TY - JOUR
T1 - The effectiveness of a transitional pain service in patients undergoing surgery with an increased risk of developing chronic postsurgical pain (TRUSt study). A randomized clinical trial
AU - Admiraal, Manouk
AU - Hermanides, Jeroen
AU - Meinsma, Soe L.
AU - Wartenberg, Hans C. H.
AU - Rutten, Martin V. H.
AU - Heine, Yvonne
AU - Kallewaard, Jan Willem
AU - Hollmann, Markus W.
AU - Hermanns, Henning
N1 - Funding Information: This study was funded by the Amsterdam UMC innovation grant. We thank all the research team, clinical staff, and most importantly the study participants for their effort and time. We thank Dick Lieven for the constructive feedback on the opioid conversion methodology. We thank Lyonne N.L. Zonneveld for helping design the folder on pain and patient empowerment, and the opportunity to consult a pain psychologist. Funding Information: The funder of this study (Amsterdam UMC innovation grant) had no role in study design, data collection, data analysis, data interpretation, or writing of the report.This study was funded by the Amsterdam UMC innovation grant. We thank all the research team, clinical staff, and most importantly the study participants for their effort and time. We thank Dick Lieven for the constructive feedback on the opioid conversion methodology. We thank Lyonne N.L. Zonneveld for helping design the folder on pain and patient empowerment, and the opportunity to consult a pain psychologist. Publisher Copyright: © 2023 The Authors
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Study objective: Poorly controlled acute postsurgical pain is associated with delayed recovery, chronic postsurgical pain (CPSP), chronic opioid use and impaired functioning in daily activities. The aim was to determine the effectiveness of a transitional pain service (TPS) to improve quality of recovery for patients at risk of CPSP. We hypothesized that a TPS improves the quality of recovery in patients at risk of CPSP. Design: Single-center, pragmatic, randomized, superiority trial. Setting: Tertiary hospital in the Netherlands. Patients: Assessed for eligibility if ≥18 years of age, undergoing elective surgery, and had an increased risk of developing CPSP. After being stratified for sex, 176 patients were included. Intervention: Patients were randomized to receive TPS or standard of care (SOC). TPS was a multidisciplinary intervention providing a patient-tailored perioperative pain management plan, throughout all phases of surgery. Measurements: The primary outcome was the difference in quality of recovery on the third postoperative day, measured by the Quality of Recovery (QoR)-15 questionnaire. Secondary outcomes include the between group differences in opioid consumption. Main results: The primary outcome was available in 169 (96.0%) patients. No difference between groups was found in QoR-15 on the third postoperative day (mean difference 2.0, 95% CI -5.5 to 9.4, p = 0.607). A decrease in opioid usage (compared to baseline) was observed in chronic opioid users, the median [IQR] reduction in total daily oral morphine milligram equivalents (MME) for TPS was −30 [−60, 0] at three and − 29.3 [−65.6, 0] at six months, whereas SOC had a median reduction of 0 [−56, 0] at three, and 0 [−60, 7.5] at six months. Conclusions: TPS did not significantly affect short-term quality of recovery but might improve long-term outcomes, such as the incidence of chronic pain, opioid consumption, and functioning in daily life. However, sample size in the present study was too small to provide solid evidence for this positive signal.
AB - Study objective: Poorly controlled acute postsurgical pain is associated with delayed recovery, chronic postsurgical pain (CPSP), chronic opioid use and impaired functioning in daily activities. The aim was to determine the effectiveness of a transitional pain service (TPS) to improve quality of recovery for patients at risk of CPSP. We hypothesized that a TPS improves the quality of recovery in patients at risk of CPSP. Design: Single-center, pragmatic, randomized, superiority trial. Setting: Tertiary hospital in the Netherlands. Patients: Assessed for eligibility if ≥18 years of age, undergoing elective surgery, and had an increased risk of developing CPSP. After being stratified for sex, 176 patients were included. Intervention: Patients were randomized to receive TPS or standard of care (SOC). TPS was a multidisciplinary intervention providing a patient-tailored perioperative pain management plan, throughout all phases of surgery. Measurements: The primary outcome was the difference in quality of recovery on the third postoperative day, measured by the Quality of Recovery (QoR)-15 questionnaire. Secondary outcomes include the between group differences in opioid consumption. Main results: The primary outcome was available in 169 (96.0%) patients. No difference between groups was found in QoR-15 on the third postoperative day (mean difference 2.0, 95% CI -5.5 to 9.4, p = 0.607). A decrease in opioid usage (compared to baseline) was observed in chronic opioid users, the median [IQR] reduction in total daily oral morphine milligram equivalents (MME) for TPS was −30 [−60, 0] at three and − 29.3 [−65.6, 0] at six months, whereas SOC had a median reduction of 0 [−56, 0] at three, and 0 [−60, 7.5] at six months. Conclusions: TPS did not significantly affect short-term quality of recovery but might improve long-term outcomes, such as the incidence of chronic pain, opioid consumption, and functioning in daily life. However, sample size in the present study was too small to provide solid evidence for this positive signal.
KW - Analgesics
KW - Operative
KW - Opioid
KW - Pain
KW - Pain management
KW - Postoperative
KW - Surgical procedures
UR - http://www.scopus.com/inward/record.url?scp=85171353863&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jclinane.2023.111262
DO - https://doi.org/10.1016/j.jclinane.2023.111262
M3 - Article
C2 - 37722149
SN - 0952-8180
VL - 91
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
M1 - 111262
ER -