Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity

Guimarães‐Pereira, Luís; Reis, Pedro; Abelha, Fernando; Azevedo, Luís Filipe; Castro-Lopes, José Manuel

doi:10.1097/j.pain.0000000000000997

Cited by 73 publications

(71 citation statements)

References 75 publications

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“… 86 Among cardiac surgery patients, 37% suffer from persistent postoperative pain in the first 6 postoperative months, and in 17% it remains present >2 years after surgery. 87 …”

Section: Chronic Pain After Cardiac Surgerymentioning

confidence: 99%

Assessment and pathophysiology of pain in cardiac surgery

Zubrzycki¹,

Liebold²,

Skrabal³

et al. 2018

JPR

139

106

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Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.

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“… 86 Among cardiac surgery patients, 37% suffer from persistent postoperative pain in the first 6 postoperative months, and in 17% it remains present >2 years after surgery. 87 …”

Section: Chronic Pain After Cardiac Surgerymentioning

confidence: 99%

Assessment and pathophysiology of pain in cardiac surgery

Zubrzycki¹,

Liebold²,

Skrabal³

et al. 2018

JPR

139

106

View full text Add to dashboard Cite

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“…1 Patients who have undergone cardiac surgery are susceptible to postoperative HA with an incidence of 37% in the first six months postsurgery. 2 Previous studies have reported a significant association of postoperative HA with a high incidence of atelectasis, mental disorders, and delayed postsurgery recovery in patients undergoing cardiac surgery. 3,4 Currently, analgesic management remains the most common method for alleviating postoperative HA.…”

Section: Introductionmentioning

confidence: 99%

<p>Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery</p>

Zhang¹,

Wang²,

Wang³

et al. 2020

JPR

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Purpose: Studies have reported that preoperative poor sleep quality could decrease the pain threshold in patients undergoing noncardiac surgery. However, the risk of postoperative hyperalgesia (HA) in cardiac surgery patients with preoperative poor sleep quality remains unclear. Patients and Methods: We retrospectively collected clinical data from patients undergoing open-heart valve surgery between May 1 and October 31, 2019, in Fuwai Hospital (Beijing). We assessed preoperative sleep quality and postoperative pain severity using the Pittsburgh sleep quality index (PSQI) and numerical pain rating scale (NPRS), respectively. A PSQI of six or greater was considered to indicate poor sleep quality, and a NPRS of four or greater was considered to indicate HA. Multivariable logistic regression analysis was used to study the risk of postoperative HA in patients with preoperative poor sleep quality. Results: We divided 214 eligible patients into two groups based on postoperative HA; HA group: n=61 (28.5%) and nonHA group: n=153 (71.5%). Compared with nonHA patients, patients with postoperative HA showed a higher percentage of history of smoking, 17 (11.1%) vs 15 (24.6%) and alcohol abuse, 5 (3.3%) vs 6 (9.8%), higher intraoperative dose of sufentanil (median, 1.02 vs 1.12 μg/kg/h), and longer duration of ventilation with tracheal catheter (median, 760 vs 934 min). Preoperative poor sleep quality was associated independently with an increased risk of postoperative HA (adjusted odds ratio [AOR]: 2.66; 95%CI: 1.31-5.39, P=0.007). Stratification by history of smoking revealed a stronger risk of postoperative HA in nonsmoking patients with preoperative poor sleep quality (AOR: 3.40; 95%CI: 1.51-7.66, P=0.003). No risk was found in patients who had history of smoking (AOR: 0.83; 95%CI: 0.14-4.75, P=0.832). Conclusion: Preoperative poor sleep quality is an independent risk factor for postoperative HA in adult patients undergoing open-heart valve surgery who had no history of smoking.

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“…Furthermore, ineffective treatment of acute postoperative chest pain can precipitate persistent postopertaive pain. In a systematic review with meta-analysis, Guimarães-Pereira et al found that persistent postoperative pain affected 37% of cardiac surgical patients in the first 6 months and continued to affect 17% for more than 2 years after surgery [8]. Contemporary studies included in the meta-analysis showed a higher incidence of persistent postoperative pain than previously noted [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Transversus Thoracis Muscle Plane Block

Fujii

Bairagi

Roche

et al. 2019

BioMed Research International

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The transversus thoracis muscle plane block (TTP) block is a newly developed regional anesthesia technique which provides analgesia to the anterior chest wall. Since its introduction, this technique has been utilized for a wide range of surgical procedures as well as nonsurgical indications. Current evidence suggests that the TTP block provides effective analgesia for breast and cardiac surgeries, cardiac device implantation, pericardiocentesis, and acute and chronic pain management. To date, no major complications have been reported. Currently there is an urgent need to standardize the nomenclature of this technique to facilitate accurate communication amongst care providers, researchers, and authors. In this review, we describe the TTP block technique, review the indications and available evidence in clinical practice, and discuss alternative blocks and future prospects.

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Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity

Cited by 73 publications

References 75 publications

Assessment and pathophysiology of pain in cardiac surgery

Assessment and pathophysiology of pain in cardiac surgery

<p>Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery</p>

Transversus Thoracis Muscle Plane Block

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