Tinker Ready

October 23, 2017

BOSTON — Patients overestimate the amount postoperative pain they will experience after surgery, according to an abstract presented October 21 here at Anesthesiology 2017 from the American Society of Anesthesiologists.

"As a whole, post-op pain continues to be poorly managed," said Amir C. Dayan, MD, an instructor of anesthesiology at Thomas Jefferson University in Philadelphia, Pennsylvania.

The team hypothesized that patients have inaccurate expectations about postoperative pain, he said. Their findings confirmed the discrepancy between expected and actual pain levels, especially for patients receiving regional anesthesia.

"It's concerning because ultimately, it boils down to them being uneducated about the regional [anesthesia] they are receiving," Dr Dayan told Medscape Medical News.

In their abstract, Dr Dayan and colleagues note that although there have been great improvements in regional anesthesia (RA), patients are often unaware of the benefits. "Patients receiving regional anesthesia prior to surgery may experience unnecessary anxiety and have exaggerated pain expectations simply because they do not understand the analgesic benefits of RA," they write.

In the study, the researchers gave questionnaires to 223 adult patients before surgery to evaluate the expected pain severity. Patients in the postanesthesia care unit (PACU) were asked to complete a pain assessment 1 hour after surgery, using a rating of 1 to 10. The same patients were asked to assess their pain on the first day after surgery (POD-1). The study subjects' female vs male distribution was 53% vs 47%. Mean age was 61.2 years.

For all subjects, before surgery, the mean expected pain rating in the PACU was 4.66 ± 0.220 compared with an actual PACU pain rating of 2.56 ± 0.224 (P < .001). Similarly, the mean expected pain rating on the first day after surgery for all subjects was 5.45 ± 0.174 vs an actual pain rating of 4.30 ± 0.205 (P < .001).

When the analysis was restricted to patients receiving RA, the mean expected pain rating in the PACU was 4.63 ± 0.358 compared with an actual PACU pain rating of 0.92 ± 0.231 (P < .001).

"Overall, patients as a whole way overestimate the severity of the pain they will have after surgery," Dr Dayan said.

The abstract notes that this is an "important finding, as it demonstrates the negative impact that lack of patient education has on patient expectations and possibly subsequent outcomes." Moreover, the data suggest providers are doing a poor job of counseling patients on realistic pain expectations. "Given the clear benefit of patient education and anxiety alleviation on post-op pain, providers must find ways to effectively manage expectations in an effort to improve outcomes."

Meg A. Rosenblatt, MD, one of the moderators for a series of abstract presentations on regional anesthesia and acute pain, called the study a "really great concept," but said the findings would vary from procedure to procedure.

"It's a good study that probably needs to be focused on silos of patients," she told Medscape Medical News. Dr Rosenblatt is the site chair for anesthesiology at Mount Sinai West in New York City.

Dr Dayan said, either way, the take-home point is that patients are not well educated as to what is being done to them. Surgeons need to address the unrealistic fears of their patients and assure them that they will be pain free when they wake up, Dr Dayan said. And that needs to happen more than 10 minutes before surgery.

He cited several actions aimed at improving patient understanding, including a more thorough preoperative discussion between the anesthesiologist and patient. Providers can also highlight the anesthetic plan and the benefits of the regional anesthesia. Involving the surgeon, who sees the patient weeks before surgery in the office, can help clarify patient expectations and explain about nerve blocks.

"It ultimately comes down to us," he said.

Dr Dayan and several coauthors have disclosed no relevant financial relationships. One coauthor reported research support from Self, Pacira, and Durect, as well as consulting fees and/or honoraria from Self, Cara, Egalet, Mallinckrodt, Medicines Company, Merck, Pacira, Pfizer, Recro, Salix, and Trevena. Dr Rosenblatt has reported no relevant disclosures.

Anesthesiology 2017: Abstract A1164. October 21, 2017.

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