Predictors of one year chronic post-surgical pain trajectories following thoracic surgery

Liu, Christopher W; Pagé, M. Gabrielle; Weinrib, Aliza; Wong, Dorothy; Huang, Alexander; McRae, Karen; Fiorellino, Joseph; Tamir, Diana; Kahn, Michael; Katznelson, Rita; Ladha, Karim; Abdallah, Faraj W.; Cypel, Marcelo; Yasufuku, Kazuhiro; Chan, Vincent; Parry, Monica; Khan, James S.; Katz, Joel; Clarke, Hance

doi:10.1007/s00540-021-02943-7

Cited by 24 publications

(20 citation statements)

References 50 publications

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“…Postoperative acute pain shares the same molecular mechanism, including peripheral and central sensitization, and is a widely recognized independent risk factor for CPSP. (23)(24)(25)(26) The ndings of this study were consistent with those in previous studies. Although intercostal nerve block reduces the severity of pain at discharge, (27) there was no clinical evidence of its preventing CPSP.…”

Section: Discussionsupporting

confidence: 91%

Nitrous Oxide Inhalation and Chronic Postsurgical Pain in Thoracoscopic Lobectomy Patients: A Prospective Cohort Study

Yuan

Zhang

et al. 2022

Preprint

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Background: Chronic postsurgical pain is a significant detriment to postsurgical recovery. Previous studies have shown that nitrous oxide may produce long-term analgesia and may benefit the prevention of chronic postsurgical pain in Asian patients. We tested the hypothesis that nitrous oxide is a protective factor against chronic pain after thoracoscopic lobectomy. Methods: Two groups of patients with and without nitrous oxide inhalation during video-assisted thoracic surgery in Peking Union Medical College Hospital were recruited. Perioperative information was documented, and postsurgical pain was followed up by telephone. The primary outcome was the presence of chronic postsurgical pain at 6 months postoperatively. Odds ratios and their 95% confidence intervals were estimated using a multivariate logistic regression model adjusted for relevant confounding factors. Results: A total of 833 patients were eligible, among whom 33.6% were male and 66.4% were female, with an average age of 56.3 ±11.1 years. A total of 387 (46.5%) patients reported incision-related pain at 6 months after surgery, and 160 (40.0%) out of 400 patients with nitrous oxide inhalation during surgery and 227 (52.4%) out of 433 patients without nitrous oxide inhalation during surgery developed chronic postsurgical pain. After adjusting for confounding factors, nitrous oxide inhalation during surgery was associated with lower odds of chronic postsurgical pain (OR=0.654; 95% CI, 0.480–0.890, P=0.007). Conclusions: Nitrous oxide inhalation during surgery was associated with lower odds of CPSP in VATS patients, and nitrous oxide may benefit the management of chronic pain related to thoracoscopic surgery. Trial registration: This study was registered in ClinicalTrials.gov on January 1, 2018, with registration number of NCT03363672.

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Section: Discussionsupporting

confidence: 91%

Nitrous Oxide Inhalation and Chronic Postsurgical Pain in Thoracoscopic Lobectomy Patients: A Prospective Cohort Study

Yuan

Zhang

et al. 2022

Preprint

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“…Acute to Chronic Pain Signatures network (http:// a2cps.org/) aims to address this research need. [47][48][49][50] Simpler acute pain descriptors may also prove helpful: Pain intensity predicts remote pain resolution, opioid cessation, and patient-reported surgical recovery when assessed 10 days after both major and minor operations conducted under either general or local anesthesia. 49,51 However, it is noteworthy that decades of excess postdischarge opioid prescribing demonstrate that liberal opioid administration is unlikely to address the issue of persistent postsurgical pain.…”

Section: Clinical Focus Reviewmentioning

confidence: 99%

Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

2022

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“…Post thoracotomy pain syndrome is relatively common (prevalence 5-65% with 45% neuropathic pain) [1] and methodological differences across studies contribute to inconsistencies of CPSP prevalence and risk factors [13]. A recent study using postoperative pain trajectories reported a 8.4% prevalence at 12 months, what seems closer to the reality [14]. Preoperative pain and acute postoperative pain intensity are commonly reported as risk factors [13,14].…”

Section: Regional Anaesthesia To Prevent Pain Chronification: Focusin...mentioning

confidence: 99%

Use of regional analgesia to prevent the conversion from acute to chronic pain

Geradon¹,

Lavand’homme²

2022

Current Opinion in Anaesthesiology

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Purpose of reviewChronic post-surgical pain (CPSP) prevalence has not changed over the past decades what questions the efficacy of preventive strategies. Regional analgesia is used to control acute pain, but preventive effect on CPSP remains debated. Failures and future application of regional analgesia to prevent transition from acute to chronic pain will be discussed. Recent findingsAfter thoracotomy, perioperative regional analgesia does not seem to prevent CPSP. After breast cancer surgery, paravertebral block might prevent CPSP intensity and impact on daily life up to 12 months, particularly in high catastrophizing patients. In knee arthroplasty, perioperative regional analgesia or preoperative genicular nerve neuroablation do not prevent CPSP, although current studies present several bias. The protective role of effective regional analgesia and early pain relief in trauma patients deserves further studies.

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Predictors of one year chronic post-surgical pain trajectories following thoracic surgery

Cited by 24 publications

References 50 publications

Nitrous Oxide Inhalation and Chronic Postsurgical Pain in Thoracoscopic Lobectomy Patients: A Prospective Cohort Study

Nitrous Oxide Inhalation and Chronic Postsurgical Pain in Thoracoscopic Lobectomy Patients: A Prospective Cohort Study

Perioperative Opioids, the Opioid Crisis, and the Anesthesiologist

Use of regional analgesia to prevent the conversion from acute to chronic pain

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