Skip to main content
Erschienen in: General Thoracic and Cardiovascular Surgery 11/2022

10.05.2022 | Original Article

U-shaped association between elapsed time after surgery and the intensity of chronic postsurgical pain following cardiac surgery via thoracotomy: an observational cohort study

verfasst von: Kimito Minami, Masahiro Kazawa, Takashi Kakuta, Satsuki Fukushima, Tomoyuki Fujita, Yoshihiko Ohnishi

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 11/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

Chronic postsurgical pain (CPSP) is defined as chronic pain that develops or increases in intensity after a surgical procedure and persists beyond the healing process, defined as at least 3 months postoperatively. However, the rationale behind this time period is weak.

Methods

This prospective observational study included a total of 238 consecutive patients who underwent mitral valve repair via thoracotomy. A questionnaire consisting of a numerical rating scale (NRS) to assess the severity of postsurgical pain was mailed to each participant more than 3 months after the operation. The outcomes of interest were current pain, peak pain in the last 4 weeks, and average pain in the last 4 weeks, each assessed using the NRS. The nonlinear associations between the elapsed time after surgery and the intensity of CPSP were evaluated. All statistical analyses were performed with a two-sided significance level of 5%.

Results

Two-hundred and ten patients (88.2%) answered the questionnaire. There was a significant nonlinear association between the elapsed time after surgery and each NRS response (all, P < 0.05). The lowest adjusted log odds of current pain, peak pain in the past 4 weeks, and average pain in the past 4 weeks were − 1.49, − 1.13, and − 1.26 at 33, 33, and 33 months postoperatively, respectively.

