PROCEDURAL CONSENT – DO ACUTE AND PERSISTENT PAIN WARRANT A MENTION? 

Background and introduction 

Persistent pain after surgery is well described (1, 2), as is the strong association between unrelieved acute pain and persistent postsurgical pain (PPSP). A surgeon’s failure to inform the patient of the risk of persistent pain after a surgical procedure has resulted in an appeal by a claimant against an NHS Trust (3). The claimant argued unsuccessfully that a breach of duty took place. 

Methods

After gaining institutional approval we undertook a prospective review of procedural consent forms of patients scheduled for intermediate and major cardiothoracic surgery (via minimally invasive and traditional surgical incisions) and cardiac device insertion (pacemakers and internal cardiac defibrillators) from 01.03.2019 – 31.05.2019 in a tertiary cardiothoracic institution. 


Results
The majority of written consent for procedures was undertaken by Specialist registrars (89%).
Of the 279 patients included in this cohort, the majority were scheduled for intermediate (32.6%) or major thoracic (15.8%) surgery and cardiac surgery (36%) via median sternotomy. 
Of the total patients(279), 30.5% were consented for acute post-operative pain, and only 7.2% where consented for PPSP
Conclusions
PPSP is well established in the literature. Recent trends in judicial claims for chronic pain may change how we consent patients for surgical procedures. This review of consent practice will illustrate proportions of patients who have been consented for pain as part of their procedural consent. Following completion, the findings will be disseminated to raise awareness, promote discussion and promote changes in practice. 

1. Gan T. Poorly controlled Postoperative pain: prevalence, consequences, and prevention J Pain Res. 2017; 10: 2287–2298.
2. Bruce J, Quinlan J. Chronic Post Surgical Pain Rev Pain. 2011 Sep; 5(3): 23–29.
3. England and Wales Court of Appeal (Civil Division) Decisions (2018): http://www.bailii.org/ew/cases/EWCA/Civ/2018/1307.html; [ Accessed 17.02.2019]

PROCEDURAL CONSENT - DO ACUTE AND PERSISTENT PAIN WARRANT A MENTION?