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    The first postoperative day: prospective evaluation of pain in adult otorhinolaryngologic surgery.

    Clin J Pain 2014 Nov;30(11):978-86
    Departments of *Otorhinolaryngology ‡Anesthesiology and Intensive Care Medicine, Jena University Hospital, Thuringia †Pain Research Laboratory, Charité-Universitätsmedizin, Berlin, Germany.
    Objectives: The aim of the study was to assess postoperative pain within the first 24 hours after otorhinolaryngologic surgery and to identify factors influencing postoperative pain.

    Methods: A total of 8447 patients from 65 German hospitals were included in a prospective evaluation using a web-based multicenter registry. On the first postoperative day, patients were asked to rate their pain using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment including numeric rating scales (0 to 10) for the determination of patients' pain on ambulation, maximal pain, and minimal pain. Quality Improvement in Postoperative Pain Treatment allowed a standardized assessment of patients' characteristics, pain parameters, outcome, and process parameters. The influence of these parameters on the patients' postoperative pain was estimated by univariate and multivariate statistical analysis.

    Results: The mean pain on ambulation, the maximal pain, and minimal pain were 3.2±2.3, 4.3±2.7, and 1.6±1.6, respectively. Oral surgery, especially the subgroup of patients receiving a tonsillectomy, was related to the highest pain scores (all Ps<0.05): pain on ambulation: 4.3±2.1; maximal pain: 5.6±2.3; minimal pain: 2.4±1.6. Several factors were independently associated with more maximal pain: female sex, younger age, chronic pain, type of surgery, no pain counseling, no usage of a sedative and/or a nonopioid as premedication, usage of a nonopioid in the recovery room and/or ward, and usage of a cold pack on ward.

    Discussion: Analgesia and perioperative pain management in otorhinolaryngologic surgery seems to be highly variable. After otorhinolaryngologic surgery many patients seem to receive less analgesia than needed or ineffective analgesic drug regimes.
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