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Pain During "Noncomplex" Electrophysiological Studies and Cardiac Rhythm Device Surgery
Sven Fikenzer1, Kati Fikenzer, Yvonne Bauer
1Sven Fikenzer, PhD, MSc Scientist, Medical Department IV-Cardiology, University of Leipzig Medical Center, Germany. Kati Fikenzer, MD Senior Physician, Medical Department IV-Cardiology, University of Leipzig Medical Center, Germany. Yvonne Bauer Pain Nurse, Department of Anesthesia, Heart Center Leipzig, Germany. Michael Kuehl, MD Senior Physician, Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom. Gerhard Hindricks, MD Professor, Head, Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany. Andreas Bollmann, MD Professor, Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany. Kerstin Bode, MD, MSc Senior Physician, Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany.
Background:
There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated.
Methods:
A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0-10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection.
Results:
In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)-maxNRS, peri: 3 (0-10) versus peri-post: 4 (0-9) (ns), and meanNRS, peri: 1.4 (0-7) versus peri-post: 2.0 (0-6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain.
Conclusion:
Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.