Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management_West China Medical Journal

Authors：

CHEN Wei ¹ , HUANG Mingjun ² ,  DAI Yan ²

1. Day Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Day Surgery Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

DAI Yan, Email: 1846703501@qq.com

Keywords：

Pain; influencing factors; day surgery; multimodal pain management

DOI：

10.7507/1002-0179.202012272

Video：

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Objective To understand the incidence and severity of postoperative acute pain in patients undergoing day surgery, and to explore the influencing factors of moderate to severe pain after surgery, so as to provide a reference for pain management in day surgery. Methods Convenience sampling method was used to select patients undergoing day surgery under multi-modal pain management in West China Hospital of Sichuan University between April and August 2020, and the general conditions, surgical conditions, and postoperative pain of the patients were investigated. According to the degree of postoperative pain, patients were divided into mild pain group and moderate to severe pain group. Logistic regression analysis was used to explore the influencing factors of postoperative pain in the two groups. Results A total of 509 patients were finally included, of which 69 patients presented with moderate to severe pain. Logistic regression analysis showed that patient age [odds ratio (OR)=0.970, 95% confidence interval (CI) (0.946, 0.993), P=0.012], pain threshold [OR=1.348, 95%CI (1.048, 1.734), P=0.020] and postoperative drainage tube [OR=2.752, 95%CI (1.090, 6.938), P=0.017] were the influencing factors of moderate to severe pain after surgery. Conclusion Under multimodal pain management, the incidence of moderate to severe pain in day surgery patients is low, and medical staff should further strengthen pain management from the factors affecting pain to reduce the incidence of moderate to severe pain after surgery.

Citation： CHEN Wei, HUANG Mingjun, DAI Yan. Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management. West China Medical Journal, 2022, 37(2): 208-213. doi: 10.7507/1002-0179.202012272 Copy

1.	Grant MC, Yang D, Wu CL, et al. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg, 2017, 265(1): 68-79.
2.	祝胜美, 刘甬民. 日间手术患者术后镇痛管理. 现代实用医学, 2019, 31(2): 141-144.
3.	黑子清, 靳三庆, 李雅兰, 等. 成人术后急性疼痛 PCIA 治疗规范化管理建议. 临床麻醉学杂志, 2018, 34(2): 187-190.
4.	Campagna S, Antonielli D'Oulx MD, Paradiso R, et al. Postoperative pain, an unmet problem in day or overnight italian surgery patients: a prospective study. Pain Res Manag, 2016, 2016: 6104383.
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7.	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计. 中华护理杂志, 2010, 45(4): 378-380.
8.	张磊, 王小成, 赵晓燕, 等. 四川大学华西医院日间手术临床路径管理基本规范. 华西医学, 2019, 34(2): 150-154.
9.	American Society of Anesthesiologists. New classification of physical status. Anesthesiology, 1963, 24(1): 111.
10.	Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs, 1988, 14(1): 9-17.
11.	Zung WW. A rating instrument for anxiety disorders. Psychosomatics, 1971, 12(6): 371-379.
12.	Soldatos CR, Dikeos DG, Paparrigopoulos TJ. The diagnostic validity of the Athens Insomnia Scale. J Psychosom Res, 2003, 55(3): 263-267.
13.	Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res, 2000, 48(6): 555-560.
14.	Apfelbaum JL, Chen C, Mehta SS, et a1. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg, 2003, 97(2): 534-540.
15.	McGrath B, Elgendy H, Chung F, et a1. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5, 703 patients. Can J Anaesth, 2004, 51(9): 886-891.
16.	Beauregard L, Pomp A, Choinière M. Severity and impact of pain after day-surgery. Can J Anaesth, 1998, 45(4): 304-311.
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18.	张海静, 刘俐惠, 周茁, 等. 围术期患者多学科疼痛管理的影响因素分析研究. 中国全科医学, 2019, 22(29): 3561-3564,3569.
19.	陈丹丹, 乔婷婷, 郑蔚, 等. 胃肠道肿瘤患者首次辅助化疗后症状群的调查研究. 中国全科医学, 2016, 19(26): 3215-3218.
20.	王超. 早期非小细胞肺癌患者肺叶切除术后急慢性疼痛的危险因素分析. 北京市结核病胸部肿瘤研究所, 2017: 29.
21.	张燕泉, 伍洪. 压痛阈值监测仪. 中国医疗器械杂志, 2002(1): 63-64.
22.	彭慧娟, 陶勇, 叶京英, 等. 综合护理干预对缓解胸腔闭式引流术后患者不良情绪及疼痛的作用. 世界最新医学信息文摘, 2019, 19(84): 292-293.
23.	李云柯, 倪逸倩. 品管圈活动降低留置胸管患者的疼痛发生率分析. 山西医药杂志, 2018, 47(19): 2380-2382.
24.	营晓, 张海燕, 路潜. 术后机械通气患者吸痰操作疼痛现状及影响因素研究. 中华护理杂志, 2018, 53(5): 537-542.
25.	王金平. 睡眠对乳腺癌术后急慢性疼痛的影响及相关炎性因子的研究. 济南: 山东大学, 2020: 27.
26.	Alabas OA, Tashani OA, Tabasam G, et al. Gender role affects experimental pain responses: a systematic review with meta-analysis. Eur J Pain, 2012, 16(9): 1211-1223.
27.	张享, 王鑫, 李爽, 等. 性别对疼痛影响机制的研究进展. 中国实验诊断学, 2017, 21(7): 1294-1296.

