There is a lack of literature regarding the procedure-specific quality of acute postoperative pain management after midfacial fracture repair. The purpose of the presented prospective clinical study was to evaluate postoperative pain management after surgical repair of midfacial fractures.
Materials and methods
Eighty-five adults were evaluated on the first postoperative day following midfacial repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. The main outcome measures were patients’ characteristics and clinical- and patient-reported outcome parameters.
Overall, pain on the first postoperative day was moderate. A significant correlation between process and outcome parameters could be shown. Duration of surgery above the calculated median was significantly associated with higher maximum pain intensity (p = 0.017). Patients requiring opioids in the recovery room presented significantly higher pain on activity (p = 0.029) and maximum pain (p = 0.035). Sleeping impairment (p = 0.001) and mood disturbance (p = 0.008) were significantly more prevalent in patients undergoing repair of a centrolateral midfacial fracture.
QUIPS is a simple and qualified tool to evaluate the procedure specific quality of acute postoperative pain management. Pain on the first postoperative day following midfacial fracture repair seems overall to be moderate. Nearly a third of the patients showed inadequate postoperative pain management. To prevent inadequate postoperative pain management, it is necessary to establish a continued procedure-specific outcome measurement.
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Kehlet H (2004) Effect of postoperative pain treatment on outcome-current status and future strategies. Langenbecks Arch Surg 389:244–9. doi:10.1007/s00423-004-0460-4
Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21:149–59
Gartner R, Jensen MB, Nielsen J, Ewertz M, Kroman N, Kehlet H (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302:1985–92. doi:10.1001/jama.2009.1568
Rathmell JP, Wu CL, Sinatra RS, Ballantyne JC, Ginsberg B, Gordon DB, Liu SS, Perkins FM, Reuben SS, Rosenquist RW, Viscusi ER (2006) Acute post-surgical pain management: a critical appraisal of current practice, December 2-4, 2005. Reg Anesth Pain Med 31:1–42. doi:10.1016/j.rapm.2006.05.002
Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97:534–40, table of contents
Benhamou D, Berti M, Brodner G, De Andres J, Draisci G, Moreno-Azcoita M, Neugebauer EA, Schwenk W, Torres LM, Viel E (2008) Postoperative analgesic therapy observational survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain 136:134–41. doi:10.1016/j.pain.2007.06.028
Fries BE, Simon SE, Morris JN, Flodstrom C, Bookstein FL (2001) Pain in U.S. nursing homes: validating a pain scale for the minimum data set. Gerontologist 41:173–9
Gureje O, Simon GE, Von Korff M (2001) A cross-national study of the course of persistent pain in primary care. Pain 92:195–200
Warfield CA, Kahn CH (1995) Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology 83:1090–4
Fletcher D, Fermanian C, Mardaye A, Aegerter P (2008) A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 137:441–51. doi:10.1016/j.pain.2008.02.026
Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L (2006) Measuring pain as the 5th vital sign does not improve quality of pain management. J Gen Intern Med 21:607–12. doi:10.1111/j.1525-1497.2006.00415.x
Gordon DB, Dahl JL (2004) Quality improvement challenges in pain management. Pain 107:1–4
Ellis E, Zide MF, Carmichael J (2006) Surgical approaches to the facial skeleton. Lippincott Williams & Wilkins, Philadelphia
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM (2000) Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 84:6–10
Sommer M, Geurts JW, Stessel B, Kessels AG, Peters ML, Patijn J, van Kleef M, Kremer B, Marcus MA (2009) Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg 135:124–30. doi:10.1001/archoto.2009.3
Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86:598–612
Beattie WS, Buckley DN, Forrest JB (1993) Epidural morphine reduces the risk of postoperative myocardial ischaemia in patients with cardiac risk factors. Can J Anaesth 40:532–41. doi:10.1007/BF03009738
Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, Lipman AG, Bookbinder M, Sanders SH, Turk DC, Carr DB (2005) American pain society recommendations for improving the quality of acute and cancer pain management: American pain society quality of care task force. Arch Intern Med 165:1574–80. doi:10.1001/archinte.165.14.1574
Rawal N, Berggren L (1994) Organization of acute pain services: a low-cost model. Pain 57:117–23
Rosenquist RW, Rosenberg J (2003) Postoperative pain guidelines. Reg Anesth Pain Med 28:279–88
Meissner W, Mescha S, Rothaug J, Zwacka S, Goettermann A, Ulrich K, Schleppers A (2008) Quality improvement in postoperative pain management: results from the QUIPS project. Dtsch Arztebl Int 105:865–70. doi:10.3238/arztebl.2008.0865
Hyllested M, Jones S, Pedersen JL, Kehlet H (2002) Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 88:199–214
Rothaug J, Weiss T, Meissner W (2013) How simple can it get? Measuring pain with NRS items or binary items. Clin J Pain 29(3):224–32
Meissner W, Ullrich K, Zwacka S (2006) Benchmarking as a tool of continuous quality improvement in postoperative pain management. Eur J Anaesthesiol 23:142–8. doi:10.1017/S026502150500205X
Savoia G, Alampi D, Amantea B, Ambrosio F, Arcioni R, Berti M, Bettelli G, Bertini L, Bosco M, Casati A, Castelletti I, Carassiti M, Coluzzi F, Costantini A, Danelli G, Evangelista M, Finco G, Gatti A, Gravino E, Launo C, Loreto M, Mediati R, Mokini Z, Mondello E, Palermo S, Paoletti F, Paolicchi A, Petrini F, Piacevoli Q, Rizza A, Sabato AF, Santangelo E, Troglio E, Mattia C (2010) Postoperative pain treatment SIAARTI Recommendations 2010. Short version. Minerva Anestesiol 76:657–67
Conflict of interest statement
The authors declare that they have no conflict of interest. There were no sources of funding or financial relationships.
Repair of a centrolateral midfacial fracture, long duration of surgery, and need of opioids in the recovery room seem to be associated with higher postoperative pain levels.
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Raschke, G.F., Peisker, A., Rieger, U. et al. Quality of postoperative pain management after midfacial fracture repair—an outcome-oriented study. Clin Oral Invest 19, 619–625 (2015). https://doi.org/10.1007/s00784-014-1283-5
- Postoperative pain
- Quality management
- Zygomaticomaxillary complex fracture
- Blow-out fracture
- Orbital floor fracture