Influence of Surgical Complications on the Level of Pain after Radical Inguinal/Iliacal Lymph Node Dissection

Abstract

Background: We collected the data of 288 patients with malignant skin tumours. We analysed the postoperative pain assessed by a visual analogue scale (VAS) to evaluate the quality of our standard peri-operative pain therapy after a radical inguinal and iliacal lymph node dissection (RILND) as well as the influence of postoperative surgical complications on the level of pain.

Materials and method: The postoperative level of pain of 85 patients with malignant skin tumours who underwent a RILND between August 2003 and December 2007 was recorded prospectively. Patients received a standardised perioperative pain therapy according to level I or II of the World Health Organisation (WHO) ladder of pain. The efficiency of our pain therapy was registered via VAS in the morning of the first three postoperative days. Results: Using our standard pain therapy, we determined a VAS < 30 in rest during the first three postoperative days, but significantly more pain (VAS median 50–30) (p < 0.001) under stress. Patients with surgical complications in the postoperative period (n = 71) had significantly more pain in the postoperative period compared to patients with a regular postoperative course (p = 0.047).

Conclusions: Immediately after a RILND, an analgesic therapy according to level I or II of the WHO pain ladder does not seem to be effective enough. Postoperative surgical complications lead to a higher VAS level of pain in the postoperative period.

Key Words:

• Melanoma
• lymph node dissection
• pain
• visual analogue pain scale.

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Notes on contributors

H. Neuss

Heiko Neuss, M.D. Department of General-, Visceral-, Thoracic-and Vascular Surgery Charité Campus Mitte Charitéplatz 1 10117 Berlin, Germany Tel.: [phone] Fax: [phone] E-mail: [email protected]