Genel Cerrahi Hastalarında Ameliyat Sonrası Ağrı Şiddeti ve Kurtarıcı Analjezik Uygulamasının Değerlendirilmesi: Prospektif Bir Kohort Çalışması

Öz

Amaç: Bu çalışma, elektif genel cerrahi hastalarında postoperatif ağrı şiddetini ve zamana bağlı kurtarıcı analjezik uygulama paternini incelemek ve bununla ilişkili faktörleri belirlemek amacıyla yapılmıştır. Gereç ve Yöntemler: Bu prospektif tanımlayıcı kohort çalışması, Şubat 2022- Ocak 2023 tarihleri arasında üçüncü basamak bir üniversite hastanesinde değerlendirilen toplam 369 elektif genel cerrahi hastasını kapsamaktadır. Ağrı şiddeti (Görsel Analog Skalası- VAS) ve kurtarıcı (ek) analjezik uygulamaları postoperatif 0-2, 3-4, 5-8, 9-12 ve 13-24. saatlerde kaydedildi. Ağrı yoğunluğu ve opioid kullanımı ile ilişkili demografik ve klinik faktörler analiz edildi. Sonuç: Ortalama ağrı şiddeti 0-2. saatlerden 13-24. saatlere doğru anlamlı şekilde azaldı (2.39 ± 1.75'e karşın 1.69 ± 2.17, p<0.001). Ağrı şiddeti, 0-2. saatlerde kadınlarda; 3-4. saatlerde ise yaşlı yetişkinlerde (≥65 yaş) ve kronik hastalığı olanlarda daha düşüktü. Erkek hastaların erken postoperatif dönemde opioid alma olasılığı daha yüksekti ve 3-4. saatlerde opioid kullanımı kronik hastalığı olmayan hastalarda daha fazlaydı. Tartışma: Postoperatif ilk 24 saat boyunca ağrı şiddeti azalırken, kurtarıcı analjezik uygulaması zamanla arttı. Kurtarıcı analjezik paternleri yaş, cinsiyet ve kronik hastalık durumundan etkilendi. Düşük ağrı skorları ağrı yönetiminin genel olarak yeterli olduğunu gösterse de artan kurtarıcı analjezik ihtiyacı rutin uygulamanın geliştirilmeye açık olduğunu işaret etmektedir. Bu bulgular, cerrahi hemşireliği uygulamasında yapılandırılmış ağrı değerlendirmesini, yeniden değerlendirmesini ve bireyselleştirilmiş, multimodal postoperatif ağrı yönetimini desteklemektedir.

Anahtar Kelimeler

• Postoperatif ağrı
• Kurtarıcı analjezi
• Genel cerrahi
• Cerrahi hemşireliği
• Ağrı yönetimi
• Analjezikler

Evaluation of Postoperative Pain Severity and Rescue Analgesic Administration in General Surgery Patients: A Prospective Cohort Study

Öz

Aim: This study was conducted to examine postoperative pain severity and the time-dependent pattern of rescue analgesic administration, and to identify factors associated with this pattern in elective general surgery patients. Materials and Methods: This prospective descriptive cohort study included a total of 369 elective general surgery patients evaluated between February 2022 and January 2023 in a tertiary university hospital. Pain severity (Visual Analogue Scale) and rescue (additional) analgesic administration were recorded at postoperative 0-2, 3-4, 5-8, 9-12, and 13-24 hours. Demographic and clinical factors associated with pain intensity and opioid use were analyzed. Results: Mean pain severity significantly decreased from 0-2 hours to 13-24 hours (2.39 ± 1.75 vs. 1.69 ± 2.17, p<0.001). Pain was lower among women at 0-2 hours and among older adults (≥65 years) and those with chronic disease at 3-4 hours. Male patients were more likely to receive opioids across the early postoperative period, and opioid use at 3-4 hours was higher in patients without chronic disease. Conclusions: During the first 24 postoperative hours, pain severity decreased while rescue analgesic administration increased over time. Rescue analgesic patterns were influenced by age, sex, and chronic disease status. Although low pain scores suggest generally adequate pain management, the increasing need for rescue analgesia indicates that routine practice is open to improvement. These findings support structured pain assessment, reassessment and individualized, multimodal postoperative pain management in surgical nursing practice.

Anahtar Kelimeler

• Postoperative pain
• Rescue analgesia
• General surgery
• Surgical nursing
• Pain management
• Analgesics

Kaynakça

1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. Crossref
2. Cooney MF. Postoperative pain management: Clinical practice guidelines. J Perianesth Nurs. 2016;31(5):445-451. Crossref
3. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: Results from a US national survey. Curr Med Res Opin. 2014;30(1):149-160. Crossref
4. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934-944. Crossref
5. Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: A combined systematic review and meta-analysis. Anesth Analg. 2012;115(2):428-442. Crossref
6. Pagé MG, Katz J, Escobar EMR, Lutzky-Cohen N, Curtis K, Fuss S, et al. Distinguishing problematic from nonproblematic postsurgical pain: A pain trajectory analysis after total knee arthroplasty. Pain. 2015;156(3):460-468. Crossref
7. Beloeil H, Sulpice L. Peri-operative pain and its consequences. J Visc Surg. 2016;153(6S):S15-S18. Crossref
8. Argoff CE. Recent management advances in acute postoperative pain. Pain Pract. 2014;14(5):477-487. Crossref

