2008 Faculty Researchers

Alice L. Landrum, MD

Pain Scores in the Post Anesthesia Care Unit and Association with Vital Signs

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Department

Anesthesiology and Perioperative Medicine

Office Location

3W27 Health Science Center

Phone #:

Office: (573) 882-2568
Fax: (573) 882-2226

Summary

Uncontrolled postoperative pain can produce a range of detrimental effects including activation of the sympathetic nervous system which can result in tachycardia, hypertension and tachypnea. A recent retrospective study that was published in the emergency medicine literature (Acad Emerg Med. 2006; 13:974-979) concluded that there was no relationship between pain scores and heart rate, blood pressure or respiratory rate.

The anesthesia literature has reported detrimental effects from uncontrolled postoperative pain which activates the sympathetic nervous system leading to an elevation of heart rate and blood pressure that causes increased myocardial oxygen consumption, myocardial ischemia and infarction.

Anesthesiologists and post anesthesia care unit (P ACU) nurses frequently use a self-reported pain score or the presence of moaning and grimacing as well as elevated vital signs to help guide pain management in the P ACU. The tool most commonly used for adults at our institution is the self-reported 11 point verbal numeric scale (a simple descriptive pain intensity scale) with 0 as no pain and 10 as the worst pain imaginable.

This study will be conducted prospectively in the P ACU to determine if an association exists between self-reported pain scores and heart rate (HR), blood pressure (BP) and respiratory rate (RR) in adult post surgical patients presenting to the P ACU. If the patient is too obtunded to give a pain score, the investigators will look at the presence of moaning, grimacing, posturing, abnormal movements and oxygen requirements to determine if there is an association with abnormal vital signs.

After obtaining approval from the IRB, the student investigator will collect information in the P ACU regarding pain scores, pain treatment and vital signs. On the day of surgery when patients arrive in the holding area, they will be invited to participate in this study. Before surgery the investigators will obtain a pain score and a set of vital signs. When the patients arrive in the P ACU after surgery, the investigator will collect at

15 minute intervals self-reported pain scores and vital signs until the patients are discharged from the PACU. If the patient is too obtunded to report a pain score, the investigator will collect information regarding facial expression, posture, body movement, vocalization (i.e. moans) and oxygen requirements. The investigator will also collect information regarding pain therapy in the PACU.

The investigators plan to collect prospective data from at least 100 patients. Data will include patients’ ages, gender, HR, BP, RR, pain scores, analgesics, and operative procedures. They will analyze the data to determine if there is a correlation between pain scores and vital signs in the PACU. The hypothesis for this study is that an elevated pain score is associated with abnormal vital signs.