Quality of Postoperative Pain Management Following Thoracic Surgery
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Observational

Summary: 
      The purpose of this study is to assess the quality of postoperative pain management in a
      Canadian teaching hospital following thoracic surgery.

      Hypothesis: Postoperative pain management following thoracotomy or thoracoscopy is still
      suboptimal despite the evidence that adequate pain relief improves outcome.
    

Detailed description: 
      Pain is an expected outcome of surgery. However, many patients experience suboptimally
      managed postoperative pain. Benefits of adequate analgesia no longer need to be demonstrated.
      Optimal analgesia leads to faster recovery, reduces the risk of postoperative complications,
      enhances patient's satisfaction and quality of life following surgery.

      Currently, approximately 1000 thoracic surgeries are performed in our hospital annually. Many
      of these surgeries that previously required a thoracotomy incision are now performed under
      Video-Assisted Thoracoscopy Surgery (VATS). Although VATS is known to be less invasive and
      causes less pain than thoracotomy, some patients still experience considerable pain following
      thoracoscopy especially during the first hours following surgery.

      Thoracic epidural has emerged as the preferred pain control technique following thoracotomy.
      However, the role of epidural analgesia after thoracoscopy remains debatable. The ideal
      postoperative analgesia regimen for the short-duration but intense pain related to
      thoracoscopy has not been elucidated. Paravertebral blockade is an alternative to epidural
      analgesia. However, the duration of pain relief associated with this technique may vary from
      4 to 48 hours. Systemic opioids given through patient-controlled devices may be used after
      thoracic surgery but the analgesic effect can be limited and undesirable side-effects may
      occur.

      This prospective observational study will investigate the quality of pain management
      following thoracic surgery and assess patient's and nurse's satisfaction regarding pain
      relief in a teaching hospital.

      Methods:

      Patients scheduled for elective thoracic surgery to be performed by thoracotomy or
      thoracoscopy will be considered for this prospective observational study.

      The surgical approach and pain management plan will not be modified by the patient's
      participation to the study. According to standard practice in our hospital, pain will be
      assessed using a Verbal Numeric Scale from 0 to 10.

      Type of analgesic technique, consumption of opioid and non-opioid drugs, type and duration of
      surgery will be noted. Side-effects attributable to analgesia and associated treatment will
      be recorded. Length of stay in the recovery room, step-down unit and in the hospital will
      also be recorded. Postoperative complications will be assessed.

      Patients will be invited to complete the short form of the "Brief Pain Inventory". They will
      be asked to grade their satisfaction with pain relief using a scale from 1 to 4 (1= very
      unsatisfied, 4= very satisfied). Nurses will be asked to provide their opinion on patient's
      pain relief, ability to move and collaboration.
    

Intervention name(s): Assessment of pain using the Brief Pain Questionnaire; Assessment of pain relief using a Verbal Numeric Scale (VNS); Assessment of patient' satisfaction with pain relief; Nurse's satisfaction with patient's pain relief and recovery
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Patients will complete this questionnaire daily from surgery until discharge from the hospital; Patients will assess their pain daily from surgery until discharge from the hospital using the VNS; Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied); Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied)
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients undergoing elective thoracotomy or thoracoscopy in a teaching hospital over a one
        year period will be considered for this study
      
Keywords: analgesia; thoracic surgery