Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

Abstract

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Cognitive Behavioural Therapy to Optimize Post-Operative Fracture Recovery (COPE): protocol for a randomized controlled trial

“…Clinical outcomes following operatively managed fractures of the extremities are variable and many patients continue to experience persistent pain and disability after surgery [ 11 ]. A prospective international cohort study of 14,831 patients that underwent non-cardiac surgery found that the highest prevalence of persistent pain at 12 months was associated with orthopedic surgery [ 12 ]. A 2006 systematic review of 20 observational studies of traumatic tibial fracture repairs found that 47% of patients experienced persistent post-surgical pain at an average of 24 months after surgery [ 13 ].…”

SP36 Opioid sparing anesthesia

“…3 Multimodal analgesia has been defined as the use of two or more analgesics or techniques that target different mechanisms or pathways in the nociceptive system. 4 As drugs are combined, lower doses of each class can be given, thereby lowering the side effects of each individual drug, but increasing overall efficacy. 5,6 Drugs commonly used in this framework include acetaminophen, non-steroidal anti-inflammatory drugs (NSAID) or cyclo-oxygenase-2 inhibitors, dexamethasone, gabapentin, clonidine, dexmedetomidine, intravenous lidocaine, magnesium and ketamine.…”

SP35 Transitional pain and prevention of pain chronification

“…3 A very recent publication (2021) assessing incisional pain at one year after non-cardiac surgery in a cohort of 14000 patients found an incidence of 3.3% with nearly half reporting moderate (35%) to severe (14%) pain. 4 Among the patients with CPSP, 85% mentioned interference with daily activities and more than 50% were taking analgesic medications. These very recent observations are in agreement with the earlier findings mentioning that 14 to 24% of patients experience suboptimal physical and emotional recovery at 6 to 12 months after surgery.…”

“…3 Multimodal analgesia has been defined as the use of two or more analgesics or techniques that target different mechanisms or pathways in the nociceptive system. 4 As drugs are combined,…”