INCIDENCE OF POSTOPERATIVE PAIN ON GENERA L SURGICAL WARDS - RESULTS WITH VARIOUS EVALUATION PROCEDURES

Knowledge of the incidence and significance of postoperative pain is e ssential for the establishment of effective pain treatment programmes. Detailed investigations on the incidence, severity and quality of pos toperative pain from the surgeon's perspective are scarce in German ho spitals. It was the aim of our study to investigate postoperative pain in general surgery under routine conditions. Patients and methods. A total of 168 patients scheduled for abdominal, vascular and orthopaedi c surgery were investigated in a prospective trial. Pain was assessed by means of a 100-point visual analogue scale (VAS), a 5-point verbal rating scale (VRS), the original version of the McGill Pain Questionna ire (MPQ) and the short form of the McGill Pain Questionnaire (SFMPQ). These were applied preoperatively and daily thereafter up to the 7th postoperative day. Patients were randomly assigned into two groups wit h different sequences of application of the instruments. The pain trea tment programme included intravenous analgesia with tramadol/metamizol (max. tramadol 400 mg + metamizol 5 g in any 24 h) after major surger y and additional administration of piritramide as needed (max. 60 mg/2 4 h i.v.). After minor surgery ibuprofen was routinely given for analg esia (3 x 500 mg). Results. All patients had pain on the days 1 and 2 postoperatively. The mean intensity of pain was 44 VAS points on day 1 and 6.8 points on day 7. The mean intensity of pain measured by the V RS on the 1st postoperative day was between ''mild'' and ''moderate''. The quality of pain showed a constant pattern concerning the mean sca le values of descriptors of each subgroup (sensory, evaluative, affect ive, mixed) for both the original and the short form of the McGill Pai n Questionnaire up to the 7th postoperative day. Sensory descriptors w ere reported more frequently than affective descriptors. Typical pain patterns were identified for different operations. After subtotal thyr oidectomy, for example, patients perceived a high intensity of pain of short duration. In contrast, patients still have a high intensity of pain up to 7 days after abdominal and rectal operations. Conclusions. We conclude from our results that patients perceive significant postop erative pain under current standardized pain treatment in our departme nt. Effective programmes for pain relief should take account of the di fferent patterns of pain after different operations, as identified in this study.