Abstract
Background
Previous postoperative investigations report morning peaks in analgesic administration. However, few studies have examined diurnal variation of both pain and analgesic consumption and little is known about dynamic pain in this context.
Methods
The diurnal pattern of postoperative pain is described using pain intensity and analgesic consumption data from a recently published hysterectomy trial.
Results
In the presence of patient-controlled analgesia with morphine, pain at 8 a.m. was significantly higher (P < 0.05) than at noon, 4 p.m. or 8 p.m. on postoperative day one (for rest pain and pain evoked by sitting, forced expiration and cough) and on postoperative day two (for pain evoked by forced expiration and cough only). This temporal pattern was observed both with and without the co-administration of non-opioid analgesics (gabapentin and/or rofecoxib). Morphine use during the four hours preceding 8 a.m. on either postoperative day was not significantly lower than any of the other corresponding time intervals.
Conclusions
Based on data from our post-hysterectomy analgesic clinical trial, static and dynamic pain in the morning appears to be more intense than pain later in the day. This pattern was observed in the presence of substantial nocturnal morphine use. Based on these and other previous observations, specifically designed investigations are needed to better characterize the clinical, neurohormonal and neurophysiological features of postoperative circadian pain variation - including pain during sleeping hours. If the above observations are replicated, future study of nocturnal sustained-release opioids as well as time-shifting the administration of non-opioid co-analgesic drugs to the very early morning may be warranted.
Résumé
Contexte
Des recherches postopératoires précédentes ont rapporté des pics matinaux dans l’administration d’antalgiques. Toutefois, peu d’études ont examiné les variations diurnes de la douleur et de la consommation d’antalgiques, et nous ne disposons que de très peu d’éléments concernant la douleur dynamique dans ce contexte.
Méthode
L’évolution diurne de la douleur postopératoire est décrite en se basant sur des données concernant l’intensité de la douleur et la consommation d’antalgiques tirées d’une étude sur l’hystérectomie publiée récemment.
Résultats
Lors d’une analgésie contrôlée par le patient avec de la morphine, la douleur à 8 h était significativement plus élevée (P < 0,05) qu’à midi, 16 h et 20 h le premier jour postopératoire (pour la douleur au repos et la douleur provoquée par la position assise, l’expiration forcée et la toux) et le deuxième jour postopératoire (pour la douleur provoquée par l’expiration forcée et la toux uniquement). Cette évolution temporelle a été observée avec et sans co-administration d’antalgiques non opioÏ des (gabapentine et/ou rofecoxib). L’utilisation de morphine durant les quatre heures précédant 8h le premier et le second jour postopératoire n’a pas été significativement plus basse qu’à aucun autre intervalle de temps correspondant.
Conclusion
Sur la base de données tirées de notre étude clinique antalgique post-hystérectomie, les douleurs statique et dynamique semblent être plus intenses le matin que plus tard dans la journée. Cette évolution a été observée malgré une utilisation nocturne importante de morphine. En se basant sur ces observations ainsi que sur d’autres qui les ont précédées, des recherches spécifiquement conçues sont nécessaires pour mieux caractériser les aspects cliniques, neuro-hormonaux et neurophysiologiques de la variation circadienne des douleurs postopératoires, y compris la douleur pendant le sommeil. Sis observations ci-dessus sont réitérées, une future étude d’opioÏdes à libération nocturne soutenue ainsi que le décalage de l’administration d’agents co-antalgiques non opioÏdes au petit matin pourraient être recommandés.
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This work was supported by PSI Foundation Grant #00-41 and Queen’s University Grant #383-861. R.B. was supported by a Queen’s University Research Studentship and I.G. is supported by a CIHR New Investigator Award.
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Boscariol, R., Gilron, I. & Orr, E. Chronobiological characteristics of postoperative pain: Diurnal variation of both static and dynamic pain and effects of analgesic therapy. Can J Anesth 54, 696–704 (2007). https://doi.org/10.1007/BF03026866
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DOI: https://doi.org/10.1007/BF03026866