Risk Factors and Early Pharmacological Interventions to Prevent Chronic Postsurgical Pain Following Cardiac Surgery

2014 ◽  
Vol 14 (5) ◽  
pp. 335-342 ◽  
Author(s):  
Kari Hanne Gjeilo ◽  
Roar Stenseth ◽  
Pål Klepstad
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Pharmacological Interventions ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals Postoperative Pain and Analgesic Requirements in the First Year after Intraoperative Methadone for Complex Spine and Cardiac Surgery

2020 ◽  
Vol 132 (2) ◽  
pp. 330-342 ◽  
Author(s):  
Glenn S. Murphy ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Torin D. Shear ◽  
Mark A. Deshur ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Spinal Surgery ◽  
Ordinal Data ◽  
Median Score ◽  
Postsurgical Pain ◽  
Surgical Closure ◽  
Chronic Postsurgical Pain ◽  
To Receive ◽  
Weekly Frequency

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Methadone is a long-acting opioid that has been reported to reduce postoperative pain scores and analgesic requirements and may attenuate development of chronic postsurgical pain. The aim of this secondary analysis of two previous trials was to follow up with patients who had received a single intraoperative dose of either methadone or traditional opioids for complex spine or cardiac surgical procedures. Methods Preplanned analyses of long-term outcomes were conducted for spinal surgery patients randomized to receive 0.2 mg/kg methadone at the start of surgery or 2 mg hydromorphone at surgical closure, and for cardiac surgery patients randomized to receive 0.3 mg/kg methadone or 12 μg/kg fentanyl intraoperatively. A pain questionnaire assessing the weekly frequency (the primary outcome) and intensity of pain was mailed to subjects 1, 3, 6, and 12 months after surgery. Ordinal data were compared with the Mann–Whitney U test, and nominal data were compared using the chi-square test or Fisher exact probability test. The criterion for rejection of the null hypothesis was P < 0.01. Results Three months after surgery, patients randomized to receive methadone for spine procedures reported the weekly frequency of chronic pain was less (median score 0 on a 0 to 4 scale [less than once a week] vs. 3 [daily] in the hydromorphone group, P = 0.004). Patients randomized to receive methadone for cardiac surgery reported the frequency of postsurgical pain was less at 1 month (median score 0) than it was in patients randomized to receive fentanyl (median score 2 [twice per week], P = 0.004). Conclusions Analgesic benefits of a single dose of intraoperative methadone were observed during the first 3 months after spinal surgery (but not at 6 and 12 months), and during the first month after cardiac surgery, when the intensity and frequency of pain were the greatest.

Prevalence, characteristics and risk factors of chronic postsurgical pain after laparoscopic colorectal surgery

2015 ◽  
Vol 32 (10) ◽  
pp. 712-717 ◽  
Author(s):  
Jean L. Joris ◽  
Mathieu J. Georges ◽  
Kamel Medjahed ◽  
Didier Ledoux ◽  
Gaëlle Damilot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals Incidence and Risk Factors for Chronic Postsurgical Pain Following Video-assisted Thoracoscopic Surgery: a Retrospective Study

2021 ◽  
Author(s):  
Yingying Zhang ◽  
Rong Zhou ◽  
Bailing Hou ◽  
Suhong Tang ◽  
Jing Hao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Thoracoscopic Surgery ◽  
Rescue Analgesia ◽  
Postsurgical Pain ◽  
Video Assisted ◽  
Chronic Postsurgical Pain ◽  
Severe Chronic Pain ◽  
Independent Risk Factors ◽  
Video Assisted Thoracoscopic Surgery

Abstract Backgroud: Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods: We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP.Results: 2,348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1,033 of 2,348). Within those suffering CPSP, 14.71% (n = 152 of 1,033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. According to multivariable analysis, age ＜ 65 years (OR 1.278, 95% CI 1.057-1.546, P = 0.011), female (OR 1.597, 95% CI 1.344-1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090-1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696-3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047-1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159-3.574, P = 0.013), subcutaneous emphysema of chest wall postoperative (OR 1.255, 95% CI 1.000-1.575, P = 0.050), and history of postoperative wound infection (OR 5.949, 95% CI 1.344-1.898, P < 0.001) were independent risk factors for CPSP development.Conclusions: CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration: Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24

scholarly journals Transition from Acute to Chronic Pain: Evaluating Risk for Chronic Postsurgical Pain

2019 ◽  
Vol 5 (22;5) ◽  
pp. 479-488
Author(s):  
Jingping Wang
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Predictive Models ◽  
Narrative Review ◽  
Current Understanding ◽  
Anesthetic Techniques ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Pain Sensitization ◽  
Underlying Pathophysiology

Background: The pathophysiology of pain involves complex nervous system interactions after initial noxious stimuli. When stimuli persist, biochemical and structural changes occur in the nociceptive pathways of the central and peripheral nervous systems, leading to pain sensitization. Peripheral and central sensitization are key in the transition from acute to chronic pain. This development of chronic pain is particularly common following various surgical procedures, with many postsurgical patients experiencing persistent pain for significant periods. Chronic pain is a common and severe complication of surgery, and preventing its development is tantamount in improving patient outcomes. Objectives: To understand underlying pathophysiology of chronic postsurgical pain (CPSP) and the underlying risk factors predisposing the transition from acute to CPSP. To review our ability to identify patients at highest risk for the development CPSP. To identify evidence-based multimodal approaches that can aid in the prevention of CPSP. Study Design: Narrative review of peer-reviewed literature. Setting: Inpatient surgical centers. Methods: Medline and Cochrane databases were reviewed to identify publications relevant to CPSP pathophysiology, risk factors, predictive models, and prevention. Publications were selected based on author expertise to summarize our current understanding of CPSP. Results: This review presents our current understanding of CPSP in the following domains: underlying pathophysiology, predisposing risk factors, predictive models of CPSP, and preventative strategies. Each section provides a structured review of key evidence base to understand the complex topic of CPSP. Limitations: This narrative review is a nonsystematic review of relevant publications aimed at presenting succinct overview of CPSP. Conclusions: The incidence of CPSP can potentially be reduced through early identification of perioperative, genetic, physiologic, and psychologic factors. Models predicting the development of CPSP continue to improve and may help focus preventative efforts in patients at highest risk. There is a growing body of evidence supporting the use of multimodal analgesia and anesthetic techniques in the reducing rates of CPSP development. Key words: Acute pain, chronic postsurgical pain, pain sensitization, chronic pain prevention, regional anesthesia, pain adjuncts, neuraxial anesthesia, chronic pain risk factors

Chronic postsurgical pain in patients 5 years after cardiac surgery: A prospective cohort study

2016 ◽  
Vol 21 (3) ◽  
pp. 425-433 ◽  
Author(s):  
K.H. Gjeilo ◽  
R. Stenseth ◽  
A. Wahba ◽  
S. Lydersen ◽  
P. Klepstad
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain
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