Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm

Anders Mølgaard Rasmussen; Mette Helene Toft; Hussein Nasser Awada; Jesper Dirks; Birgitte Brandsborg; Line Kirkegaard Rasmussen; Ellen Kirkegaard; Dorthe Hasfeldt-Hansen; Thomas Egemose Larsen; Georgios Charalampidis; Emilie Louise Schjøtt Mørk; Chirstine Linaa Rosager; Idress Ahmad Salam; Bodil Steen Rasmussen; Marlene Jørgensen; Martin Skjønnemand; Caterina Amanti Lund; Save Schroder; Johan Kløvgaard Sørensen; Christoffer Sølling; Kristian Kraft Hansen; Christina Kirkegaard Rasmussen; Nick Phaff Steen; Anne Staal Nielsen; Anja Geisler; Kasper Storm Køppen; Maria Bolther Pælestik; Thorbjørn Grøfte; Christian Sylvest Meyhoff; Charlotte Loumann Kroh; Amalie Prien Christensen; Aleksander Fjeld Haugstvedt; Maria Aagaard Hansen; Christian Viggo Nielsen; Bitten Dybdal; Lars Falcon; Daniel Hägi-Pedersen; Kristian Jauho; Henrik Wolsted; Christian Alves Kohler Pedersen; Trine Nyboe Sommer; Laurits Schou Kromberg; Danja Lykke Kristensen; Camilla Kara Svensson; Hans Fjeldsøe Nielsen; Martin Kryspin Sørensen; Stig Jacobsen; Martin Sundskard; Nicole Brahe; Karina Jakobsen; Mette Skov Jensen; Lillian Odder; Hansjörg Selter; Tróndur Høgnason Mohr; Elin H Jensen; Pernille Pia Jensen; Christine Skjold; Eske Kvanner Aasvang

doi:10.1136/rapm-2021-102583

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm

Anders Mølgaard Rasmussen, Mette Helene Toft, Hussein Nasser Awada, Jesper Dirks, Birgitte Brandsborg, Line Kirkegaard Rasmussen, Ellen Kirkegaard, Dorthe Hasfeldt-Hansen, Thomas Egemose Larsen, Georgios Charalampidis, Emilie Louise Schjøtt Mørk, Chirstine Linaa Rosager, Idress Ahmad Salam, Bodil Steen Rasmussen, Marlene Jørgensen, Martin Skjønnemand, Caterina Amanti Lund, Save Schroder, Johan Kløvgaard Sørensen, Christoffer SøllingKristian Kraft Hansen, Christina Kirkegaard Rasmussen, Nick Phaff Steen, Anne Staal Nielsen, Anja Geisler, Kasper Storm Køppen, Maria Bolther Pælestik, Thorbjørn Grøfte, Christian Sylvest Meyhoff, Charlotte Loumann Kroh, Amalie Prien Christensen, Aleksander Fjeld Haugstvedt, Maria Aagaard Hansen, Christian Viggo Nielsen, Bitten Dybdal, Lars Falcon, Daniel Hägi-Pedersen, Kristian Jauho, Henrik Wolsted, Christian Alves Kohler Pedersen, Trine Nyboe Sommer, Laurits Schou Kromberg, Danja Lykke Kristensen, Camilla Kara Svensson, Hans Fjeldsøe Nielsen, Martin Kryspin Sørensen, Stig Jacobsen, Martin Sundskard, Nicole Brahe, Karina Jakobsen, Mette Skov Jensen, Lillian Odder, Hansjörg Selter, Tróndur Høgnason Mohr, Elin H Jensen, Pernille Pia Jensen, Christine Skjold, Eske Kvanner Aasvang

Abstract

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.

METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.

RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.

CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.

TRIAL REGISTRATION NUMBER: RoPR ID 43191.

