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Abstract
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Background and Aims Perioperative pain treatment affects well-being and recovery after surgery.1-3 Some studies show that women tend to report higher pain and opioid-related adverse-effects.4-5 We aimed to assess sex-related severity of post-operative pain and opioid-related adverse-effects.
Methods Patients after general surgery were asked to fulfill patient-reported outcomes (PRO)6-7 on first post-operative day between 01/2018-05/2019 in our center. We report findings for the abdominal surgery sub-group. Composite pain score (CPS) was created for PROs addressing pain intensity and interference with activity/mood. Secondary outcomes included analgesic administration and composite opioid adverse-effects score (CAES). Logistic regression was used to identify variables associated with CPS≥5.5 and CAES≥4. The study had IRB approval.
Results 205 patients underwent open abdominal surgery, 410 had laparoscopic/combined surgery. There was no difference in analgesics administration between sexes. In the complete cohort a larger proportion of females reported CPS≥5.5 (OR 2.3,p<0.0001). However, epidural anesthesia in open abdominal surgery reduced pain in all patients and eliminated sex differences. BMI<35, Muslim religion and intraoperative ketorolac were associated with reduced postoperative pain (in trend, p=0.06). CAES≥4 was associated with female sex (OR 2.6, p<0.0001), and tramadol administration (OR 3.5, p=0.036).
Composite pain score (CPS) by gender and surgery
Patient reported outcomes (PROs) – pain intensity and pain interference in abdominal surgery
Composite adverse effects score (CAES). Multivariate logistic regression
Conclusions Females reported higher postoperative pain and opioid-related adverse-effects after abdominal surgery. Epidural reduced pain intensity and eliminated sex differences. We attribute the higher opioid-related adverse-effects in females to a higher exposure to tramadol adjusted to weight. Our results support using epidural analgesia during and after open abdominal surgery in men but especially in women, as well as considering lower doses of tramadol in women as part of multimodal analgesia.
Attachment 592-15 – מנהל אישור.pdf