Postoperative pain management in France : a national prospective study

Position du problème et objectif(s) de l’étude

Postoperative pain management remains a critical issue in surgical care. While past French studies revealed high rates of severe pain and suboptimal analgesia use, recent improvements were reported but previous studies lacked methodological rigor. This study aimed to fill this gap by assessing postoperative pain management practices in France through a prospective national survey.

Matériel et méthodes

The AlgoSFAR 2 study was a prospective, multicentre, observational study across 99 French surgical centres, randomly selected, including patients undergoing elective surgery on September 30 and October 1, 2024. The primary objective was to assess pain intensity at rest and during mobilization over the first three postoperative days using the Numerical Rating Scale (NRS). Secondary outcomes included analgesic use, adverse effects, and organizational pain management practices. The study was supported by the SFAR research network and obtained the approval from its ethics committee (IRB 00010254 ‐ 2024 – 025).

Résultats & Discussion

A total of 81 centres finally participated in the study, contributing data from 3,879 patients to the final analysis. The mean age was 57 ± 18 years and included 53% women (Table 1). The majority of patients were classified as ASA I or II (28% and 46%, respectively) and did not receive preoperative analgesic treatment (81%). The most common surgical specialties were orthopaedic (30%), digestive (14%), and urologic (12%) surgeries. Pain scores at rest were minimal preoperatively and in the recovery room. A marked increase was observed on postoperative day 1, with a wide interindividual variability, including extreme values up to 10. While median pain scores decreased from day 2 onward, variability persisted, indicating that a substantial proportion of patients continued to report moderate-to-severe pain during mobilization through day 3. The evolution of pain during mobilization over the first 3 postoperative days is shown on Figure 1.

Table 1: Characteristics of the population
Age, mean ± SD (years)	57 ± 18
Sex, n (%) Female Male	2064 (53%) 1814 (47%)
ASA score, n (%) 1 2 3 4	1055 (28%) 1755 (46%) 1007 (26%) 16 (0%)
Preoperative NRS, median [IQR]	1 [1-1]
Preoperative analgesic use, n (%) None Level 1 Level 2 Level 3 Antidepressant therapy Gabapentinoid therapy	3120 (81%) 539 (14%) 193 (5%) 175 (5%) 27 (1%) 61 (2%)
Premedication, n (%) Analgesic Anxiolytic	547 (14%) 321 (8%)
Surgical specialty, n (%) Orthopaedic Digestive Urological Gynaecological (excluding breast) Ear, nose and throat Vascular Plastic Endoscopic Breast Dental Ophthalmic Proctological Thoracic Interventional radiology Other	1180 (30%) 554 (14%) 468 (12%) 288 (7%) 250 (6%) 226 (6%) 205 (5%) 118 (3%) 112 (3%) 112 (3%) 89 (2%) 64 (2%) 40 (1%) 34 (1%) 72 (2%)

Conclusion

These results, based on a rigorous methodology, underlined the need for adapted pain management strategies, particularly in the early postoperative period.

Auteurs

Emile DAUREL (1) , Chafia DAOUI (2), Chloe ROUSSEAU (1), Helene BELOEIL (1), Pauline ROUXEL (1), . ALGOSFAR GROUP (2), . SFAR RESEARCH NETWORK (2) - (1)Chu De Rennes, Rennes, France, (2)Sfar, Paris, France

Orateur(s)

Emile DAUREL (Rennes)