Quality of Postoperative Pain Management Following Thoracic Surgery

• Pain relief according to analgesic technique [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  

• Consumption of analgesics [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  
• Interference of pain on daily activities [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  
• Patient's satisfaction with pain relief [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  
• Nurse's satisfaction with patient's pain relief, mobility and collaboration [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  
• Length of stay in the recovery room [ Time Frame: From arrival (Day 0) until discharge from the recovery room (Day 0) ] [ Designated as safety issue: No ]
  
• Length of stay in the step-down unit [ Time Frame: From arrival (Day 0) until discharge from the step-down unit (Day 1) ] [ Designated as safety issue: No ]
  
• Length of stay in the hospital [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  
• Side-effects attributable to analgesia [ Time Frame: From surgery (Day 0) to discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  
• Presence of postoperative complications [ Time Frame: From surgery (Day 0) until discharge from the hospital (Day 5) ] [ Designated as safety issue: No ]
  

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.