Biomedical subjects

D Janet Pavlin

Publications and source records attributed to D Janet Pavlin.

4 recordsLinked to original sources

PubMed2004

A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit.

STUDY OBJECTIVE: To determine the significance of pain and other symptoms on the recovery process after ambulatory surgery, by surveying pain, analgesic use, and related aspects of recovery in the first 48 hours after discharge from an ambulatory surgery unit. DESIGN: Prospective, observational, surveillance survey. PATIENTS: A total of 175 patients were studied, 25 in each of 6 surgical groups including knee arthroscopy, hernia repair, pelvic laparoscopy, transvaginal surgery, surgery for breast disease, and plastic surgery. INTERVENTIONS: Patients were treated in a manner considered normal or "usual" for the surgeon and the institution. MEASUREMENTS: Pain scores (0 to 10), analgesic use, symptom frequency, symptom distress scores, activity level (% of normal), and satisfaction scores were obtained by telephone interview 24 and 48 hours after discharge. Group means (+/-SE), proportions and correlations between predictor variables were determined in relevant groups. MAIN RESULTS: The response rate to postoperative telephone calls was 89% at 24 hours, and 82% at 48 hours. At 24 hours, maximum pain was >3/10 in 60%, or >7/10 in 20% of patients. Pain prevented or disrupted sleep in 46% of patients. Activity level was reduced to 33% of normal at 24 hours; pain was reported as the primary or secondary reason for limiting activity by 54% of patients. At 24 hours, average pain scores correlated inversely with activity (r = -0.49, p = or < 0.0001); least pain score correlated best with satisfaction (r = 0.03, p = 0.0005). CONCLUSIONS: Improvements in pain therapy after discharge appear warranted to provide more consistent pain relief, and hasten return to normal activity.

Adult↗

PubMed2003

Preincisional treatment to prevent pain after ambulatory hernia surgery.

UNLABELLED: We designed this study as a randomized comparison of postoperative pain after inguinal hernia repair in patients treated with triple preincisional analgesic therapy versus standard care. Triple therapy consisted of a nonsteroidal antiinflammatory, a local anesthetic field block, and an N-methyl-D-aspartate inhibitor before incision. The treatment group (n = 17) received rofecoxib, 50 mg PO, a field block with 0.25% bupivacaine/0.5% lidocaine, and ketamine 0.2 mg/kg IV before incision; controls (n = 17) received a placebo PO before surgery. The anesthetic protocol was standardized. Postoperative pain was treated by fentanyl IV and oxycodone 5 mg/acetaminophen 325 mg PO as required for pain. Pain scores (0-10) and analgesic were recorded for the first 7 days after surgery. Pain scores were 47% lower in the treatment group before discharge (3.1 +/- 0.6 versus 5.9 +/- 0.6, P = 0.0026) (mean +/- SE) and 18% less in the first 24 h after discharge (5.6 +/- 0.4 versus 6.8 +/- 0.5, P = 0.05); oral analgesic use was 34% less in the treatment group (4.6 +/- 0.8 doses versus 7.1 +/- 0.7 doses, P = 0.02) in the first 24 h after surgery. We conclude that triple preincisional therapy diminishes pain and analgesic use after outpatient hernia repair, and encourage further evaluation of this technique. IMPLICATIONS: Outpatients undergoing inguinal hernia repair under general anesthesia report moderate-to-severe pain after surgery. Triple preincisional therapy that included rofecoxib, 50 mg PO, ketamine, 0.2 mg/kg IV, and local anesthetic field block reduced pain scores and analgesic use in the first 24 h after discharge.

Adolescent↗

PubMed2002

Pain as a factor complicating recovery and discharge after ambulatory surgery.

UNLABELLED: Pain complicates the recovery process after ambulatory surgery. We surveyed 175 ambulatory surgery patients to determine pain severity, analgesic use, relationship of pain to duration of recovery, and the relative importance of various factors to predicting these outcomes. Multivariate regression analysis was used to determine unique contributions of predictor variables to outcome. Surgical procedures included knee arthroscopy (n = 50), hernia surgery (n = 25), pelvic laparoscopy (n = 25), transvaginal uterine surgery (n = 25), surgery for breast disease (n = 25), and plastic surgery (n = 25). Maximum pain (on a scale of 0-10) varied from 2.3 +/- 0.5 to 5.1 +/- 0.5 (mean +/- SE), depending on surgical procedure; 24% of patients had pain scores of > or =7, and 24% were delayed in Phase 1 recovery by pain. Pain scores were lower if local anesthetic or ketorolac was administered intraoperatively (22% and 26% respectively). Fentanyl dose during recovery correlated with maximum pain scores; fentanyl dose was 42% less if ketorolac was administered intraoperatively. In females, the recovery fentanyl dose increased in proportion to the intraoperative fentanyl dose. The maximum pain score was predictive of total recovery time (135, 172, and 212 min of recovery for maximum pain scores of 0-3, 4-6, and 7-10, respectively; P < 0.001). We conclude that improvements in pain therapy are warranted to improve patient comfort and to expedite recovery. IMPLICATIONS: Moderate to severe pain is common after ambulatory surgery and is a frequent cause of delayed discharge. Postoperative pain, opioid-related side effects, and time to discharge were less when nonsteroidal antiinflammatory drugs or local anesthetics were used intraoperatively to prevent pain before patient awakening.

Adult↗

PubMedDate not supplied

Catastrophizing: a risk factor for postsurgical pain.

OBJECTIVE: This research was designed to test the hypothesis that presurgery "catastrophizing" would predict postsurgical pain and postsurgical analgesic consumption. METHODS: A sample of 48 individuals who underwent anterior cruciate ligament repair participated in the study. All participants completed the Pain Catastrophizing Scale (described by Sullivan et al in 1995) prior to surgery. Measures of pain (pain scores on a scale of 0-10) were obtained in the postanesthetic care unit, as well as 1, 2, and 7 days after surgery. Opioid and nonopioid analgesic consumption was tabulated while patients were in the hospital and after discharge. RESULTS: Results showed that the Pain Catastrophizing Scale was a significant predictor of acute postsurgical pain in the postanesthetic care unit (r = 0.48, P = 0.004 for maximum pain in the postanesthetic care unit). Maximum pain ratings in patients with high Pain Catastrophizing Scale scores (> median of 13) were 33% to 74% higher numerically than in patients with low Pain Catastrophizing Scale scores (< or = median), and the duration of moderate-severe pain (>3/10) was more prolonged (45 minutes versus 28 minutes in patients with high and low Pain Catastrophizing Scale scores, respectively; P < 0.05). The Pain Catastrophizing Scale was also predictive of pain with activity at 24 hours (r = 0.65 for pain on walking, P < or = 0.0001). The Pain Catastrophizing Scale did not predict postoperative analgesic use. CONCLUSION: The pattern of findings suggests that high catastrophizing scores may be a risk factor for heightened pain following surgery. Clinical and theoretical implications of the findings are addressed.

Adolescent↗