Preexisting Chronic Pain is Not Associated with Moderate-to-severe Acute Pain After Laparoscopic Cholecystectomy: a Prospective Cohort Study

Overview

Journal Pain Rep

Publisher Wolters Kluwer

Date 2024 Nov 15

PMID 39544228

Authors

Bishal Nepali

Asish Subedi

Krishna Pokharel

Ashish Ghimire

Jagat Narayan Prasad

Affiliations

Soon will be listed here.

Abstract

Introduction: We aimed to evaluate the relationship between preexisting chronic pain and acute postoperative pain after laparoscopic cholecystectomy (LC) and to identify predictors of acute postsurgery pain.

Methods: In this prospective cohort study, patients undergoing LC with general anesthesia were enrolled. The primary outcome was the incidence of moderate-to-severe pain during movement in the first 24 hours after surgery. Logistic regression analysed the association of perioperative risk factors with acute postoperative pain. Model performance was assessed using receiver operating characteristic curves (ROC), calibration belt plots, and 10-fold cross-validation.

Results: Of the 193 patients analysed, 49.74% experienced moderate-severe acute pain. Univariable analysis indicated that preoperative chronic pain increased the likelihood of acute postoperative pain (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.40-4.55). Risk factors identified in the multivariable analysis were higher preoperative pain intensity (OR, 1.28; 95% CI, 1-1.65), sleep disturbances (OR, 1.42; 95% CI, 1.24-1.61), intraoperative fentanyl supplementation (OR, 3.68; 95% CI, 1.48-9.12), incision extension for gallbladder retrieval (OR, 7.27; 95% CI, 1.58-33.39), and abdominal drain placement (OR, 6.09; 95% CI, 1.08-34.34). Dexamethasone use was associated with reduced pain (OR, 0.05; 95% CI, 0.004-0.74). The model demonstrated strong discrimination (ROC = 0.909) and good calibration (test statistic = 0.02; = 0.89). Cross-validation showed slightly lower accuracy (ROC = 0.896).

Conclusions: Preexisting chronic pain was not associated with acute postoperative pain following laparoscopic cholecystectomy. Significant predictors for acute pain included higher preoperative pain intensity, sleep disturbances, intraoperative fentanyl, incision extension, and abdominal drain placement, while dexamethasone use was associated with reduced pain.

References

Joshi S, Acharya K . Modification of Kuppuswamy's Socioeconomic Status Scale in the Context of Nepal, 2019. Kathmandu Univ Med J (KUMJ). 2019; 17(65):1-2. View

Santa Cruz Mercado L, Liu R, Bharadwaj K, Johnson J, Gutierrez R, Das P . Association of Intraoperative Opioid Administration With Postoperative Pain and Opioid Use. JAMA Surg. 2023; 158(8):854-864. PMC: 10267849. DOI: 10.1001/jamasurg.2023.2009. View

Sharma S, Palanchoke J, Reed D, Abbott J . Translation, cross-cultural adaptation and psychometric properties of the Nepali versions of numerical pain rating scale and global rating of change. Health Qual Life Outcomes. 2017; 15(1):236. PMC: 5715544. DOI: 10.1186/s12955-017-0812-8. View

Hah J, Cramer E, Hilmoe H, Schmidt P, McCue R, Trafton J . Factors Associated With Acute Pain Estimation, Postoperative Pain Resolution, Opioid Cessation, and Recovery: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2019; 2(3):e190168. PMC: 6484627. DOI: 10.1001/jamanetworkopen.2019.0168. View

Gramke H, de Rijke J, van Kleef M, Raps F, Kessels A, Peters M . The prevalence of postoperative pain in a cross-sectional group of patients after day-case surgery in a university hospital. Clin J Pain. 2007; 23(6):543-8. DOI: 10.1097/AJP.0b013e318074c970. View

Yu S, Xiong Y, Lu G, Xiong X . Effects of Preoperative Sleep Disorders on Anesthesia Recovery and Postoperative Pain in Patients Undergoing Laparoscopic Gynecological Surgery under General Anesthesia. Mediators Inflamm. 2022; 2022:7998104. PMC: 9779992. DOI: 10.1155/2022/7998104. View

Nattino G, Finazzi S, Bertolini G . A new calibration test and a reappraisal of the calibration belt for the assessment of prediction models based on dichotomous outcomes. Stat Med. 2014; 33(14):2390-407. DOI: 10.1002/sim.6100. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61(4):344-9. DOI: 10.1016/j.jclinepi.2007.11.008. View

Bisgaard T, Rosenberg J, Kehlet H . From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol. 2005; 40(11):1358-64. DOI: 10.1080/00365520510023675. View

10.

Friedrich S, Raub D, Teja B, Neves S, Thevathasan T, Houle T . Effects of low-dose intraoperative fentanyl on postoperative respiratory complication rate: a pre-specified, retrospective analysis. Br J Anaesth. 2019; 122(6):e180-e188. DOI: 10.1016/j.bja.2019.03.017. View

11.

van Boekel R, Bronkhorst E, Vloet L, Steegers M, Vissers K . Identification of preoperative predictors for acute postsurgical pain and for pain at three months after surgery: a prospective observational study. Sci Rep. 2021; 11(1):16459. PMC: 8361098. DOI: 10.1038/s41598-021-95963-y. View

12.

McMahon A, Russell I, Ramsay G, Sunderland G, Baxter J, ANDERSON J . Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery. 1994; 115(5):533-9. View

13.

Long D, Lihn A, Friedrich S, Scheffenbichler F, Safavi K, Burns S . Association between intraoperative opioid administration and 30-day readmission: a pre-specified analysis of registry data from a healthcare network in New England. Br J Anaesth. 2018; 120(5):1090-1102. DOI: 10.1016/j.bja.2017.12.044. View

14.

Schnabel A, Yahiaoui-Doktor M, Meissner W, Zahn P, Pogatzki-Zahn E . Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Rep. 2020; 5(4):e831. PMC: 7390596. DOI: 10.1097/PR9.0000000000000831. View

15.

Madni T, Leshikar D, Minshall C, Nakonezny P, Cornelius C, Imran J . The Parkland grading scale for cholecystitis. Am J Surg. 2017; 215(4):625-630. DOI: 10.1016/j.amjsurg.2017.05.017. View

16.

Kalkman J, Visser K, Moen J, Bonsel J, Grobbee E, Moons M . Preoperative prediction of severe postoperative pain. Pain. 2003; 105(3):415-423. DOI: 10.1016/S0304-3959(03)00252-5. View

17.

Gan T . Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10:2287-2298. PMC: 5626380. DOI: 10.2147/JPR.S144066. View

18.

Gerbershagen H, Pogatzki-Zahn E, Aduckathil S, Peelen L, Kappen T, van Wijck A . Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2013; 120(5):1237-45. DOI: 10.1097/ALN.0000000000000108. View

19.

Szental J, Webb A, Weeraratne C, Campbell A, Sivakumar H, Leong S . Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI®) monitoring: a randomized clinical trial. Br J Anaesth. 2014; 114(4):640-5. DOI: 10.1093/bja/aeu411. View

20.

Treede R, Rief W, Barke A, Aziz Q, Bennett M, Benoliel R . Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2018; 160(1):19-27. DOI: 10.1097/j.pain.0000000000001384. View