Immediate Postoperative Pain in Orthopedic Patients Is More Intense and Requires More Analgesia than in Post-Laparotomy Patients


  • Margaret P. Ekstein MD,

    1. Department of Anesthesia and Intensive Care Medicine
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  • Avi A. Weinbroum MD

    Corresponding author
    1. Department of Anesthesia and Intensive Care Medicine
    2. Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
    • Avi A. Weinbroum, MD, Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel. Tel: 972-3-697-3237; Fax: 972-3-692-5749; E-mail:

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  • No benefits or funds were received in support of this study.

  • Support for this project: Internal departmental funds.

  • Financial support: nothing to declare on the part of either author.


Objective.  To compare the immediate postoperative pain intensity between orthopedic and general surgery patients and evaluate the extent of severe pain in each group.

Design.  Observational, open-label study.

Setting.  Post-anesthesia care unit (PACU) in a tertiary, university-affiliated hospital.

Patients.  Patients undergoing orthopedic surgery or laparotomy under general anesthesia over a one-year period.

Interventions.  Follow-up of patient self-rated pain visual analog scale (VAS, 0–10), and observation of the efficacy of the routine analgesic protocol of morphine, ketamine, and diclofenac administration in the PACU.

Outcome Measures.  We followed pain scores and sorted patients according to morphine requirements during the PACU immediate postoperative stay. Patients whose pain was controlled with ≤120 µg/kg intravenous morphine were considered pain-controllable. Where this amount was insufficient to control pain (VAS ≥5/10), patients were categorized as suffering from severe pain. They were further treated with repeated doses of 1 mg morphine plus 350 µg/kg ketamine (M+K) and eventually diclofenac. PACU follow-up lasted 3 hours.

Results.  The overall rate of immediate severe postoperative pain within the entire cohort (3,460 patients) was 9.4%: 123 (6.6%) of laparotomy patients and 202 (12.7%) of orthopedic patients. Pain in the laparotomy patients identified as suffering from severe pain was controlled with 1.21 ± 0.45 doses of M+K compared with 1.37 ± 0.62 (P < 0.0001) in the orthopedic counterparts. One-fifth of these laparotomy patients demanded more than one injection of M+K compared with one-third of the orthopedic subgroup (P = 0.045). Twenty-seven orthopedic vs nine surgical patients (P = 0.036) required diclofenac.

Conclusions.  More orthopedic than laparotomy patients suffered from severe immediate postoperative pain. They required more analgesia than that dictated by existing PACU analgesia protocols. Ketamine and morphine co-administration proved effective in controlling severe postoperative pain after each type of surgery.