Predictors and barriers to adequate treatment of postoperative pain after radical prostatectomy

The purpose of this study was to identify preoperative predictors of postoperative pain and barriers to adequate treatment of pain and to describe the pain experience during 3 days after radical prostatectomy. Ninety patients undergoing radical prostatectomy under general anaesthesia with postoperative epidural analgesia were studied. "Worst pain" during the last 24 h was measured with visual analogue scale (VAS) at 24, 48 and 72 h postoperatively. Depending on their pain scores, the patients were referred to three separate groups, i.e. VAS scores 0-30 (no pain), 31-70 (moderate pain) and 71-100 (severe pain). There was a high incidence of pain, with 35 (39%) of the patients having moderate and 27 (30%) having severe pain (VAS > 70) for 1 or more days. In patients with severe pain, preoperative depression was more common (p < 0.01), opioid consumption was increased (p < 0.01) and length of hospital stay (LoS) was prolonged (p < 0.05). Catheter related problem occurred in 57% of the patients, with no intergroup variation. Aside from preoperative depression, the treatment failures could not be predicted but seemed rather to be related to barriers associated with management, technical and pharmacological factors and an inadequate service response in general to patients with moderate or severe pain.