Has the pendulum swung too far in postoperative pain control?

BACKGROUND: The Joint Commission on Accreditation of Health Care Organizations declared pain level to be the "fifth vital sign." This has led to increased efforts to reduce patients' pain scores. Current postoperative analgesic modalities may not be entirely safe. We prospectively studied pain and sedation scores to determine whether postoperative patients were reaching sedation levels similar to patients undergoing "conscious sedation" (eg, colonoscopy cases). "Conscious sedation" patients have been shown to achieve states of sedation, which at time result in oxygen desaturation.
METHODS: Fifty-three patients within three groups were compared in an observational study. Group 1 included "conscious sedation" patients undergoing colonoscopy. Group 2 included postoperative patients using patient-controlled analgesia (PCA). Group 3 included postoperative patients under nurse-controlled analgesia (NCA). Levels of sedation were monitored using the 6-point Ramsay sedation scale. Pain and oxygen saturation were monitored using an 11-point verbal scale and finger pulse oximetry, respectively. Patients were monitored for up to 12 hours in the postoperative period or for the length of their colonoscopy procedure.
RESULTS: Patients in groups 1 and 2 reached similar sedation levels.
CONCLUSIONS: Patients may reach dangerous levels of sedation during the first 24 hours postoperatively. Patients using PCA devices warrant close observation during this time period.