Conclusions

There was a significant U-shaped association between the elapsed time after surgery and intensity of CPSP. The adjusted log odds of each NRS response was lowest at 33 months after cardiac surgery via thoracotomy.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al. Chronic postsurgical pain in Europe: An observational study. Eur J Anaesthesiol. 2015;32:725–34.CrossRef Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al. Chronic postsurgical pain in Europe: An observational study. Eur J Anaesthesiol. 2015;32:725–34.CrossRef
2.
Zurück zum Zitat Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede RD. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160:45–52.CrossRef Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede RD. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain. 2019;160:45–52.CrossRef
3.
Zurück zum Zitat Yoon S, Hong WP, Joo H, Kim H, Park S, Bahk JH, et al. Long-term incidence of chronic postsurgical pain after thoracic surgery for lung cancer: a 10-year single-center retrospective study. Reg Anesth Pain Med. 2020;45:331–6.CrossRef Yoon S, Hong WP, Joo H, Kim H, Park S, Bahk JH, et al. Long-term incidence of chronic postsurgical pain after thoracic surgery for lung cancer: a 10-year single-center retrospective study. Reg Anesth Pain Med. 2020;45:331–6.CrossRef
4.
Zurück zum Zitat Maguire MF, Ravenscroft A, Beggs D, Duffy JP. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardio-Thoracic Surg. 2006;29:800–5.CrossRef Maguire MF, Ravenscroft A, Beggs D, Duffy JP. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardio-Thoracic Surg. 2006;29:800–5.CrossRef
5.
Zurück zum Zitat Peng Z, Li H, Zhang C, Qian X, Feng Z, Zhu S. A retrospective study of chronic post-surgical pain following thoracic surgery: prevalence, risk factors, incidence of neuropathic component, and impact on qualify of life. PLoS ONE. 2014;9: e90014.CrossRef Peng Z, Li H, Zhang C, Qian X, Feng Z, Zhu S. A retrospective study of chronic post-surgical pain following thoracic surgery: prevalence, risk factors, incidence of neuropathic component, and impact on qualify of life. PLoS ONE. 2014;9: e90014.CrossRef
6.
Zurück zum Zitat Minami K, Kabata D, Kakuta T, Fukushima S, Fujita T, Yoshitani K, et al. Association between sternotomy versus thoracotomy and the prevalence and severity of chronic postsurgical pain after mitral valve repair: an observational cohort study. J Cardiothorac Vasc Anesth. 2021;35:2937–2944.CrossRef Minami K, Kabata D, Kakuta T, Fukushima S, Fujita T, Yoshitani K, et al. Association between sternotomy versus thoracotomy and the prevalence and severity of chronic postsurgical pain after mitral valve repair: an observational cohort study. J Cardiothorac Vasc Anesth. 2021;35:2937–2944.CrossRef
7.
Zurück zum Zitat Karcioglu O, Topacoglu H, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018;36:707–14.CrossRef Karcioglu O, Topacoglu H, Dikme O. A systematic review of the pain scales in adults: Which to use? Am J Emerg Med. 2018;36:707–14.CrossRef
8.
Zurück zum Zitat Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41:1073–93.CrossRef Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH, et al. Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41:1073–93.CrossRef
9.
Zurück zum Zitat Matsubayashi Y, Takeshita K, Sumitani M, Oshima Y, Tonosu J, Kato S, et al. Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. PLoS ONE. 2013;8: e68013.CrossRef Matsubayashi Y, Takeshita K, Sumitani M, Oshima Y, Tonosu J, Kato S, et al. Validity and reliability of the Japanese version of the painDETECT questionnaire: a multicenter observational study. PLoS ONE. 2013;8: e68013.CrossRef
10.
Zurück zum Zitat Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22:1911–20.CrossRef Freynhagen R, Baron R, Gockel U, Tolle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22:1911–20.CrossRef
11.
Zurück zum Zitat Fujita T, Kakuta T, Kawamoto N, Shimahara Y, Yajima S, Tadokoro N, et al. Benefits of robotically-assisted surgery for complex mitral valve repair. Interact Cardiovasc Thorac Surg. 2021;32:417–25.CrossRef Fujita T, Kakuta T, Kawamoto N, Shimahara Y, Yajima S, Tadokoro N, et al. Benefits of robotically-assisted surgery for complex mitral valve repair. Interact Cardiovasc Thorac Surg. 2021;32:417–25.CrossRef
12.
Zurück zum Zitat Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–25.CrossRef Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–25.CrossRef
13.
Zurück zum Zitat Aili K, Campbell P, Michaleff ZA, Strauss VY, Jordan KP, Bremander A, et al. Long-term trajectories of chronic musculoskeletal pain: a 21-year prospective cohort latent class analysis. Pain. 2021;162:1511–20.CrossRef Aili K, Campbell P, Michaleff ZA, Strauss VY, Jordan KP, Bremander A, et al. Long-term trajectories of chronic musculoskeletal pain: a 21-year prospective cohort latent class analysis. Pain. 2021;162:1511–20.CrossRef
14.
Zurück zum Zitat Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017;2: e627.CrossRef Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Pain Rep. 2017;2: e627.CrossRef
15.
Zurück zum Zitat Cabañero D, Campillo A, Célérier E, Romero A, Puig MM. Pronociceptive effects of remifentanil in a mouse model of postsurgical pain: effect of a second surgery. Anesthesiology. 2009;111:1334–45.CrossRef Cabañero D, Campillo A, Célérier E, Romero A, Puig MM. Pronociceptive effects of remifentanil in a mouse model of postsurgical pain: effect of a second surgery. Anesthesiology. 2009;111:1334–45.CrossRef
