Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 9;10(3):e101669.
doi: 10.5812/aapm.101669. eCollection 2020 Jun.

Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery

Ina Callebaut #  1   2 , Steffe Jorissen #  1 , Caroline Pelckmans  1 , Noor Berends  1 , Martijn Droogmans  3 , Maxime van Rossum  1 , Marijke Nulens  1 , Bjorn Stessel  1   2
Affiliations

Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery

Ina Callebaut et al. Anesth Pain Med. .

Abstract

Background: Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting.

Objectives: The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery.

Methods: The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4.

Results: Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent.

Conclusions: Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.

Keywords: Ambulatory Surgery; Postoperative Pain; Treatment Adherence.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interests: No conflict of interest is declared.

Figures

Figure 1.
Figure 1.. Study set up. NRS: numerical rating scale, POD: postoperative day.
Figure 2.
Figure 2.. Study flow diagram. LOFU: loss to follow-up, POD: postoperative day
Figure 3.
Figure 3.. Average pain (A), pain at movement (B) and pain at rest (C) reported by patients undergoing hemorrhoid surgery, inguinal hernia repair, knee or shoulder arthroscopy. Mean and standard deviation NRS pain ratings at various fixed time points are shown.
See this image and copyright information in PMC

References

    1. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. DHHS Publication; 2009. - PubMed
    1. Stessel B, Boon M, Joosten EA, Ory JP, Evers S, van Kuijk SM, et al. Metamizole versus ibuprofen at home after day surgery: study protocol for a randomised controlled trial. Trials. 2016;17(1):471. doi: 10.1186/s13063-016-1586-8. - DOI - PMC - PubMed
    1. Stessel B, Fiddelers AA, Marcus MA, van Kuijk SM, Joosten EA, Peters ML, et al. External Validation and Modification of a Predictive Model for Acute Postsurgical Pain at Home After Day Surgery. Clin J Pain. 2017;33(5):405–13. doi: 10.1097/AJP.0000000000000413. - DOI - PMC - PubMed
    1. Gramke HF, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Sommer M, et al. Predictive factors of postoperative pain after day-case surgery. Clin J Pain. 2009;25(6):455–60. doi: 10.1097/AJP.0b013e31819a6e34. - DOI - PubMed
    1. Wu CL, Berenholtz SM, Pronovost PJ, Fleisher LA. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology. 2002;96(4):994–1003. doi: 10.1097/00000542-200204000-00030. - DOI - PubMed

LinkOut - more resources