Presentation Outline ICHP Annual Meeting September 13-15

Impact of Postoperative Pain
• Pilot prospective cohort study
• Purpose was to describe postoperative pain and health‐related QOL, and functioning
1 month after hospital discharge
• Participants underwent radical prostatectomy (RP), total hip replacement (THR), or
total knee replacement (TKR), and completed the SF‐36 and questions from the
Treatment Outcomes of Pain Survey (TOPS) 4 weeks after leaving the hospital
– N = 30 ( RP = 15, TKR = 8, THR = 7) )
• Postoperative pain interfered with patient's ability to participate in desired activities
(42.9% RP, 28.6% THR, 100% TKR), ability to sleep (21.4% RP, 71.4% THR, 75% TKR),
and sexual functioning (50% RP, 28.6% THR, 25% TKR). During the first month after
surgery, postop pain contributed to diminished health‐related QOL and interfered
with activities important to patients. Mean SF‐36 scale scores in each surgical group
were lower than US norms for physical functioning, physical roles, bodily pain,
vitality and social functioning
Strassels SA, McNicol E, Wagner AK, et al. Persistent postoperative pain, health‐related quality of life, and functioning 1
month after hospital discharge. Acute Pain. 2004; 6(3):95‐104.
Opioid Adverse Events
• Historically, opioid monotherapy primary treatment of
postoperative pain
• 24 –48 hours postoperatively: morphine or hydromorphone
PCA followed by oral hydrocodone, morphine, or oxycodone
• In a systematic review of several randomized controlled trials
analyzing opioid‐associated ADEs in postop patients, more than
30% of patients reported GI ADEs
– Most common: vomiting, constipation, and ileus
– Most severe ADEs reported: sedation and resp depression
Oderda GM, Said Q, Evans RS, et al. Opioid‐related adverse drug events in surgical hospitalizations: impact
on costs and length of stay. Ann Pharmacother. 2007;41(3):400‐406.
Wheeler M, Oderda GM, Ashburn MA, el al. Adverse events associated with postoperative opioid analgesia:
a systemic review. J Pain. 2002;3(3):159‐180.
Multimodal Analgesia
Kehlet H, Dahl JB. Anesth Analg. 1993;77:1048‐1056.
Active Learning Assessment
POLL
1. How many of you have had an inpatient or outpatient
surgical procedure in your lifetime?
2. How many of you have experienced pain following the
procedure?
3. How many of you have experienced one of the negative
clinical outcomes following the procedure?
4. How many of you have missed work or school following the
procedure?
Multimodal Analgesia
• Use of different classes of analgesics that employ different
pathways AND receptors to provide pain relief
• Ideal components of multimodal analgesia include:
‐ Agents with ability to modulate ≥ mechanism of pain transmission
‐ Agents with an acceptable safety profile
‐ Availability of an analgesic in a non‐oral formulation
• Multimodal analgesia includes the use of local and systemic
pharmaceutical agents in addition to perineural blockade and
regional anesthesia
White PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs. 2008;
9(1):76‐82.
Joshi GP. Multimodal analgesia techniques and postoperative rehabilitation. Anesthesiol Clin North Am.
2005;23(1):185‐202.
WHO Pain Ladder
Adapted from World Health Organization. Cancer Pain Relief and Palliative Care, Report of a WHO
Expert Committee. Geneva: World Health Organization; 1990.
8/29/2012
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