Description

Kalkman et al developed a model and nomogram for the preoperative prediction of severe postoperative pain. This can help identify a patient who may benefit from closer monitoring and more aggressive management of pain. The authors are from the University Medical Center Utrecht, The Netherlands.


Patient selection: age range 15 to > 90 years

 

Parameters:

(1) gender

(2) age

(3) preoperative pain: 10 cm VAS from 0 (none) to 10 (extreme)

(4) surgery type

(5) incision size

(6) anxiety level (based on the anxiety subscore of the Amsterdam Preoperative Anxiety and Information Scale, APAIS)

(7) need for information (based on the need for information subscore of the Amsterdam Preoperative Anxiety and Information Scale, APAIS)

 

Parameter

Findings

Points

gender

male

0

 

female

3

age

15 - 19

17

 

20 - 24

16

 

25 - 29

15

 

30 - 34

13

 

35 - 39

12

 

40 - 44

11

 

45 - 49

10

 

50 - 54

9

 

55 - 59

8

 

60 - 64

7

 

65 - 69

6

 

70 - 74

4

 

75 - 79

3

 

80 - 84

2

 

85 - 89

1

 

>= 90

0

preoperative pain

0 to 10

(value) * 2

surgery type

ophthalmology

0

 

laparoscopy

5

 

ENT

8

 

orthopedic

14

 

abdominal

18

 

other

7

incision size

small (< 10 cm)

0

 

medium to large (>= 10 cm)

3

anxiety level (APAIS)

4 to 5

0

 

6 to 7

2

 

8 to 9

3

 

10 to 11

5

 

12 to 13

6

 

14 to 15

8

 

16 to 17

9

 

18 to 19

11

 

20

12

need for info (APAIS)

2

9

 

3

8

 

4

7

 

5

6

 

6

5

 

7

3

 

8

2

 

9

1

 

10

0

 

where:

• The point assignment is based on Appendix A on page 422.

 

total score =

= SUM(points for all 7 parameters)

 

Interpretatation:

• minimum score: 0

• maximum score: 82

• The higher the score the greater the risk of severe postoperative pain.

 

Total Score

Probability of Postoperative Pain

0

3%

11

5%

22

10%

34

20%

41

30%

48

40%

53

50%

59

60%

65

70%

73

80%

 

If this data is analyzed in Minitab:

 

Total Points

Percent Probability of Postoperative Pain (from 0 to 100)

0 to 48

(0.01776 * ((points)^2)) - (0.08791 * (points)) + 3.279

48 to 73+

(-0.01784 * ((points)^2)) + (3.761 * (points)) - 99.40

 


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