Abstract
Background content
The goal of postoperative pain management is to facilitate the patient's return to
normal activity and decrease the detrimental effects of acute postsurgical pain. In
order to provide more tailored and successful pain treatment, it is necessary to identify
individuals who are at a high risk of experiencing severe postoperative pain. The
most precise way to assess pain sensitivity is by determining the pressure pain threshold
and heat pain threshold by objective methods using a digital algometer and neurotouch
respectively.
Purpose
The primary aim of the study is to assess the preoperative pain threshold and its
influence on postoperative pain severity and analgesics requirements in patients undergoing
lumbar fusion surgeries
Study Design
Prospective, observational study
Patient sample
60 patients requiring a single-level lumbar fusion surgery
Outcome measures
Postoperative pain intensity and the amount of postoperative analgesics consumption.
Methods
In our patients, preoperative pain sensitivity was assessed by pressure pain threshold
measurements with the help of a digital algometer, and heat pain threshold using a
neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used
in all our patients to determine pain sensitivity. Preoperative psychosocial and functional
assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry
disability index (ODI) respectively. Preoperative visual analog scale (VAS) score
was determined at three instances of needle prick (phlebotomy, glucometer blood sugar,
intradermal antibiotic test dose) and during the range of movements of the lumbar
spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements
were recorded in all of these patients from day 0 to day 3.
Results
The average age of the patients was 51.11 ± 13.467 years and 70% were females. Females
had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients
with higher HADS (p<0.0016), higher PSQ (p<0.001), higher ODI scores(p<0.001), and
female gender significantly correlated with a lower algometer average indicating high
pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch
scores showed lower postoperative VAS scores at different time periods. Preoperative
VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered
as independent variables (predictors) for post-operative VAS at 6 hr period. By the
multivariate analysis, factors like preoperative VAS scores, algometer average scores,
and HADS scores were statistically significant (P<0.05). There was a significant correlation
between algometer average scores (p<0.001) with the breakthrough analgesics.
Conclusion
Preoperative assessment of pain sensitivity can predict postoperative analgesic requirements
and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively
and also receive a better titration of analgesics perioperatively.
Keywords
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Article info
Publication history
Accepted:
May 18,
2023
Received in revised form:
April 18,
2023
Received:
January 17,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
