Journal of Anesthesiology
Abstract: Background - Pain control in surgical patients remains problematic globally. Intraoperative pain assessment
poses significant challenge to many anesthesiologists in poorly resourced countries where monitors andexperts are limited.
Due to poor intraoperative pain assessment and management, many patients wake up from anesthesia after surgery
experiencing moderate to severe pain. It has been reported that about 56% of surgical patients cite pain as their primary
concern after surgery. The aim of this study was touse a novel intraoperative pain assessment tool (APPS) and depth of
anesthesia monitor (CSM) to assess and score pain in patients undergoing orthopedic procedures under general anesthesia.
Methods - Data was prospectively collected for 12-months from 246 patients, aged 20 - 81 years who were undergoing
orthopedic surgical procedures. Initial pain intensity was scored using Anesthetized Patients Pain Scale (APPS). The depth
of anesthesia was assessed using a CSM prior to pain assessment during surgery. Fentanyl was administered and the pain
and depth of anesthesia re-evaluated after 5 to 10min. Results - About 75.6% of patients scored moderate to severe pain
with their depth of anesthesia ranging 37-89 score.While 20.7% scored moderate pain with a mean scoreof 9.56 at the
initial pain assessment. A dose of fentanyl, 30 - 50 mcg was administered for pain treatment intraoperatively. Pain was reevaluated after treatment. About 31.3% scored no pain 49.6% scored moderate pain and 19.1% scored moderate to severe
pain. The mean pain intensity scored after treatment was 7.30. Conclusions - Despite adequate depth ofanesthesia observed
during surgery about 68.7% of surgical patients experienced moderate to severe pain. The use of both APPS and CSM
offered adequate intraoperative pain and anesthesiamanagement. Our novel model, APPS has great prospects with clinical
application for intraoperative pain assessment.
Keywords:Anesthetized Patient Pain Scale, Cerebral State Monitor, Intraoperative, Pain Assessment