Pre- and post-surgical factors that predict the provision of rescue analgesia following hysterectomy

Authors

  • P.R. Pinto,

    1. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
    2. ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
    3. Health Psychology Group, Newcastle University, UK
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  • T. McIntyre,

    1. Texas Institute for Measurement, Evaluation and Statistics (TIMES) and Department of Psychology, University of Houston, USA
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  • C. Fonseca,

    1. Alto Ave Hospital Center, Anaesthesiology Unit, Guimarães, Portugal
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  • A. Almeida,

    Corresponding author
    1. ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
    • Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
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  • V. Araújo-Soares

    1. Health Psychology Group, Newcastle University, UK
    2. Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, UK
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  • Funding sources

    This work was supported by a grant (SFRH/BD/36368/2007) from the Portuguese Foundation of Science and Technology.

  • Conflicts of interest

    We declare that none of the authors have any financial or other relationships that might lead to conflict of interest.

Correspondence

Armando Almeida

E-mail: aalmeida@ecsaude.uminho.pt

Abstract

Background

To better manage post-surgical pain, standardized analgesic protocols allow for rescue analgesia (RA). This study seeks to determine which pre- and post-surgical clinical and patient-related factors, in addition to post-surgical pain, may influence health care professional decisions on RA administration.

Methods

A consecutive sample of 185 women, submitted to hysterectomy for benign disorders, was assessed 24 h before (time 1; T1) and 48 h after (time 2; T2) surgery. At T1, baseline demographic, clinical and psychological predictors were assessed and at T2, post-surgical pain, anxiety and RA administration were recorded.

Results

After controlling for post-surgical acute pain intensity, logistic regression results revealed several pre-surgical (T1) and surgical factors associated with post-surgical RA: having other previous pain states [odds ratio (OR), 4.551; 95% confidence interval (CI), 1.642–12.611, p = 0.004], being anaesthetized with only general or loco-regional anaesthesia (OR, 5.349; 95% CI, 1.976–14.483, p = 0.001) and pre-surgical fear of immediate consequences of surgery (OR, 1.306; 95% CI, 1.031–1.655, p = 0.027). Concerning post-surgical variables, higher pain intensity (OR, 1.591; 95% CI, 1.353–1.871, p <0.001) and post-surgical anxiety (OR, 1.245; 95% CI, 1.084–1.430, p = 0.002) were significantly associated with RA provision.

Conclusions

Health care decision making to administer RA might be influenced not only by post-surgical pain intensity but also by pre-surgical and surgical clinical factors, such as previous pain and type of anaesthesia. Patient-related psychological characteristics, such as pre-surgical fear and post-surgical anxiety, may also play a role in decision making on RA provision. Implications for practice are discussed.

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