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Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm
  1. Anders Mølgaard Rasmussen1,2,
  2. Mette Helene Toft3,
  3. Hussein Nasser Awada1,
  4. Jesper Dirks4,
  5. Birgitte Brandsborg5,
  6. Line Kirkegaard Rasmussen5,
  7. Ellen Kirkegaard5,
  8. Dorthe Hasfeldt-Hansen6,
  9. Thomas Egemose Larsen6,
  10. Georgios Charalampidis6,
  11. Emilie Louise Schjøtt Mørk3,
  12. Chirstine Linaa Rosager3,
  13. Idress Ahmad Salam7,
  14. Bodil Steen Rasmussen7,
  15. Marlene Jørgensen7,
  16. Martin Skjønnemand8,
  17. Caterina Amanti Lund9,
  18. Save Schroder10,
  19. Johan Kløvgaard Sørensen10,
  20. Christoffer Sølling11,
  21. Kristian Kraft Hansen11,
  22. Christina Kirkegaard Rasmussen2,
  23. Nick Phaff Steen12,
  24. Anne Staal Nielsen12,
  25. Anja Geisler13,
  26. Kasper Storm Køppen13,
  27. Maria Bolther Pælestik14,
  28. Thorbjørn Grøfte14,15,
  29. Christian Sylvest Meyhoff16,
  30. Charlotte Loumann Kroh16,
  31. Amalie Prien Christensen17,
  32. Aleksander Fjeld Haugstvedt17,
  33. Maria Aagaard Hansen18,
  34. Christian Viggo Nielsen18,
  35. Bitten Dybdal4,
  36. Lars Falcon19,
  37. Daniel Hägi-Pedersen20,
  38. Kristian Jauho20,
  39. Henrik Wolsted20,
  40. Christian Alves Kohler Pedersen21,
  41. Trine Nyboe Sommer21,
  42. Laurits Schou Kromberg22,
  43. Danja Lykke Kristensen1,
  44. Camilla Kara Svensson23,
  45. Hans Fjeldsøe Nielsen23,
  46. Martin Kryspin Sørensen24,
  47. Stig Jacobsen25,
  48. Martin Sundskard26,
  49. Nicole Brahe27,
  50. Karina Jakobsen28,
  51. Mette Skov Jensen28,
  52. Lillian Odder29,
  53. Hansjörg Selter29,
  54. Tróndur Høgnason Mohr30,
  55. Elin H Jensen30,
  56. Pernille Pia Jensen31,
  57. Christine Skjold32 and
  58. Eske Kvanner Aasvang1
  1. 1Dept of Anesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2Department of Anaesthesiology and Intensive Care Medicine, Kolding Hospital, Kolding, Denmark
  3. 3Department of Anaesthesiology and Intensive Care, Herlev Hospital, Herlev, Denmark
  4. 4Department of Anaesthesiology, Copenhagen University Hospital Centre of Head and Orthopaedics, København, Denmark
  5. 5Department of Anaesthesiology and Intensive Care, Aarhus University Hospital Skejby, Aarhus, Denmark
  6. 6Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
  7. 7Department of Anaesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
  8. 8Department of Anaesthesiology and Intensive Care, Gentofte University Hospital, Hellerup, Denmark
  9. 9Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Hvidovre, Denmark
  10. 10Department of Anaesthesiology and Intensive Care, Esbjerg Central Hospital, Esbjerg, Denmark
  11. 11Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital, Viborg, Midtjylland, Denmark
  12. 12Department of Anaesthesiology and Intensive Care, Vejle Hospital, Vejle, Denmark
  13. 13Department of Anaesthesiology, Zealand University Hospital Køge, Køge, Denmark
  14. 14Department of Anaesthesiology and Intensive Care, Randers Regional Hospital, Randers, Denmark
  15. 15Prehospital Emergency Medical Services, Region Midtjylland, Aarhus, Denmark
  16. 16Department of Anaesthesia and Intensive Care, Bispebjerg Hospital, København, Denmark
  17. 17Department of Anaesthesiology and Intensive Care, Hillerød Hospital, Hillerød, Denmark
  18. 18Department of Anaesthesiology and Intensive Care, Herning Hospital, Herning, Denmark
  19. 19Department of Anaesthesiology, Juliane Marie Centre, København, Denmark
  20. 20Department of Anaesthesiology and Intensive Care, Slagelse Hospital, Slagelse, Denmark
  21. 21Department of Anaesthesiology and Intensive Care, South Jutland Hospital Aabenraa Campus, Aabenraa, Denmark
  22. 22Department of Anaesthesiology and Intensive Care, Holbaek Hospital, Holbaek, Denmark
  23. 23Department of Anaesthesiology and Intensive Care, Nykobing Falster Hospital, Nykobing, Denmark
  24. 24Department of Anaesthesiology, Copenhagen University Hospital Neuroscience Centre, København, Denmark
  25. 25Department of Anaesthesiology, Copenhagen University Hospital Centre for Cardiac Vascular Pulmonary and Infectious Diseases, København, Denmark
  26. 26Department of Anaesthesiology, Zealand University Hospital Roskilde, Roskilde, Denmark
  27. 27Department of Anaesthesiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark
  28. 28Department of Anaesthesiology and Intensive Care, Næstved Hospital, Næstved, Denmark
  29. 29Department of Anaesthesiology, Aalborg University Hospital Thisted, Thisted, Denmark
  30. 30Department of Internal Medicine, Landssjúkrahúsid Dronning Alexandrines Hospital, Torshavn, Faroe Islands
  31. 31Department of Anaesthesiology, Dronning Ingrids Hospital, Nuuk, Greenland
  32. 32Department of Anaesthesiology and Intensive Care, Bornholms Hospital, Ronne, Denmark
  1. Correspondence to Dr Eske Kvanner Aasvang, Section for Surgical Pathophysiology, Copenhagen University Hospital Centre for Cancer and Organ Diseases, København 2100, Denmark; eske.kvanner.aasvang.01{at}regionh.dk

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.

  • pain
  • postoperative
  • acute pain
  • pain management

Data availability statement

Data are available upon reasonable request. Data are available upon request from the corresponding author, after consideration by the research consortium, of the research protocol that must be sent along with the request.

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Data availability statement

Data are available upon reasonable request. Data are available upon request from the corresponding author, after consideration by the research consortium, of the research protocol that must be sent along with the request.

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Footnotes

  • Correction notice This article has been corrected since it published Online First. The first affiliation has been corrected.

  • Collaborators Laurits Elgaard, Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Bettina Nygaard Nielsen, Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Mie Heerwagen Hagerup, Department of Anaesthesiology and Intensive Care, Neuroanesthesiology, Copenhagen University Hospital, Rigshospitalet, Denmark.

  • Contributors All authors participated in the protocol design and approval, data collection and manuscript revisions. AMR, MHT, and EKA drafted the protocol. AMR, MHT, EKA, and HNA analyzed the data and the first version of the manuscript. EKA conceptualized the study.

  • Funding The study was supported by an unrestricted €2.500 grant from Norpharma for data entry. All other expenses related to the study were covered by the participating departments.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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