An Algorithm for Postoperative Pain Management in Visceral and Thoracic Surgery: An Observational Study

Introduction: We report the results of an observational study of pain intensity before and after implementation of an algorithm for postoperative pain management. The algorithm included multiple factors for treatment. Methods: Data of 130 consecutive patients with defined surgical procedures were extracted from charts before and after implementation of the algorithm. Our patients documented pain intensity at rest and on movement on a numerival rating scale (NRS) from 0 (= no pain) to 10 (= worst pain). A successful pain management was definded as maximum pain intensity at rest <= 3 and on movement <= 5 on the NRS. For statistical analysis we used the Wilcoxon and the chi squared test. Results: The frequency of a successful pain management increased from 49% (individual pain management) to 85% (algorithm) at rest 8 (p<0.001), on movement the rates were 42% and 86%, respectively (p<0.001). In the total group, we found a reduction of maximum pain intensity at rest (mean +/- sd) from 4.05 +/- 2.54 to 2.18 +/- 1.82 (p<0.001) and with movement from 6.04 +/- 2.51 to 3.5 +/- 2.08 (p<0.001). Conclusion: Implementing an algorithm for postoperative pain management resulted in a clinically relevant reduction of postoperative pain. Our findings reflect the result of a complex change in pain management, and therefore cannot be attributed to any single factors involved.