Original language	English
Article number	102583
Journal	Regional Anesthesia and Pain Medicine
Volume	46
Issue number	11
Pages (from-to)	948-953
Number of pages	6
ISSN	1098-7339
DOIs	https://doi.org/10.1136/rapm-2021-102583
Publication status	Published - Nov 2021

Keywords

Analgesics, Opioid
Anesthesia, General
Cohort Studies
Denmark/epidemiology
Female
Humans
Pain, Postoperative/diagnosis
Prospective Studies

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10.1136/rapm-2021-102583

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Rasmussen, A. M., Toft, M. H., Awada, H. N., Dirks, J., Brandsborg, B., Rasmussen, L. K., Kirkegaard, E., Hasfeldt-Hansen, D., Larsen, T. E., Charalampidis, G., Mørk, E. L. S., Rosager, C. L., Salam, I. A., Rasmussen, B. S., Jørgensen, M., Skjønnemand, M., Lund, C. A., Schroder, S., Sørensen, J. K., ... Aasvang, E. K. (2021). Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm. Regional Anesthesia and Pain Medicine, 46(11), 948-953. Article 102583. https://doi.org/10.1136/rapm-2021-102583

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm. / Rasmussen, Anders Mølgaard; Toft, Mette Helene; Awada, Hussein Nasser et al.
In: Regional Anesthesia and Pain Medicine, Vol. 46, No. 11, 102583, 11.2021, p. 948-953.

Research output: Contribution to journal › Journal article › Research › peer-review

Rasmussen, AM, Toft, MH, Awada, HN, Dirks, J, Brandsborg, B, Rasmussen, LK, Kirkegaard, E, Hasfeldt-Hansen, D, Larsen, TE, Charalampidis, G, Mørk, ELS, Rosager, CL, Salam, IA, Rasmussen, BS, Jørgensen, M, Skjønnemand, M, Lund, CA, Schroder, S, Sørensen, JK, Sølling, C, Hansen, KK, Rasmussen, CK, Steen, NP, Nielsen, AS, Geisler, A, Køppen, KS, Pælestik, MB, Grøfte, T, Meyhoff, CS , Kroh, CL, Christensen, AP, Haugstvedt, AF, Hansen, MA, Nielsen, CV, Dybdal, B , Falcon, L, Hägi-Pedersen, D, Jauho, K, Wolsted, H, Pedersen, CAK, Sommer, TN, Kromberg, LS, Kristensen, DL, Svensson, CK, Nielsen, HF, Sørensen, MK, Jacobsen, S, Sundskard, M, Brahe, N, Jakobsen, K, Jensen, MS, Odder, L, Selter, H, Mohr, TH, Jensen, EH, Jensen, PP, Skjold, C & Aasvang, EK 2021, 'Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm', Regional Anesthesia and Pain Medicine, vol. 46, no. 11, 102583, pp. 948-953. https://doi.org/10.1136/rapm-2021-102583

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title = "Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm",

abstract = "BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.TRIAL REGISTRATION NUMBER: RoPR ID 43191.",

keywords = "Analgesics, Opioid, Anesthesia, General, Cohort Studies, Denmark/epidemiology, Female, Humans, Pain, Postoperative/diagnosis, Prospective Studies",

author = "Rasmussen, {Anders M{\o}lgaard} and Toft, {Mette Helene} and Awada, {Hussein Nasser} and Jesper Dirks and Birgitte Brandsborg and Rasmussen, {Line Kirkegaard} and Ellen Kirkegaard and Dorthe Hasfeldt-Hansen and Larsen, {Thomas Egemose} and Georgios Charalampidis and M{\o}rk, {Emilie Louise Schj{\o}tt} and Rosager, {Chirstine Linaa} and Salam, {Idress Ahmad} and Rasmussen, {Bodil Steen} and Marlene J{\o}rgensen and Martin Skj{\o}nnemand and Lund, {Caterina Amanti} and Save Schroder and S{\o}rensen, {Johan Kl{\o}vgaard} and Christoffer S{\o}lling and Hansen, {Kristian Kraft} and Rasmussen, {Christina Kirkegaard} and Steen, {Nick Phaff} and Nielsen, {Anne Staal} and Anja Geisler and K{\o}ppen, {Kasper Storm} and P{\ae}lestik, {Maria Bolther} and Thorbj{\o}rn Gr{\o}fte and Meyhoff, {Christian Sylvest} and Kroh, {Charlotte Loumann} and Christensen, {Amalie Prien} and Haugstvedt, {Aleksander Fjeld} and Hansen, {Maria Aagaard} and Nielsen, {Christian Viggo} and Bitten Dybdal and Lars Falcon and Daniel H{\"a}gi-Pedersen and Kristian Jauho and Henrik Wolsted and Pedersen, {Christian Alves Kohler} and Sommer, {Trine Nyboe} and Kromberg, {Laurits Schou} and Kristensen, {Danja Lykke} and Svensson, {Camilla Kara} and Nielsen, {Hans Fjelds{\o}e} and S{\o}rensen, {Martin Kryspin} and Stig Jacobsen and Martin Sundskard and Nicole Brahe and Karina Jakobsen and Jensen, {Mette Skov} and Lillian Odder and Hansj{\"o}rg Selter and Mohr, {Tr{\'o}ndur H{\o}gnason} and Jensen, {Elin H} and Jensen, {Pernille Pia} and Christine Skjold and Aasvang, {Eske Kvanner}",

