Reduced pain intensity at the first dressing improves postoperative pain control after anorectal surgery

Abstract

This study aimed to investigate the effects of first dressing changes on the postoperative pain intensity and the duration of pain in patients after anorectal surgeries to provide evidence for improving postoperative pain control. A total of 164 patients with an anorectal disease scheduled to undergo surgery were enrolled in this study, and their postoperative pain levels and duration were recorded. The status of severe pain for a rating score ≥7 during hospitalization after surgery was considered as the study endpoint. The pain score at the first dressing change was recorded and considered a potential risk factor for predicting severe pain during hospitalization by logistic regression analysis. Comparisons of postoperative pain outcomes between patients with a pain rating score ≥7 or <7 were performed before and after propensity score matching. Severe pain (rating score ≥7) at the first dressing change was an independent risk factor for severe pain during hospitalization (odds ratio (OR) = 8.33, p < 0.001). Pain on the first night after surgery in the Severe group was higher than in the Non-Severe group (3.2 ± 0.9 vs. 2.8 ± 1.0, p = 0.006). Patients in the Severe group had higher pain number rating scale (NRS) scores at the second (5.2 ± 1.3 vs. 3.1 ± 1.2, p < 0.001) and third (3.5± 1.5 vs. 1.9 ± 0.9, p < 0.001) dressing change than those in the Non-Severe group. Moreover, the overall NRS pain score during hospitalization in the Severe group was significantly higher than the Non-Severe group (5.7 ± 1.1 vs. 3.9 ± 1.5, p < 0.001), and the incidence of severe postoperative pain during hospitalization was also higher (61.6% vs. 12.1%, p < 0.001). In addition, pain duration in the Severe group was significantly longer than in the Non-Severe group (10 (3, 18) vs. 5 (2, 10), p < 0.001). Regarding the distributions of propensity scores, the overall NRS pain score during hospitalization in the Severe group was significantly higher than in the Non-Severe group (5.7 ± 1.1 vs. 3.8 ± 1.4, p < 0.001), as well as a higher incidence in severe postoperative pain (61.2% vs. 7.5%, p < 0.001), which was accompanied by a significantly longer pain duration in the Severe group (10 (3, 18) vs. 5 (2, 10), p < 0.001). Moreover, subgroup analysis showed that patients in the Severe group had higher overall pain NRS scores than the Non-Severe group for both the Milligan-Morgan (5.6 ± 1.5 vs. 4.0 ± 1.1, p < 0.001) and Thread-ligating (5.8 ± 1.4 vs. 3.9 ± 1.0, p < 0.001) surgery groups. Pain intensity at the first dressing change was sociated with the intensity and duration of postoperative pain in patients who underwent anorectal surgery. Thus, proper actions are needed to relieve the pain intensity at the first dressing change.