Clinical validation of a new “call-out algorithm” for postoperative pain management: a two-center prospective randomized trial

Abstract

The goal of modern postoperative pain management is to relieve pain while keeping side effects to a minimum. Still, in recent investigations, between 20% and 40% of all postoperative patients report high levels of pain after surgery, while 20-30% experience adverse effects of opioid analgetics [1,2]. In a study, in which the hospitals had introduced pain management guided by the patients' own numerical scale scores, the investigators unexpectedly found that the side effects of drugs had more than doubled [3]. The authors suggested that more than just a one-dimensional numerical assessment of pain should be undertaken, for the postoperative treatment to be safe and effective [3]. Recently, Efficacy Safety Score (ESS), a new "call-out algorithm" for monitoring of efficacy and safety of postoperative pain management and its side effects, was developed and implemented in clinical practice at Kongsberg hospital in Norway [4]. ESS was established after obtaining consensus between 10 international experts in a DELPHI process on which parameters that should be included in the score [4]. ESS consists of the sum of two subjective scores (Verbal Numeric Rate Scale of pain (VNRS) at rest and during mobilization) and four vital scores (consciousness level, postoperative nausea and vomiting, circulation and respiration status) [4]. In the present trial, we aimed to validate the influence of ESS registration and the application of a "call-out algorithm" on hospital length of stay (LOS) in two university hospitals of Kazakhstan and Russian Federation in which a policy of routine registration of pain as "the fifth vital sign" had not been adopted yet. Thus, the primary endpoint for the study was to assess LOS in groups of patients with different types of clinical data registration, while secondary endpoints were to compare the degree of mobilization, number of postoperative nonsurgical complications, and 28 days survival between the groups.