Pre- and post-surgical factors that predict the provision of rescue analgesia following hysterectomy.
BACKGROUND
To better manage post-surgical pain, standardized analgesic protocols allow for rescue analgesia (RA). This study seeks to determine which pre- and post-surgical clinical and patient-related factors, in addition to post-surgical pain, may influence health care professional decisions on RA administration.


METHODS
A consecutive sample of 185 women, submitted to hysterectomy for benign disorders, was assessed 24 h before (time 1; T1) and 48 h after (time 2; T2) surgery. At T1, baseline demographic, clinical and psychological predictors were assessed and at T2, post-surgical pain, anxiety and RA administration were recorded.


RESULTS
After controlling for post-surgical acute pain intensity, logistic regression results revealed several pre-surgical (T1) and surgical factors associated with post-surgical RA: having other previous pain states [odds ratio (OR), 4.551; 95% confidence interval (CI), 1.642-12.611, p = 0.004], being anaesthetized with only general or loco-regional anaesthesia (OR, 5.349; 95% CI, 1.976-14.483, p = 0.001) and pre-surgical fear of immediate consequences of surgery (OR, 1.306; 95% CI, 1.031-1.655, p = 0.027). Concerning post-surgical variables, higher pain intensity (OR, 1.591; 95% CI, 1.353-1.871, p < 0.001) and post-surgical anxiety (OR, 1.245; 95% CI, 1.084-1.430, p = 0.002) were significantly associated with RA provision.


CONCLUSIONS
Health care decision making to administer RA might be influenced not only by post-surgical pain intensity but also by pre-surgical and surgical clinical factors, such as previous pain and type of anaesthesia. Patient-related psychological characteristics, such as pre-surgical fear and post-surgical anxiety, may also play a role in decision making on RA provision. Implications for practice are discussed.
Life and Health Sciences Research Institute-ICVS, School of Health Sciences, University of Minho, Braga, Portugal.
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Pinto
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McIntyre
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Fonseca
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Almeida
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Araújo-Soares
D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D000698:Analgesia; D000758:Anesthesia; D001007:Anxiety / Q000523:psychology; D058443:Catastrophization / Q000523:psychology; D004522:Educational Status; D005239:Fear / Q000523:psychology; D005260:Female; D005544:Forecasting; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D020250:Postoperative Nausea and Vomiting / Q000150:complications / Q000628:therapy; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011537:Pruritus / Q000150:complications / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome