Quality of Postoperative Pain Management Following Thoracic Surgery

NCT ID: NCT01616550

Last Updated: 2013-09-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

250 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-09-30

Study Completion Date

2013-09-30

Brief Summary

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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

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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.

Conditions

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Postoperative Pain

Keywords

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analgesia thoracic surgery

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients undergoing thoracic surgery

Assessment of postoperative pain management in patients undergoing elective thoracoscopy or thoracotomy in a teaching hospital

Assessment of pain using the Brief Pain Questionnaire

Intervention Type OTHER

Patients will complete this questionnaire daily from surgery until discharge from the hospital

Assessment of pain relief using a Verbal Numeric Scale (VNS)

Intervention Type OTHER

Patients will assess their pain daily from surgery until discharge from the hospital using the VNS

Assessment of patient' satisfaction with pain relief

Intervention Type OTHER

Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied)

Nurse's satisfaction with patient's pain relief and recovery

Intervention Type OTHER

Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied)

Interventions

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Assessment of pain using the Brief Pain Questionnaire

Patients will complete this questionnaire daily from surgery until discharge from the hospital

Intervention Type OTHER

Assessment of pain relief using a Verbal Numeric Scale (VNS)

Patients will assess their pain daily from surgery until discharge from the hospital using the VNS

Intervention Type OTHER

Assessment of patient' satisfaction with pain relief

Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied)

Intervention Type OTHER

Nurse's satisfaction with patient's pain relief and recovery

Will be assessed three times a day using a scale from 1 to 4 (1= very unsatisfied, 4= very satisfied)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Consenting patients aged 18-80 years
* ASA physical status 1-3
* Patients undergoing elective thoracic surgery (thoracotomy/thoracoscopy)

Exclusion Criteria

* Current regular use of drugs belonging to the class of opioids
* Presence of a coexisting chronic pain syndrome
* The inability to understand a verbal numeric pain scale (VNS) despite previous instruction
* Patient refusal
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Centre hospitalier de l'Université de Montréal (CHUM)

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Daniel Boudreault, MD, FRCPC

Role: PRINCIPAL_INVESTIGATOR

Centre hospitalier de l'Université de Montréal (CHUM)

Locations

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Centre Hospitalier de l'Université de Montréal

Montreal, Quebec, Canada

Site Status

Countries

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Canada

Other Identifiers

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DB 2012-001

Identifier Type: -

Identifier Source: org_study_id