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Risk factors for increased postoperative pain and recommended orderset for postoperative analgesic usage

Clinical Journal of PainArmstrong AD, Hassenbein SE, Black S, et al. | October 13, 2020

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At researchers' institution, an interdisciplinary pain team was established with the aim to determine options for enhancing pain control in patients undergoing orthopedic surgery by recognizing traits that put a patient at raised risk for inadequate pain control postoperatively. The following seven potential risk factors were identified by the interdisciplinary pain team that may result in inadequate pain control postoperatively: (1) history of physical, emotional, or sexual abuse; (2) history of anxiety; (3) history of drug or alcohol abuse; (4) preoperative nonsteroidal anti-inflammatory drug, or disease-modifying antirheumatic drug use; (5) current opioid use; (6) psychological conditions other than anxiety; and (7) current smoker. Among the 1,923 retrospectively identified patients undergoing elective orthopedic surgery, 78.5% had 3 or fewer risk factors and 17.1% had no risk factors. Anxiety, current smoking, psychological conditions, and current opioid use were noted to be significantly associated with increased preoperative and postoperative reported pain score. Researchers emphasize that recognition of these risk factors should prompt greater attention to postoperative pain control plans and will improve communication with patients and providers. In this study, a multimodal approach is recommended to postoperative pain control, and a pain orderset was developed to help guide providers.  

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