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Acute Pain | Chronic Pain | General

Postoperative fatigue

Clinical bottom line

Analgesia may attenuate immediate postoperative fatigue, but there's not much evidence that any intervention is effective for longer-tern postoperative fatigue.


After even uncomplicated surgery patients can feel tired and washed out for several months. They often need to sit or lie down, and need to sleep more. Most severe illness, like serious infection, does this, so it is not unexpected. But neither is it understood nor is it well studied.

Reference

GJ Rubin, M Hotopf. Systematic review and meta-analysis of interventions for postoperative fatigue. British Journal of Surgery 2002 89: 971-984.

Review

Thirteen different electronic databases were searched for studies. For inclusion they had to be randomised trials in English. The definition of randomisation included methods (date of birth, hospital number) known to be associated with bias. The outcome was self-reported fatigue following surgery, using any measure quantifying fatigue, and with at least one assessment more than 24 hours after surgery.

Exclusions were studies in which not all patients had undergone surgery, and organ transplant studies.

Results

There were 68 papers on 66 randomised trials. The most frequent interventions were analgesia (17 studies), psychosocial interventions (16), and nutritional (8).

Analgesia appeared to reduce fatigue on the first postoperative day. There was no overall benefit from any other intervention.

Comment

This is a well conducted review, though whether the different outcome measures of fatigue can properly be combined in a meta-analysis will exercise minds. Most trials were small, and most showed no effect. Postoperative fatigue is important and deserves more attention, first to derive some scientific framework, and secondly some quality primary studies to investigate interventions.