note = "{\textcopyright} American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = nov,

doi = "10.1136/rapm-2021-102583",

language = "English",

volume = "46",

pages = "948--953",

journal = "Regional Anesthesia and Pain Medicine",

issn = "1098-7339",

publisher = "Lippincott Williams & Wilkins",

number = "11",

}

TY - JOUR

T1 - Waking Up in Pain

T2 - a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm

AU - Rasmussen, Anders Mølgaard

AU - Toft, Mette Helene

AU - Awada, Hussein Nasser

AU - Dirks, Jesper

AU - Brandsborg, Birgitte

AU - Rasmussen, Line Kirkegaard

AU - Kirkegaard, Ellen

AU - Hasfeldt-Hansen, Dorthe

AU - Larsen, Thomas Egemose

AU - Charalampidis, Georgios

AU - Mørk, Emilie Louise Schjøtt

AU - Rosager, Chirstine Linaa

AU - Salam, Idress Ahmad

AU - Rasmussen, Bodil Steen

AU - Jørgensen, Marlene

AU - Skjønnemand, Martin

AU - Lund, Caterina Amanti

AU - Schroder, Save

AU - Sørensen, Johan Kløvgaard

AU - Sølling, Christoffer

AU - Hansen, Kristian Kraft

AU - Rasmussen, Christina Kirkegaard

AU - Steen, Nick Phaff

AU - Nielsen, Anne Staal

AU - Geisler, Anja

AU - Køppen, Kasper Storm

AU - Pælestik, Maria Bolther

AU - Grøfte, Thorbjørn

AU - Meyhoff, Christian Sylvest

AU - Kroh, Charlotte Loumann

AU - Christensen, Amalie Prien

AU - Haugstvedt, Aleksander Fjeld

AU - Hansen, Maria Aagaard

AU - Nielsen, Christian Viggo

AU - Dybdal, Bitten

AU - Falcon, Lars

AU - Hägi-Pedersen, Daniel

AU - Jauho, Kristian

AU - Wolsted, Henrik

AU - Pedersen, Christian Alves Kohler

AU - Sommer, Trine Nyboe

AU - Kromberg, Laurits Schou

AU - Kristensen, Danja Lykke

AU - Svensson, Camilla Kara

AU - Nielsen, Hans Fjeldsøe

AU - Sørensen, Martin Kryspin

AU - Jacobsen, Stig

AU - Sundskard, Martin

AU - Brahe, Nicole

AU - Jakobsen, Karina

AU - Jensen, Mette Skov

AU - Odder, Lillian

AU - Selter, Hansjörg

AU - Mohr, Tróndur Høgnason

AU - Jensen, Elin H

AU - Jensen, Pernille Pia

AU - Skjold, Christine

AU - Aasvang, Eske Kvanner

PY - 2021/11

Y1 - 2021/11

N2 - BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.TRIAL REGISTRATION NUMBER: RoPR ID 43191.

AB - BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.TRIAL REGISTRATION NUMBER: RoPR ID 43191.

KW - Analgesics, Opioid

KW - Anesthesia, General

KW - Cohort Studies

KW - Denmark/epidemiology

KW - Female

KW - Humans

KW - Pain, Postoperative/diagnosis

KW - Prospective Studies

UR - http://www.scopus.com/inward/record.url?scp=85120508253&partnerID=8YFLogxK

U2 - 10.1136/rapm-2021-102583

DO - 10.1136/rapm-2021-102583

M3 - Journal article

C2 - 34408068

SN - 1098-7339

VL - 46

SP - 948

EP - 953

JO - Regional Anesthesia and Pain Medicine

JF - Regional Anesthesia and Pain Medicine

IS - 11

M1 - 102583

ER -

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm

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Keywords

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