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Arch Hellen Med, 18(2), March-April 2001, 161-168


Pain as an outcome measure in various anesthesia and analgesia techniques


1Department of Anesthesiology, 251 Air Force General Hospital,
2Health Economics, Astra Zeneca SA,
3University of Athens, Athens, Greece

OBJECTIVE To compare the effectiveness of the most commonly used surgical anesthesia and post-operative analgesia techniques in Greek hospitals in terms of patients' reported subjective pain assessment, measured via a visual analogue scale (VAS).

METHOD A prospective, open label, multicenter study in three major general hospitals in Athens. During a period of one calendar year ending on 25/12/1998 308 patients were studied. All patients were eligible for all anesthesia techniques and participating anesthesiologists conducted their routine anesthesia and analgesia techniques. Effectiveness was measured in terms of units of pain relief via a linear VAS. The clinical significance of these scores was first tested, based on an expert opinion of a 5% clinically meaningful difference. Next, the statistical significance of the results was tested using one-way analysis of variance tests. Sensitivity analysis was carried out with particular emphasis on the extent of clinically meaningful difference.

RESULTS Combined general-epidural, combined spinal-epidural and epidural anesthesia techniques seem to result in lower early post-operative pain levels. In terms of lower achievable absolute pain levels, combined general-epidural technique was the most preferable technique with the lowest pain levels at the first pain measurement immediately after surgery. The superiority of the epidural technique was also shown in the period of post-operative analgesia. The results revealed that the absolute pain levels in the analgesia period of the patients with continuous epidural infusion were significantly lower than those with the per os and intra-muscular technique.

CONCLUSIONS Pain measurement via a linear VAS is a reliable measure of pain which can be easily incorporated into routine pain management processes. Combined general epidural and epidural alone surgical and post-operative analgesia techniques lead to lower absolute post-operative pain levels.

Key words: General anesthesia, Pain, Post-operative analgesia, Regional anesthesia, Visual analogue scale.

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