Patient satisfaction with postoperative analgesia in ICU: pain is not the unique determinant

Despite advances in its management, pain is a frequent problem in ICU. It is a major determinant of patient stress and it is also correlated with morbidity, probably due to sympathetic activation, respiratory restriction, immobility, etc. Several studies have tried to validate different tools for analgesia evaluation, but they fail to evaluate the impact of pain management strategies on patient satisfaction.

Our objective was to evaluate whether different pain management strategies alter postoperative ICU patient satisfaction reports. A total of 110 postoperative patients without evident cognitive deficits were evaluated. We obtained data about type of surgery, type of analgesia used (continuous or intermittent, regularly administered or on a patient-demand basis), patient pain scores from an analogic-visual pain scale (AVPS: 0, no pain; 4, moderate pain; 10, most severe pain) and patient satisfaction scores at the moment they left the ICU.

Sixty per cent of the patients were males, 40% were females, and mean age was 63 ± 17 years (mean ± SE). Of the patients investigated 82% gave high satisfaction scores with the analgesia strategy used, but 18% (20 patients) were not satisfied, referring they had unbearable pain during ICU stay; from those 20 patients, 10 (50%) never referred a pain score above3 during ICU, 13 (66%) were female and 16 (80%) did not receive analgesia on a regular basis.

Our data suggest that evaluation of satisfaction with pain management in ICU should take into account pain scores, but also a specific satisfaction questionnaire. We could observe that female and patients with on-demand-basis analgesia are more prone to refer low levels of satisfaction with pain management. Further, simple pain scores like the classical analogic-visual pain scale may fail to detect pain in the ICU patient because of a putative high incidence of a communication disorder.