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Myles, P. S., Wallace, S., Boney, O., et al. | Br J Anaesth (2025) 134(5):1450-1459 | An updated systematic review and consensus definitions for standardised endpoints in perioperative medicine: patient comfort and pain relief

November 29, 2025

Background: Effective postoperative acute pain management remains challenging, and it is unclear whether poorly controlled postoperative pain increases the risk of postoperative complications. This study investigated whether indicators of poor pain control are associated with an increased risk of cardiac, pulmonary, infectious, thromboembolic, and surgical complications, as well as prolonged analgesic use.

Methods: This prospective observational study combined treatment data from the German net-ra registry with claims data from the BARMER public health insurance database between March 1, 2021, and March 31, 2022. A total of 539 adult inpatients undergoing major surgery who received planned postoperative care from acute pain services were included. Adjusted binary logistic regression models compared patients with inadequately controlled pain (Numerical Rating Scale [NRS] >3) versus adequately controlled pain, patients with (NRS >6) versus without pain peaks, and patients with slow versus rapid pain recovery (based on the median time to sustained adequate pain control, NRS ≤3) in relation to postoperative complications and prolonged analgesic use as a surrogate for chronic postsurgical pain.

Results: Patients with inadequately controlled pain during the first three postoperative days had more than twice the risk of postoperative complications (adjusted odds ratio [adjOR] 2.56; 95% confidence interval [CI] 1.43-4.80; P = 0.002). Similarly, patients with slow pain recovery had a significantly higher risk of complications (adjOR 2.21; 95% CI 1.35-3.64; P = 0.002). Pain peaks were not significantly associated with postoperative complications (adjOR 1.27; 95% CI 0.64-2.42; P = 0.478). Inadequate pain control was not significantly associated with prolonged analgesic use (adjOR 1.87; 95% CI 0.98-3.72; P = 0.064), and neither pain peaks nor recovery speed significantly influenced prolonged analgesic use.

Conclusions: Poor postoperative pain control and delayed pain recovery were associated with a substantially increased risk of postoperative complications. Although no significant association with prolonged analgesic use was demonstrated, a trend was observed. These findings support regular assessment and optimization of postoperative pain management and highlight the need for further research into patient- and procedure-specific factors that contribute to pain-related adverse outcomes.