Postoperative pain after colorectal surgery
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ORIGINAL ARTICLE
Postoperative pain after colorectal surgery Margaretha Lindberg 1 & Oskar Franklin 1 & Johan Svensson 1,2 & Karl A. Franklin 1 Accepted: 4 April 2020 # The Author(s) 2020
Abstract Purpose Postoperative pain is a keystone in perioperative programs, as pain negatively impacts recovery. This study aimed to evaluate pain after elective colorectal surgery and to identify risk factors for postoperative pain. Methods This prospective cohort study comprised consecutive patients undergoing elective colorectal surgery within the Enhanced Recovery after Surgery (ERAS) perioperative program between March 2013 and April 2017. The numeric rating scale (NRS) was used to estimate maximum pain. Logistic regression was used to model associations with the type of surgery, age, gender, and comorbidities. Results The cohort comprised 434 of 459 eligible patients. On the day of surgery to postoperative day 3, 50–64% of patients reported moderate to severe pain (NRS 4–10). Postoperative pain was similar for open and minimally invasive rectal surgery, while patients undergoing minimally invasive colonic surgery experienced more pain on the day of surgery and less pain on postoperative days 2 and 3 vs. open colonic surgery. Younger age was associated with more pain every postoperative day and by 0.7 NRS/10 years (95% CI 0.5–0.9, P < 0.001) on the day of surgery, while having diabetes type 2 was associated with less postoperative pain by − 1.3 NRS (95% CI − 2.4 to − 0.2) on the day of surgery. Conclusions The majority, and young patients in particular, experience moderate to severe pain after open and minimally invasive colorectal surgery, despite following ERAS perioperative program. There is a need for effective and individualized analgesia after colorectal surgery, since the individual pain response to surgery is difficult to predict. Keywords Postoperative pain . Colorectal surgery . Numeric rating scale . Minimally invasive surgery . Risk factors
Introduction Pain after surgery is a major concern for patients, especially when it is undermanaged [1]. Postoperative pain delays mobilization and oral intake after surgery, as well as increasing the risk of chronic pain after surgery [2, 3]. Colorectal cancer is the third most common cancer, with 1.2 million new cases a year, the majority of which undergo surgery [4]. A numeric rating scale (NRS) scores pain from 0 to 10. A tolerable threshold for pain is estimated at NRS = 3, and patients scoring NRS > 4, i.e., moderate and severe pain, are therefore in need of extra analgesia [5, 6]. Reported risk factors for increased postoperative pain in general include a high * Karl A. Franklin [email protected] 1
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
2
Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
American Society of Anesthesiologist classification (ASA class), young age, preoperative pain, female gender, and the anatomic location of surgery [7–12]. Ther
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