Pain perception after colorectal surgery: A propensity score matched prospective cohort study

Area of Science:

• Colorectal Surgery
• Pain Management
• Enhanced Recovery Pathways

Background:

• Enhanced recovery care pathways aim to optimize postoperative recovery.
• Multimodal pain management is often employed to reduce pain and improve outcomes.
• Comparing pain perception after open versus laparoscopic colorectal surgery is crucial for patient care.

Purpose of the Study:

• To compare pain perception and management between open and laparoscopic colorectal surgery within enhanced recovery care.
• To identify risk factors for significant postoperative pain peaks.
• To evaluate the efficacy of multimodal pain strategies compared to opioids alone.

Main Methods:

• Prospective cohort study design.
• Visual Analog Scales (VAS) used for pain assessment at rest and mobilization.
• Propensity score matching used to compare open and laparoscopic groups.
• Logistic regression analysis to identify risk factors for pain peaks (VAS ≥ 4).

Main Results:

• Mean VAS scores remained below 3 for both groups up to 96 hours postoperatively.
• Laparoscopic surgery patients experienced more pain peaks within 24 hours (p < 0.05).
• Open surgery patients experienced more pain peaks during mobilization at 72 hours (p < 0.05).
• Independent risk factors for pain peaks within 24 hours included procedure duration, emergency surgery, wound infiltration, younger age, and lower ASA score.
• Perioperative addition of lidocaine ± ketamine to opioids did not improve pain scores or reduce opioid consumption.

Conclusions:

• Overall postoperative pain is low after colorectal surgery within enhanced recovery protocols.
• Pain peaks remain a concern, particularly early after laparoscopic surgery and after epidural removal in open surgery.
• Multimodal pain management strategies were not found to be superior to opioids alone in this cohort.