INTRAOPERATIVE PAIN ASSESSMENT: THE USE OF ANESTHETIZED PATIENT PAIN SCALE AND CEREBRAL STATE MONITOR

Abstract

Background - Pain control in surgical patients remains problematic globally. Intraoperative pain assessment poses significant challenge to many anesthesiologists in poorly resourced countries where monitors and experts are limited.Due to poor intraoperative pain assessment and management, many patients wake up from anesthesia after surgery experiencing moderate to severe pain. It has been reported that about 56% of surgical patients cite pain as their primary concern after surgery. The aim of this study was to use a novel intraoperative pain assessment tool (APPS) and depth of anesthesia monitor (CSM) to assess and score pain in patients undergoing orthopedic procedures under general anesthesia. Methods - Data was prospectively collected for 12-months from 246 patients, aged 20 - 81 years who were undergoing orthopedic surgical procedures. Initial pain intensity was scored using Anesthetized Patients Pain Scale (APPS). The depth of anesthesia was assessed using a CSM prior to pain assessment during surgery. Fentanyl was administered and the pain and depth of anesthesia re-evaluated after 5 to 10min. Results - About 75.6% of patients scored moderate to severe pain with their depth of anesthesia ranging 37-89 score. While 20.7% scored moderate pain with a mean score of 9.56 at the initial pain assessment. A dose of fentanyl, 30 - 50 mcg was administered for pain treatment intraoperatively. Pain was re evaluated after treatment. About 31.3% scored no pain 49.6% scored moderate pain and 19.1% scored moderate to severe pain. The mean pain intensity scored after treatment was 7.30. Conclusions - Despite adequate depth of anesthesia observed during surgery about 68.7% of surgical patients experienced moderate to severe pain. The use of both APPS and CSM offered adequate intraoperative pain and anesthesia management. Our novel model, APPS has great prospects with clinical application for intraoperative pain assessment.