Factors associated with poor pain experience after surgery

Objective To identify factors associated with poor postoperative pain experience by examining patient-related and procedural variables. Methods An exploratory secondary analysis was conducted on data from 971 adult patients undergoing elective surgery under general anesthesia across five French teaching hospitals. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Pain, sleep quality and well-being were measured preoperatively and postoperatively using visual analog scales (VAS). The primary endpoint was the patient experience measured by the Evaluation du Vécu de l'Anesthésie Generale (EVAN-G) questionnaire on postoperative day 1, with poor pain experience defined as a score below the 25th percentile on the EVAN-G pain dimension. Univariate and multivariate logistic regression analyses were performed to identify factors associated with poor pain experience. Results Poor pain experience was reported by 271 patients (27.9%). Multivariate analysis identified intraoperative use of remifentanil and sufentanil as an independent predictor of poor pain experience with an OR of 26.96 (95% CI 2.17 to 334.23, p=0.01). Additionally, age (OR 0.97, p=0.003), absence of premedication (OR 0.49, p=0.035) and orthopedic surgery (OR 0.29, p=0.005) were associated with a lower likelihood of poor pain experience. Conversely, American Society of Anesthesiologists (ASA) 3 status (OR 5.09, p=0.028), postoperative anxiolytic use (OR 8.20, p<0.001), amnesia (OR 1.58, p=0.001), higher VAS pain (p<0.001) and lower well-being scores (p=0.007) on day 1 were predictors of poor pain experience. Conclusion The intraoperative use of remifentanil and sufentanil is independently associated with poorer postoperative pain experience. These findings highlight the need to reassess intraoperative analgesic strategies to enhance patient outcomes and reduce postoperative complications.