2009 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 (PACU) 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 PACU. 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 ongoing study is being conducted prospectively in the PACU 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 PACU.

The student investigator will collect information in the PACU regarding pain scores, pain treatment and vital signs. When patients arrive in the PreOp Clinic, they are 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 PACU 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.