Persistent and acute postoperative pain after cardiac surgery with anterolateral thoracotomy or median sternotomy: A prospective observational study - 17/01/22
, Massimiliano Meineri a, 1 , Waseem Z.A. Zakhary a , Ingrid Balga a , Khalil Jawad b , Joerg Ender a , Anna Flo Forner a, ⁎ Abstract |
Objective |
The primary objective of this study was to compare the association between cardiac surgical approach (thoracotomy vs. sternotomy) and incidence of persistent postoperative pain at 3 months. Secondary objectives were the incidence and intensity of persistent pain at 6 and 12 months, acute postoperative pain, analgesic requirement and its side effects.
Design |
Single-center, prospective, observational study. Recruitment between December 2017 and August 2018.
Setting |
Perioperative care at university-affiliated tertiary care centre.
Patients |
202 adults scheduled for cardiac surgery. Patients with chronic pain or behavioural disorder were excluded.
Interventions |
Thoracotomy (n = 106) and sternotomy (n = 96).
Measurements |
Pain scores and pain medication requirements from extubation until hospital discharge. Persistent postoperative pain was assessed using a telephone questionnaire.
Main results |
Incidence and intensity of pain was not significantly different between thoracotomy or sternotomy either in the short- or in the long-term follow-up. Incidence of persistent postoperative pain showed no differences between groups (30.2 vs 22.9% at 3 months (p = 0.297), 10.4 vs 7.3% at 6 months (p = 0.364) and 7.5 vs 7.3% at 12 months (p = 0.518) in thoracotomy and sternotomy group). A significant decrease of pain incidence was observed between 3 and 6 months (p < 0.001) but not between 6 and 12 months (p = 0.259) in both groups. ANOVA of repeated measures adjusted for confounding variable showed a decrease of acute pain intensity over time (p = 0.001) with no difference between groups (p = 0.145). Acute pain medication requirements were not different between the groups (p = 0.237 for piritramide and p = 0.743 for oxycodone) with no difference in their side effects.
Conclusions |
Our study showed no difference in short- or long-term pain in patients undergoing anterolateral thoracotomy or median sternotomy. Both groups showed a decrease in persistent postoperative pain incidence between 3 and 6 months without any significant changes at 12 months.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Cardiac surgery through thoracotomy has been postulated to decrease pain and accelerate recovery compared to sternotomy. |
• | More than half of patients experience moderate to severe pain during the first 24h independently of the surgical approach. |
• | The incidence of acute and persistent postoperative pain decreases over time. |
• | There is no association between surgical approach and incidence or intensity of acute and persistent pain. |
Keywords : Acute postoperative pain, Persistent postoperative pain, Minimally invasive cardiac surgery, Anterolateral thoracotomy, Sternotomy, Fast-track cardiac anesthesia
Plan
Vol 77
Article 110577- mai 2022 Retour au numéro
Article précédent
- Assessing gastric contents in children before general anesthesia for acute extremity fracture: An ultrasound observational cohort study
- Jean-Noël Evain, Zoé Durand, Kelly Dilworth, Sarah Sintzel, Aurélien Courvoisier, Guillaume Mortamet, François-Pierrick Desgranges, Lionel Bouvet, Jean-François Payen
- Anesthetic management of placenta accreta spectrum at an academic center and a comparison of the combined spinal epidural with the double catheter technique: A retrospective study
- Katherine A. Herbert, Luke A. Gatta, Matthew Fuller, Chad A. Grotegut, Jennifer Gilner, Ashraf S. Habib
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?