16.
Zurück zum Zitat Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2015;19:451–65.CrossRef Humble SR, Dalton AJ, Li L. A systematic review of therapeutic interventions to reduce acute and chronic post-surgical pain after amputation, thoracotomy or mastectomy. Eur J Pain. 2015;19:451–65.CrossRef
17.
Zurück zum Zitat Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev. 2013;2013:Cd008307. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev. 2013;2013:Cd008307.
18.
Zurück zum Zitat Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis †. Br J Anaesth. 2013;111:711–20.CrossRef Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis †. Br J Anaesth. 2013;111:711–20.CrossRef
19.
Zurück zum Zitat Levene JL, Weinstein EJ, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: A Cochrane systematic review and meta-analysis update. J Clin Anesth. 2019;55:116–27.CrossRef Levene JL, Weinstein EJ, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: A Cochrane systematic review and meta-analysis update. J Clin Anesth. 2019;55:116–27.CrossRef
20.
Zurück zum Zitat Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of regional anesthesia and pain medicine evidence-based guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43:263–309. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of regional anesthesia and pain medicine evidence-based guidelines (Fourth Edition). Reg Anesth Pain Med. 2018;43:263–309.
21.
Zurück zum Zitat Narouze S, Benzon HT, Provenzano D, Buvanendran A, De Andres J, Deer T, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (Second Edition). Reg Anesth Pain Med. 2018;43:225–62.PubMed Narouze S, Benzon HT, Provenzano D, Buvanendran A, De Andres J, Deer T, et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (Second Edition). Reg Anesth Pain Med. 2018;43:225–62.PubMed
22.
Zurück zum Zitat Neuburger PJ, Ngai JY, Chacon MM, Luria B, Manrique-Espinel AM, Kline RP, et al. A prospective randomized study of paravertebral blockade in patients undergoing robotic mitral valve repair. J Cardiothorac Vasc Anesth. 2015;29:930–6.CrossRef Neuburger PJ, Ngai JY, Chacon MM, Luria B, Manrique-Espinel AM, Kline RP, et al. A prospective randomized study of paravertebral blockade in patients undergoing robotic mitral valve repair. J Cardiothorac Vasc Anesth. 2015;29:930–6.CrossRef
23.
Zurück zum Zitat Minami K, Yoshitani K, Inatomi Y, Sugiyama Y, Iida H, Ohnishi Y. A Retrospective examination of the efficacy of paravertebral block for patients requiring intraoperative high-dose unfractionated heparin administration during thoracoabdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2015;29:937–41.CrossRef Minami K, Yoshitani K, Inatomi Y, Sugiyama Y, Iida H, Ohnishi Y. A Retrospective examination of the efficacy of paravertebral block for patients requiring intraoperative high-dose unfractionated heparin administration during thoracoabdominal aortic aneurysm repair. J Cardiothorac Vasc Anesth. 2015;29:937–41.CrossRef
24.
Zurück zum Zitat Zhang S, Wu X, Guo H, Ma L. Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials. Eur J Med Res. 2015;20:25.CrossRef Zhang S, Wu X, Guo H, Ma L. Thoracic epidural anesthesia improves outcomes in patients undergoing cardiac surgery: meta-analysis of randomized controlled trials. Eur J Med Res. 2015;20:25.CrossRef
25.
Zurück zum Zitat Tryba M. Epidural regional anesthesia and low molecular heparin: Pro. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993;28:179–81.CrossRef Tryba M. Epidural regional anesthesia and low molecular heparin: Pro. Anasthesiol Intensivmed Notfallmed Schmerzther. 1993;28:179–81.CrossRef
26.
Zurück zum Zitat Draugalis JR, Plaza CM. Best practices for survey research reports revisited: implications of target population, probability sampling, and response rate. Am J Pharm Educ. 2009;73:142.CrossRef Draugalis JR, Plaza CM. Best practices for survey research reports revisited: implications of target population, probability sampling, and response rate. Am J Pharm Educ. 2009;73:142.CrossRef
27.
Zurück zum Zitat Story DA, Tait AR. Survey research. Anesthesiology. 2019;130:192–202.CrossRef Story DA, Tait AR. Survey research. Anesthesiology. 2019;130:192–202.CrossRef
28.
Zurück zum Zitat Montes A, Roca G, Cantillo J, Sabate S. Presurgical risk model for chronic postsurgical pain based on 6 clinical predictors: a prospective external validation. Pain. 2020;161:2611–8.CrossRef Montes A, Roca G, Cantillo J, Sabate S. Presurgical risk model for chronic postsurgical pain based on 6 clinical predictors: a prospective external validation. Pain. 2020;161:2611–8.CrossRef
Metadaten
Titel
U-shaped association between elapsed time after surgery and the intensity of chronic postsurgical pain following cardiac surgery via thoracotomy: an observational cohort study
verfasst von
Kimito Minami
Masahiro Kazawa
Takashi Kakuta
Satsuki Fukushima
Tomoyuki Fujita
Yoshihiko Ohnishi
Publikationsdatum
10.05.2022
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 11/2022
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01825-3

Weitere Artikel der Ausgabe 11/2022

General Thoracic and Cardiovascular Surgery 11/2022 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.