Persistent Pain After Cardiac Surgery: Prevention and Management

Abstract

Persistent postoperative pain (PPP) after cardiac surgery is a significant complication that negatively affects patient quality of life and increases health care system burden. However, there are no standards or guidelines to inform how to mitigate these effects. Therefore, in this review, we will discuss strategies to prevent and manage PPP after cardiac surgery. Adequate perioperative analgesia may prove instrumental in the prevention of PPP. Although opioids have historically been the primary analgesic approach to cardiac surgery, an opioid-sparing strategy may prove advantageous in reducing side effects, avoiding secondary hyperalgesia, and decreasing risk of PPP. Implementing a multimodal analgesic plan using alternative medications and regional anesthetic techniques may offer superior efficacy while reducing adverse effects.

Analgesic efficacy and risk of low-to-medium dose intrathecal morphine in patients undergoing cardiac surgery: An updated meta-analysis

“…minimize the possibility of persistent chronic pain following cardiac surgery (46,47) but could also reduce the risk of postoperative delirium, which has been identified as a potential sequela of acute pain (48,49) possibly associated with long-term cognitive decline (50). Hence, our findings suggested that incorporation of ITM into the standard pain management strategy may be recommended for this patient population.…”

“…Despite the lack of a significant beneficial impact of ITM on mortality or the incidence of myocardial infarction following cardiac surgery from pooled evidence ( 8 , 45 ), optimization of acute pain management with ITM not only may enhance postoperative recovery and minimize the possibility of persistent chronic pain following cardiac surgery ( 46 , 47 ) but could also reduce the risk of postoperative delirium, which has been identified as a potential sequela of acute pain ( 48 , 49 ) possibly associated with long-term cognitive decline ( 50 ). Hence, our findings suggested that incorporation of ITM into the standard pain management strategy may be recommended for this patient population.…”

The anesthesia management of totally thoracoscopic cardiac surgery: A single-center retrospective study

“…Poorly controlled PP has been shown to increase the risk of pulmonary, cardiovascular, and endocrine complications, long LOS, and chronic pain [ 26 ]. Beyond suffering, pain affects post-operative rehabilitation, resulting in functional disability that prevents return to normal work and life [ 27 ]. Considering that high-dose opioid therapy is associated with prolonged intubation and ventilator-associated pneumonia, which may lead to a longer ICU stay and higher mortality [ 28 ], we adopted a multimodal analgesia strategy with SAPB as the main intervention.…”

“… Post-operative pain management: Abundant data have suggested that inadequate postoperative pain control increases morbidity and mortality, and a significant proportion of patients who report severe acute pain will end up suffering from chronic postsurgical pain [ 27 , 42 ]. Despite the small incision in TTCS, postoperative pain management remains very important.…”

Prevalence and Risk Factors for Chronic Postsurgical Pain after Cardiac Surgery: A Single-center Prospective Cohort Study

“…5 While the etiology of chronic pain after cardiac surgery is multifactorial, several specific risk factors have been identified. 6,7 These include younger age, female sex, baseline chronic pain, surgical duration, and acute postoperative pain. 2 However, most of these previous studies were insufficiently powered to employ multivariable modeling techniques, and many did not evaluate modifiable perioperative factors.…”