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Cited by 37Anesthesia and Pain ManagementPain Management and Opioid UsePediatric Pain Management Techniques

Locked out and still knocking: predictors of excessive demands for postoperative intravenous patient-controlled analgesia

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Katz, Joel, Buis, Tom, Cohen, Lorenzo·2008·Canadian Journal of Anesthesia/Journal canadien d'anesthésie
DOI 10.1007/bf03016320
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Abstract

Background Psychosocial factors governing the use of postoperative, intravenous patient-controlled analgesia (PCA) have received little attention in spite of the fact that PCA is the most common modality for managing pain after surgery. The motivation behind requests for analgesia during lockout periods is not known. Unrelieved pain and need for pain medication are obvious reasons but other factors may be involved. The aim of the present study was to predict PCA lockout interval demands based on preoperative psychosocial factors.Methods Approximately one week before major abdominal gynecologic surgery, 117 women completed the impact of events scale (IES) measuring intrusive thoughts and avoidant behaviours. Pain was measured by visual analogue scale at three, six, 12, 24 and 48 hr after surgery. Measures of anxiety and negative affect were obtained 24 and 48 hr after surgery. Cumulative morphine consumption and every PCA demand (drug delivered and not delivered) were downloaded from the PCA pump.Results Multiple regression analyses revealed that preoperative intrusive thoughts and avoidant behaviours about the upcoming surgery positively predicted PCA lockout interval demands after controlling for postoperative pain, morphine consumption, anxiety, and negative affect (R2 = 0.45; P < 0.0001). Path analysis showed a direct pathway from preoperative IES scores to lockout interval demands (beta = 0.23, P = 0.002) which was not associated with untreated pain, anxiety, or negative affect.Conclusions Excessive demands for postoperative intravenous- PCA morphine during lockout intervals appear to reflect, in part, poor preoperative adaptation to surgery involving intrusive thoughts and avoidant behaviours about the upcoming surgery.

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  • Negative affect and pain catastrophizing are risk factors for intense acute postoperative pain and excessive opioid use.

    “Negative affect and pain catastrophizing are also risk factors for intense, acute postoperative pain and excessive opioid use.50–52”

    From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [52]

    The Path analysis section links preoperative intrusive thoughts and avoidance to heightened postoperative pain and greater morphine consumption; the Discussion also reports associations between perioperative anxiety, pain, and PCA morphine use. But this study did not establish that negative affect and pain catastrophizing are each risk factors for both outcomes: it measured negative affect without finding it on the reported pain-to-morphine pathway, and catastrophizing appears chiefly in discussion of other work. The cited paper studied 117 women after major abdominal gynecologic surgery, so the unqualified claim is broader than its findings. (LLM, conf=0.84)

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2 retracted

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Research works printed but not linked: 2

  1. Savoia G, Loreto M, Gravino E. Sufentanil: an over- view of its use for acute pain management. Minerva Anestesiol 2001; 67: 206-16.
  2. Salmon P, Hall GM. PCA: patient-controlled analgesia or politically correct analgesia? Br J Anaesth 2001; 87: 815-8.

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Authors
Katz, J., Buis, T., & Cohen, L.
Affiliations
  • York University (CA)
  • The University of Texas MD Anderson Cancer Center (US)
Corresponding author
Katz, Joel
ORCID
Venue
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Publisher
Springer Science and Business Media LLC
Published
2008-02
Volume
55
Issue
2
Pages
88-99
ISSN
  • 0832-610X (ISSN-L)
  • 1496-8975
DOI
10.1007/bf03016320
OpenAlex
W1587837764
Cited by
37
References
51
Citations by year
2025: 1 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 2 · 2016: 1 · 2015: 3 · 2014: 4 · 2013: 4 · 2012: 3
FWCI
2.46
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
  • PubMed (publishedVersion)
  • YorkSpace (York University) (submittedVersion)
Funders
  • National Institutes of Health (1r01ns035480-01a1)
  • Canadian Institutes of Health Research
  • National Institute of Neurological Disorders and Stroke (NS 35480)
Topics
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
patient-controlled analgesia, postoperative pain, intrusive thoughts, morphine consumption, anxiety, negative affect, Impact of Event Scale
MeSH terms
Adult, Aged, Analgesics, Opioid, Female, Humans, Infusions, Intravenous, Middle Aged, Morphine, Neuropsychological Tests, Pain Measurement, Postoperative Pain, Regression Analysis, Time Factors, Analgesia, Patient-Controlled

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