Postoperative discomfort (other than pain) - A neglected feature of postanesthesia patient care

Objective: Patients may experience various kinds of discomfort other than pain during the immediate period following surgery and anesthesia. These complaints may not be dealt with, especially when they are shadowed by the more pressing need to alleviate pain. The issue of discomfort in the setting of an adult post anesthesia care unit (PACU) has not been adequately addressed. We assessed the extent of unreported distressing or unpleasant events among patients who had undergone general surgery or orthopedic procedures under standard general anesthesia and their recall 24 h afterwards. Methods: As customary, the PACU staff recorded vital signs, and assessed pain level; if pain score was ≤ 4/10 on a visual analogue scale (VAS), pain was considered adequately controlled. Since patients do not always volunteer reporting their feelings of discomfort, one staff member further asked them to identify and report such events at each time point in PACU and re-interviewed them 24 h later. The study was undertaken in a tertiary, university-affiliated hospital during the prime shift for two months. Results: Of the 431 studied patients, 93 (22%) expressed discomfort. Most of them (86/93 patients, 92%) recalled unpleasantness but not painful PACU events when questioned 24 h later, even though by that time they were otherwise highly satisfied with the treatment they received during the immediate perioperative period. The chief complaint was urinary catheter (43%), followed by throat and gastric tube hurting the nostril (11 cases [11%] each). Conclusions: Almost one-fourth of the patients undergoing general surgery and orthopedic procedures under general anesthesia suffered from postoperative discomfort other than pain. Of these, >90% recalled 24 h after surgery having had postoperative discomfort. PACU staff needs to inquire for and attempt reducing such events.