9. Coluzzi F, Pergolizzi J, Raffa RB, Mattia C. The unsolved case of "bone-impairing analgesics": The endocrine effects of opioids on bone metabolism. Ther Clin Risk Manag. 2015;11:515-523. Crossref
10. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131-157. Crossref
11. Baker DW. History of The Joint Commission's Pain Standards: Lessons for Today's Prescription Opioid Epidemic. JAMA. 2017;317(11):1117-1118. Crossref
12. Özveren H, Faydalı S, Gülnar E, Faydalı Dokuz H. Attitude and applications of nurses to evaluate pain. J Contemp Med. 2018;8(1):60-66. Crossref
13. Erden S, Arslan S, Deniz S, Kaya P, Gezer D. A review of postoperative pain assessment records of nurses. Appl Nurs Res. 2017;38:1-4. Crossref
14. Sierżantowicz R, Lewko J, Bitiucka D, Lewko K, Misiak B, Ładny JR. Evaluation of pain management after surgery: An observational study. Medicina (Kaunas). 2020;56(2):65. Crossref
15. van Boekel RL, Steegers MA, Verbeek-van Noord I, van der Sande R, Vissers KC. Acute pain services and postsurgical pain management in the Netherlands: A survey. Pain Pract. 2015;15(5):447-454. Crossref
16. Kaafarani HM, Han K, El Moheb M, Kongkaewpaisan N, Jia Z, El Hechi MW, et al. Opioids after surgery in the United States versus the rest of the world: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study. Ann Surg. 2020;272(6):879-886. Crossref
17. Gordon DB, de Leon-Casasola OA, Wu CL, Sluka KA, Brennan TJ, Chou R. Research gaps in practice guidelines for acute postoperative pain management in adults: Findings from a review of the evidence for an American Pain Society Clinical Practice Guideline. J Pain. 2016;17(2):158-166. Crossref
18. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. Crossref
19. Aydın A, Araz A, Aslan A. Visual analog scale and emotion lattice: Adaptation to our culture. Turk Psychol Art. 2011;14(27):1-13.
20. Begum MR, Hossain MA. Validity and reliability of visual analogue scale (VAS) for pain measurement. J Med Case Rep Rev. 2019;2(11):394-402.
21. • Mitra S, Carlyle D, Kodumudi G, Kodumudi V, Vadivelu N. New advances in acute postoperative pain management. Curr Pain Headache Rep. 2018;22(5):35. Crossref
22. Fink RM, Brant JM. Complex cancer pain assessment. Hematol Oncol Clin North Am. 2018;32(3):353-369. Crossref
23. Bozer C, Erden S. Analysis of nurses' pain assessment records in colorectal surgery. Online Turk J Health Sci. 2024;9(2):105-111. Crossref
24. Zaslansky R, Rothaug J, Chapman CR, Bäckström R, Brill S, Fletcher D, et al. PAIN OUT: The making of an international acute pain registry. Eur J Pain. 2015;19(4):490-502. Crossref
25. Lindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. Int J Colorectal Dis. 2020;35(7):1265-1272. Crossref
26. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019;43(3):659-695. Crossref
27. Simpson JC, Bao X, Agarwala A. Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols. Clin Colon Rectal Surg. 2019;32(2):121-128. Crossref
28. Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg. 2003;97(5):1464-1468. Crossref
29. Gagliese L, Gauthier LR, Macpherson AK, Jovellanos M, Chan VW. Correlates of postoperative pain and intravenous patient-controlled analgesia use in younger and older surgical patients. Pain Med. 2008;9(3):299-314. Crossref
30. Zhang H, Yang YT, Jiang L, Xu X, Zhang J, Zhang L. Predicting risk factors for acute pain after hepatobiliary and pancreatic surgery: an observational case control study. BMJ Open. 2024;14(8):e078048. Crossref
31. Saari TI, Ihmsen H, Neuvonen PJ, Olkkola KT, Schwilden H. Oxycodone clearance is markedly reduced with advancing age: a population pharmacokinetic study. Br J Anaesth. 2012;108(3):491-498. Crossref
32. Yezierski RP. The effects of age on pain sensitivity: preclinical studies. Pain Med. 2012;13(Suppl 2):S27-S36. Crossref
33. van Dijk JF, Zaslansky R, van Boekel RL, Cheuk-Alam JM, Baart SJ, Huygen FJ, et al. Postoperative pain and age: A Retrospective cohort association study. Anesthesiology. 2021;135(6):1104-1119. Crossref
34. Koh JC, Song Y, Kim SY, Park S, Ko SH, Han DW. Postoperative pain and patient-controlled epidural analgesia-related adverse effects in young and elderly patients: a retrospective analysis of 2,435 patients. J Pain Res. 2017;10:897-904. Crossref
35. Köse Tosunöz İ, Yurtseven Ş, Deniz Doğan S. Perceptions of Nurses Regarding Opioid Administration: A cross-sectional study. Pain Manag Nurs. 2024;25(4):363-368. Crossref
36. Cooley R, Venkatachalam AM, Aguilera V, Olson DM, Stutzman SE. A Qualitative Study of Nurses' Perceptions of Narcotic Administration after Subarachnoid Hemorrhage. Pain Manag Nurs. 2022;23(2):151-157. Crossref
37. Yin HH, Tse MM, Wong FK. Systematic review of the predisposing, enabling, and reinforcing factors which influence nursing administration of opioids in the postoperative period. Jpn J Nurs Sci. 2015;12(4):259-275. Crossref
38. Al-Sayaghi KM, Fadlalmola HA, Aljohani WA, Alenezi AM, Aljohani DT, Aljohani TA, et al. Nurses' knowledge and attitudes regarding pain management and management in Saudi Arabia. Healthcare (Basel). 2022;10(3):528. Crossref