1. Grant MC, Yang D, Wu CL, et al. Impact of enhanced recovery after surgery and fast track surgery pathways on healthcare-associated infections: results from a systematic review and meta-analysis. Ann Surg, 2017, 265(1): 68-79.
2. 祝胜美, 刘甬民. 日间手术患者术后镇痛管理. 现代实用医学, 2019, 31(2): 141-144.
3. 黑子清, 靳三庆, 李雅兰, 等. 成人术后急性疼痛 PCIA 治疗规范化管理建议. 临床麻醉学杂志, 2018, 34(2): 187-190.
4. Campagna S, Antonielli D'Oulx MD, Paradiso R, et al. Postoperative pain, an unmet problem in day or overnight italian surgery patients: a prospective study. Pain Res Manag, 2016, 2016: 6104383.
5. 刘洋, 李志超, 马洪升. 四川大学华西医院日间手术患者延迟出院原因分析. 中国循证医学杂志, 2016, 16(4): 383-386.
6. 国家卫生健康委三级公立医院绩效考核工作领导小组. 国家三级公立医院绩效考核操作手册(2020 版). (2020-06-09)[2020-12-24]. http://www.nhc.gov.cn/yzygj/s7659/202006/7912483be2784e2ca08a9ea4628369b8/files/01e1771db4504e799d5c302dc99b93f4.pdf.
7. 倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计. 中华护理杂志, 2010, 45(4): 378-380.
8. 张磊, 王小成, 赵晓燕, 等. 四川大学华西医院日间手术临床路径管理基本规范. 华西医学, 2019, 34(2): 150-154.
9. American Society of Anesthesiologists. New classification of physical status. Anesthesiology, 1963, 24(1): 111.
10. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs, 1988, 14(1): 9-17.
11. Zung WW. A rating instrument for anxiety disorders. Psychosomatics, 1971, 12(6): 371-379.
12. Soldatos CR, Dikeos DG, Paparrigopoulos TJ. The diagnostic validity of the Athens Insomnia Scale. J Psychosom Res, 2003, 55(3): 263-267.
13. Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res, 2000, 48(6): 555-560.
14. Apfelbaum JL, Chen C, Mehta SS, et a1. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg, 2003, 97(2): 534-540.
15. McGrath B, Elgendy H, Chung F, et a1. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5, 703 patients. Can J Anaesth, 2004, 51(9): 886-891.
16. Beauregard L, Pomp A, Choinière M. Severity and impact of pain after day-surgery. Can J Anaesth, 1998, 45(4): 304-311.
17. Rawal N. Analgesia for day-case surgery. Br J Anaesth, 2001, 87(1): 73-87.
18. 张海静, 刘俐惠, 周茁, 等. 围术期患者多学科疼痛管理的影响因素分析研究. 中国全科医学, 2019, 22(29): 3561-3564,3569.
19. 陈丹丹, 乔婷婷, 郑蔚, 等. 胃肠道肿瘤患者首次辅助化疗后症状群的调查研究. 中国全科医学, 2016, 19(26): 3215-3218.
20. 王超. 早期非小细胞肺癌患者肺叶切除术后急慢性疼痛的危险因素分析. 北京市结核病胸部肿瘤研究所, 2017: 29.
21. 张燕泉, 伍洪. 压痛阈值监测仪. 中国医疗器械杂志, 2002(1): 63-64.
22. 彭慧娟, 陶勇, 叶京英, 等. 综合护理干预对缓解胸腔闭式引流术后患者不良情绪及疼痛的作用. 世界最新医学信息文摘, 2019, 19(84): 292-293.
23. 李云柯, 倪逸倩. 品管圈活动降低留置胸管患者的疼痛发生率分析. 山西医药杂志, 2018, 47(19): 2380-2382.
24. 营晓, 张海燕, 路潜. 术后机械通气患者吸痰操作疼痛现状及影响因素研究. 中华护理杂志, 2018, 53(5): 537-542.
25. 王金平. 睡眠对乳腺癌术后急慢性疼痛的影响及相关炎性因子的研究. 济南: 山东大学, 2020: 27.
26. Alabas OA, Tashani OA, Tabasam G, et al. Gender role affects experimental pain responses: a systematic review with meta-analysis. Eur J Pain, 2012, 16(9): 1211-1223.
27. 张享, 王鑫, 李爽, 等. 性别对疼痛影响机制的研究进展. 中国实验诊断学, 2017, 21(7): 1294-1296.

West China Medical Journal

Analysis of the influencing factors of postoperative pain in day surgery patients under multimodal pain management

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