Intraoperative Pain Assessment: The Use of Anesthetized Patient Pain Scale and Cerebral State Monitor
Journal of Anesthesiology
Volume 1, Issue 2, September 2013, Pages: 15-20
Received: Aug. 3, 2013;
Published: Oct. 20, 2013
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Sylvanus Kampo, Department of Anesthesiology, Dalian Medical University, 9 Western Section, Lvshun South Road, Lvshunkou District Dalian City, Liaoning, P. R. China
Jun Han, Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning, P.R. China; Department of Anesthesia, School of Medicine and Health Science, University for Development Studies, Tamale, Ghana
Juventus Benogle Ziem, Department of Clinical Laboratory Sciences, School of Medicine & Health Sciences, University for Development Studies, Tamale, Ghana
Faraja Mpemba, School of Nursing, Dalian Medical University, Dalian, Liaoning P.R. China; School of Nursing, St. John’s University of Tanzania, Dodoma, Tanzania
Yabasin Iddrisu Baba, Department of Anesthesiology, Dalian Medical University, 9 Western Section, Lvshun South Road, Lvshunkou District Dalian City, Liaoning, P. R. China
Peng Gao, Department of Anesthesiology, Dalian Medical University, 9 Western Section, Lvshun South Road, Lvshunkou District Dalian City, Liaoning, P. R. China
Qingping Wen, Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, Dalian City, Liaoning, P.R. China
Background - Pain control in surgical patients remains problematic globally. Intraoperative pain assessment poses significant challenge to many anesthesiologists in poorly resourced countries where monitors and experts 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 to use 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 score of 9.56 at the initial pain assessment. A dose of fentanyl, 30 - 50 mcg was administered for pain treatment intraoperatively. Pain was re-evaluated 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 of anesthesia 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 anesthesia management. Our novel model, APPS has great prospects with clinical application for intraoperative pain assessment.
Juventus Benogle Ziem,
Yabasin Iddrisu Baba,
Intraoperative Pain Assessment: The Use of Anesthetized Patient Pain Scale and Cerebral State Monitor, Journal of Anesthesiology.
Vol. 1, No. 2,
2013, pp. 15-20.
Apfelbaum JL, Chen C, Mehta SS, Gan JT. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003: 97(30): 534-540.
Pasero C, Paice JA, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C. Pain: clinical manual. 2nd ed. St. Louis, MO: Mosby; 1999: 15-34.
Gelinas C, Fillion L, Puntillo KA, Viens C, Fortier M. Validation of the critical-care pain observation tool in adult patients. American Journal of Critical Care 2006; 15: 420–427.
Mateo OM, Krenzischek DA. A pilot study to assess the relationship between behavioral manifestations and self-report of pain in postanaesthesia care unit patients. J Post Anesth Nurs. 1992; 7:15-21.
Webb MR, Kennedy MG. Behavioral responses and self-reported pain in postoperative patients. J Post Anesth Nurs. 1994; 9:9-95.
Marks RM, Sachar EJ. Undertreatment of medical inpatients with narcotic analgesics. Ann Intern Med. 1973; 78:173-8.
Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management. Br J Anesth. 2002; 89(3):409-423.
Oztas B, Akqui S, Arslan FB. Influence of surgical pain stress on the blood-brain barrier permeability in rates. Life Sci. 2004; 74(16): 1973-9.
Manjushree R. Challenges in postoperative pain management: In: 99th session of the Indian Section of Medical Science January3-7, 2012; Bhubaneswar.
Turk DC, Okifuji A. Pain terms and taxonomies of pain. In: Bonica JJ, Loeser JD, Chapman CR, Turk DC, Butler SH. Bonica's management of pain. Hagerstown, MD: Lippincott Williams & Wilkins; 2001. ISBN 0-683-30462-3.
Thienhaus O, Cole BE. Classification of pain. In: Weiner R. Pain management: a practical guide for clinicians. Boca Raton: CRC Press; 2002. 28.
Pasero C, Paice JA, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C, editors. Pain: clinical manual. 2nd ed. St. Louis, MO: Mosby; 1999:15–34.
Wells N, Pasero C, McCaffery M. Improving the quality of care through pain assessment and managements. In: Hughas RG. Patient safety and quality: An evidence based handbook for nurses. Rockville: Agency for healthcare research and quality; 2008 Apr.
Merskey H. Pain terms: a list with definitions and notes on usage recommended by the IASP subcommittee on taxonomy. Pain. 1979; 6: 249–252.
Anderson KO, Mendoza TR, Valeroo V, Richman SP, Russell C, Hurley J, Deleon C, Washington P, Palos G, Payne R, Cleeland CS. Minority cancer patients and their providers: Pain management attitudes and practice. Cancer 2000; 88 (8):1929-1938
Brown JE, Chatterjee N, Younger J, Mackey S. Towards a Physiology-Based Measure of Pain: Patterns of Human Brain Activity Distinguish Painful from Non-Painful Thermal Stimulation. PLoS ONE 2011; 6(9): 24124.
Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs. 2000 Mar; 1(1):13-21.
Horgas AL. Assessing pain in persons with dementia. In: Boltz M, series ed. Try this: Best Practices in Nursing Care for Hospitalized Older Adults with Dementia. The Hartford Institute for Geriatric Nursing, Fall 2003; 1(2).
Cade CH. Clinical tools for the assessment of pain in sedated critically ill adults. Nursing in Critical care 2008; 13 (6): 288-297.
Stomberg MW, Sjöström B, Haljamäe H. Assessing pain responses during general anesthesia. J. AANA. 2001; 69 (3): 218-222.
Anderson RE, Jakobsson JG. Cerebral state monitor, a new small handheld EEG monitor for determining depth of anesthesia: a clinical comparison with the Bispectral index during day- surgery. Eur J Anaesthesiol. 2006; 23 (3): 2008-12
Lavand’ Homme P. Perioperative pain. Current opinion in Anesthesiology. 2006; 19:556-56
Lyons G, Macdonald R. Awareness during caesarian section. Anesthesia. 1991; 46: 62-4.
Philips AA, Mclean RF, Devitt JH, Harrington EM. Recall of intraoperative events after general anesthesia and cardiopulmonary bypass. Can J Anesth. 1993; 40:922-6.
Bogetz MS, Katz JA. Recall of surgery for major trauma. Anesthesiology. 1984; 61: 6-9.
Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during Anesthesia; a closed claims analysis. Anesthesiology. 1999; 90: 153-1061.
Ranta SO, Laurila R, Saario J, Ali- Melkkila T, Hynynen M. Awareness with recall during general anesthesia; incidence and risk factors. Anesth Analg. 1998; 68: 959-961.
Osterman JE, Vander Kolk BA. Awareness during anesthesia and posttraumatic stress disorder. Gen Hosp Psychiatry. 1998; 20: 274-281.
Heier T, Steen PA. Awareness in anesthesia; incidence, consequences and prevention. Acta Anesthesiological Scandinavia. 1996; 40: 1073-1086.
Sandin RH, Enlund G, Samuelsson P, Lennmarken C. Awareness during anesthesia; a prospective case study. Lancet. 2000; 355: 707-711.