Influence of surgical complications on the level of pain after radical inguinal/iliacal lymph node dissection.
BACKGROUND
We collected the data of 288 patients with malignant skin tumours. We analysed the postoperative pain assessed by a visual analogue scale (VAS) to evaluate the quality of our standard peri-operative pain therapy after a radical inguinal and iliacal lymph node dissection (RILND) as well as the influence of postoperative surgical complications on the level of pain.


METHODS
The postoperative level of pain of 85 patients with malignant skin tumours who underwent a RILND between August 2003 and December 2007 was recorded prospectively. Patients received a standardised perioperative pain therapy according to level I or II of the World Health Organisation (WHO) ladder of pain. The efficiency of our pain therapy was registered via VAS in the morning of the first three postoperative days.


RESULTS
Using our standard pain therapy, we determined a VAS < 30 in rest during the first three postoperative days, but significantly more pain (VAS median 50-30) (p < 0.001) under stress. Patients with surgical complications in the postoperative period (n = 71) had significantly more pain in the postoperative period compared to patients with a regular postoperative course (p = 0.047).


CONCLUSIONS
Immediately after a RILND, an analgesic therapy according to level I or II of the WHO pain ladder does not seem to be effective enough. Postoperative surgical complications lead to a higher VAS level of pain in the postoperative period.
Neuss
H
H
Department of General, Visceral, Thoracic and Vascular Surgery, Medical Faculty of the Humboldt University, Berlin, Germany. heiko.neuss@charite.de
Reetz
C
C
Raue
W
W
Koplin
G
G
Mall
J W
JW
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001365:Axilla; D003371:Cough / Q000150:complications; D005260:Female; D006119:Groin; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery; D016138:Walking
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal