.8)%. For epidural analgesia the incidence of moderate-severe pain was 20.9 (17.8–24.0)% and that of severe pain was 7.8 (6.1–9.5)%. The incidence of premature catheter dislodgement was 5.7 (4.0–7.4)%. Over the period 1973–1999 there has been a highly significant (P<0.0001) reduction in the incidence of moderate-severe pain of 1.9 (1.1–2.7)% per year.
Conclusions. These results suggest that the UK Audit Commission (1997) proposed standards of care might be unachievable using current analgesic techniques. The data may be useful in setting standards of care for Acute Pain Services.
Br J Anaesth 2002; 89: 409–23
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Sommer, J. W. J. M. Geurts, B. Stessel, A. G. H. Kessels, M. L. Peters, J. Patijn, M. van Kleef, B. Kremer, and M. A. E. Marcus Prevalence and Predictors of Postoperative Pain After Ear, Nose, and Throat Surgery Arch Otolaryngol Head Neck Surg, February 1, 2009; 135(2): 124 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Popping, N. Elia, E. Marret, C. Remy, and M. R. Tramer Protective Effects of Epidural Analgesia on Pulmonary Complications After Abdominal and Thoracic Surgery: A Meta-Analysis Arch Surg, October 1, 2008; 143(10): 990 - 999. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Turan, P. F. White, O. Koyuncu, B. Karamanliodlu, G. Kaya, and C. C. Apfel Transdermal Nicotine Patch Failed to Improve Postoperative Pain Management Anesth. Analg., September 1, 2008; 107(3): 1011 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Panchal, C. V. Damaraju, W. W. Nelson, D. J. Hewitt, and J. R. Schein System-Related Events and Analgesic Gaps During Postoperative Pain Management with the Fentanyl Iontophoretic Transdermal System and Morphine Intravenous Patient-Controlled Analgesia Anesth. Analg., November 1, 2007; 105(5): 1437 - 1441. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Brennan, D. B. Carr, and M. Cousins Pain Management: A Fundamental Human Right Anesth. Analg., July 1, 2007; 105(1): 205 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kotze, W. Hinton, D. C. G. Crabbe, and B. J. Carrigan Audit of epidural analgesia in children undergoing thoracotomy for decortication of empyema Br. J. Anaesth., May 1, 2007; 98(5): 662 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. W. Hutchison Challenges in acute post-operative pain management Am. J. Health Syst. Pharm., March 15, 2007; 64(6_Supplement_4): S2 - S5. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Nightingale, M. V. Knight, B. Higgins, and T. Dean Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection Br. J. Anaesth., March 1, 2007; 98(3): 380 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Power Fentanyl HCl iontophoretic transdermal system (ITS): clinical application of iontophoretic technology in the management of acute postoperative pain Br. J. Anaesth., January 1, 2007; 98(1): 4 - 11. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Motamed, F. Farhat, F. Remerand, J. Stephanazzi, A. Laplanche, and C. Jayr An Analysis of Postoperative Epidural Analgesia Failure by Computed Tomography Epidurography Anesth. Analg., October 1, 2006; 103(4): 1026 - 1032. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. I. Usichenko, H. Edinger, V. V. Gizhko, C. Lehmann, M. Wendt, and F. Feyerherd Low-Intensity Electromagnetic Millimeter Waves for Pain Therapy Evid. Based Complement. Altern. Med., June 1, 2006; 3(2): 201 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Cashman and S. J. Dolin Standards of care for PONV. Br. J. Anaesth., May 1, 2006; 96(5): 665 - 666. [Full Text] [PDF]
|
|
|
|
|
|
G. A. McLeod, K. Dell, C. Smith, and J. A. W. Wildsmith Measuring the quality of continuous epidural block for abdominal surgery Br. J. Anaesth., May 1, 2006; 96(5): 633 - 639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. de Medicis, J.-P. Tetrault, R. Martin, R. Robichaud, and L. Laroche A Prospective Comparative Study of Two Indirect Methods for Confirming the Localization of an Epidural Catheter for Postoperative Analgesia Anesth. Analg., December 1, 2005; 101(6): 1830 - 1833. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Dolin and J. N. Cashman Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritis, and urinary retention. Evidence from published data Br. J. Anaesth., November 1, 2005; 95(5): 584 - 591. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. McDonnell, J. Nicholl, and S. Read Exploring the impact of Acute Pain Teams (APTs) on patient outcomes using routine data: Can it be done? Journal of Research in Nursing, July 1, 2005; 10(4): 383 - 402. [Abstract] [PDF]
|
|
|
|
|
|
I. Power Recent advances in postoperative pain therapy Br. J. Anaesth., July 1, 2005; 95(1): 43 - 51. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Bucknall Review: a single dose of oral naproxen or naproxen sodium reduced acute postoperative pain in adults Evid. Based Nurs., April 1, 2005; 8(2): 53 - 53. [Full Text] [PDF]
|
|
|
|
|
|
P. E. Frasco, J. Sprung, and T. L. Trentman The Impact of the Joint Commission for Accreditation of Healthcare Organizations Pain Initiative on Perioperative Opiate Consumption and Recovery Room Length of Stay Anesth. Analg., January 1, 2005; 100(1): 162 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. H. Geerts, G. F. Pineo, J. A. Heit, D. Bergqvist, M. R. Lassen, C. W. Colwell, and J. G. Ray Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 338S - 400S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Cashman and S. J. Dolin Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data Br. J. Anaesth., August 1, 2004; 93(2): 212 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Seers Review: single dose, oral paracetamol reduces moderate to severe postoperative pain Evid. Based Nurs., July 1, 2004; 7(3): 84 - 84. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ahdieh, T. Ma, N. Babul, and D. Lee Efficacy of Oxymorphone Extended Release in Postsurgical Pain: A Randomized Clinical Trial in Knee Arthroplasty J. Clin. Pharmacol., July 1, 2004; 44(7): 767 - 776. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Powell, H. T. O. Davies, J. Bannister, and W. A. Macrae Rhetoric and reality on acute pain services in the UK: a national postal questionnaire survey Br. J. Anaesth., May 1, 2004; 92(5): 689 - 693. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Wu, B. M. Block, A. J. Rowlingson, S. S. Liu, A. R. Cowan, and J. A. Cowan Parenteral vs Epidural Analgesia for Postoperative Pain--Reply JAMA, March 10, 2004; 291(10): 1198 - 1198. [Full Text] [PDF]
|
|
|
|
|
|
H. Van Aken, L. Thys, L. Veekman, and H. Buerkle Assessing Analgesia in Single and Repeated Administrations of Propacetamol for Postoperative Pain: Comparison with Morphine After Dental Surgery Anesth. Analg., January 1, 2004; 98(1): 159 - 165. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Block, S. S. Liu, A. J. Rowlingson, A. R. Cowan, J. A. Cowan Jr, and C. L. Wu Efficacy of Postoperative Epidural Analgesia: A Meta-analysis JAMA, November 12, 2003; 290(18): 2455 - 2463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Z. Michel, M. K. Sanders, S. J. Dolin, and J. Cashman Effectiveness of acute postoperative pain management Br. J. Anaesth., September 1, 2003; 91(3): 448 - 449. [Full Text] [PDF]
|
|