title: The Algoplus Score to Assess Acute Postoperative pain in Elderly patients-A Pilot Observational Study.
abstract: Standard verbal or analogue scales may not be accurate to assess acute postoperative pain in elderly patients. This study was designed to field test the Algoplus tool, developed specifically for this population and based on observation of patient behavior. Prospective, observational cohort. Single center, French University hospital. Forty-eight patients, aged over 65, scheduled for surgery under general anesthesia, and observed on admission to the postanesthesia care unit, immediately after extubation, during the different steps of analgesic intervention (demand, relief with intravenous opioid titration, plus intermediate measures when relevant), and either at discharge or 3 hours after admission. A numerical rating scale (NRS) was used to guide analgesia. The Algoplus score and the state of alertness or sedation were noted. NRS scores and Algoplus scores were significantly related, and both scores significantly decreased under the effect of analgesia, but the correlation was low. In early observations, the Algoplus score was higher than that predicted by the NRS score, in relation to residual sedation. Female gender tended to lower the Algoplus score compared to the NRS score. When the NRS score exceeded 3/10, indicating the need for analgesic intervention, the Algoplus score was generally lower than the recommended trigger for analgesia (2/5). These results are promising, but further evidence of a clinical benefit to the use of Algoplus for acute postoperative pain is needed. In future studies, scoring should be adjusted to take into account the time from extubation, the state of sedation, and the patient's gender in order to interpret results.
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC1405 & U1107 "Neuro-Dol", Clermont-Ferrand, France. Electronic address: cduale@chu-clermontferrand.fr.
authors.forename: Christian
authors.initials: C
authors.lastname: Dualé
authors.affiliation: CHU Clermont-Ferrand, Direction de la Recherche Clinique et des Innovations, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: CHU Clermont-Ferrand, Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, Clermont-Ferrand, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Abbal
authors.affiliation: CHU Clermont-Ferrand, Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, Clermont-Ferrand, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Julien
authors.affiliation: Univ Méditerranée, Marseille, France; AP-HM, Médecine Interne et Gériatrie, CHU Nord, Marseille, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Rat
authors.affiliation: Inserm, CIC1405 & U1107 "Neuro-Dol", Clermont-Ferrand, France; CHU Clermont-Ferrand, Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, Clermont-Ferrand, France; Univ Clermont1, Clermont-Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Schoeffler
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC1405 & U1107 "Neuro-Dol", Clermont-Ferrand, France; Univ Clermont1, Clermont-Ferrand, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Pickering
mesh_terms: D059787:Acute Pain / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis*; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index