PAIN OUT INTERNATIONAL: Treatment of postoperative pain in Catania's area. Patient's perspective

The centre of Catania joined Pain Out International, a prospective observational project (now involving more than 60 centres) aiming to improve management of postoperative pain (PP) by providing feedback and benchmarking of patient reported outcomes regarding PP [www.pain-out.eu]. The residents of the School of Anaesthesia and Intensive Care of the University of Catania collected data in 8 different Hospitals involving 4 different surgical specialities (general surgery, orthopaedics, gynaecology and urology). We collected information from medical records and asked adult patients to fill in an anonymous questionnaire on postoperative day 1 regarding the PP treatment. We analysed data collected between March 2010 and April 2012. Non parametric tests Chi-square test with Yates correction (X2) were used for the analysis. We considered as significant a p<0.05. In total we collected data from 2706 patients (almost 10% of the international data collection) and 2441 filled in the anonymous questionnaire. Many difference were found. In such a large database we found some interesting results in the first analysis. Among them: 1. Postoperative pain after thyroidectomy seems to be treated better in the private Healthcare System. There are also consistent differences of patient s outcomes regarding postoperative pain management between all the Hospitals in our territory 2. The use of remifentanil provided worse outcomes after thyroidectomy or open abdominal uterine surgery. 3. In patients undergoing caesarean section and receiving spinal anaesthesia, morphine and fentanyl as adjunct to the local anaesthetic did not produce differences among the patient s outcome, even though patients receiving morphine required less frequently a combination of drugs to manage PP. As main results we showed the feasibility of data collection through a model based on the residents of the School of Anaesthesia and Intensive Care of the University of Catania. Moreover, Catania s contribution to the overall worldwide data collection has been outstanding. We will discuss our results with the Hospitals and surgical specialties involved in the attempt to improve the management of PP in our territory. We are aware that small sample size and study design may have affected our analysis by hiding some other significant difference. We believe that the differences seen in our subgroup analysis should be investigated in larger samples. We are planning to update our analyses once the sample of data collection in Catania will be larger and also to consider some analysis in the same subgroups (i.e. remifentanil anaesthesia) of the overall data collected so far in Pain Out Project.