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Cui YY, Xu ZQ, Hou HJ, Zhang J, Xue JJ. Transversus Thoracic Muscle Plane Block For Postoperative Pain in Pediatric Cardiac Surgery: A Systematic Review And Meta-Analysis of Randomized And Observational Studies. J Cardiothorac Vasc Anesth 2024; 38:1228-1238. [PMID: 38453555 DOI: 10.1053/j.jvca.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Pediatric patients undergoing cardiac surgery usually experience significant surgical pain. Additionally, the effect of poor surgical analgesia creates a pain continuum that extends to the postoperative period. Transversus thoracic muscle plane block (TTMPB) is a novel plane block technique that can provide analgesia to the anterior chest wall. The analgesic role of TTMPB in pediatric cardiac surgery is still uncertain. A meta-analysis was conducted to determine the analgesic efficacy of this procedure. DESIGN AND SETTING Systematic review and meta-analysis. PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure were searched to November 2023, and the Grading of Recommendations Assessment, Development, and Evaluation approach was followed to evaluate the certainty of evidence. PARTICIPANTS Eligible studies enrolled pediatric patients from 2 months to 12 years old scheduled to undergo cardiac surgery, and randomized them to receive a TTMPB or no block/sham block. MEASUREMENTS AND MAIN RESULTS Six studies that enrolled 601 pediatric patients were included. Low-certainty evidence from randomized trials showed that, compared with no block or sham block, TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative modified objective pain score at 12 hours (weighted mean difference [WMD] -2.20, 95% CI -2.73 to -1.68) and 24 hours (WMD -1.76, 95% CI -2.09 to -1.42), intraoperative opioid consumption (WMD -3.83, 95% CI -5.90 to -1.76 μg/kg), postoperative opioid consumption (WMD -2.51, 95% CI -2.84 to -2.18 μg/kg), length of intensive care unit (ICU) stay (WMD -5.56, 95% CI -8.30 to -2.83 hours), and extubation time (WMD -2.13, 95% CI -4.21 to -0.05 hours). Retrospective studies provided very low certainty that the results were consistent with the randomized trials. CONCLUSION Very low- to low-certainty evidence showed that TTMPB in pediatric patients undergoing cardiac surgery may reduce postoperative pain, opioid consumption, ICU length of stay, and extubation time.
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Affiliation(s)
- Yi-Yang Cui
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District, Lanzhou, China
| | - Zi-Qing Xu
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China
| | - Huai-Jing Hou
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China
| | - Jie Zhang
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China
| | - Jian-Jun Xue
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine, Lanzhou, China; Gansu Clinical Research Center of Integrative Anesthesiology, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu, Lanzhou, China.
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Kim S, Song SW, Jeon YG, Song SA, Hong S, Park JH. Evaluating the Efficacy of the Erector Spinae Plane Block as a Supplementary Approach to Cardiac Anesthesia during Off-Pump Coronary Bypass Graft Surgery via Median Sternotomy: A Randomized Clinical Trial. J Clin Med 2024; 13:2208. [PMID: 38673480 PMCID: PMC11051109 DOI: 10.3390/jcm13082208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Pain control after off-pump coronary artery bypass graft (OPCAB) facilitates mobilization and improves outcomes. The efficacy of the erector spinae plane block (ESPB) after cardiac surgery remains controversial. Methods: We aimed to investigate the analgesic effects of ESPB after OPCAB. Precisely 56 patients receiving OPCAB were randomly divided into ESPB and control groups. The primary outcome was visual analog scale (VAS) pain scores at 6, 12, 24, and 48 h postoperatively. Secondary outcomes were the dose of rescue analgesics in terms of oral morphine milligram equivalents, the dose of antiemetics, the length of intubation time, and the length of stay in the intensive care unit (ICU). Results: The VAS scores were similar at all time points in both groups. The incidence of severe pain (VAS score > 7) was significantly lower in the ESPB group (50% vs. 15.4%; p = 0.008). The dose of rescue analgesics was also lower in the ESPB group (19.04 ± 18.76, 9.83 ± 12.84, p = 0.044) compared with the control group. The other secondary outcomes did not differ significantly between the two groups. Conclusions: ESPB provides analgesic efficacy by reducing the incidence of severe pain and opioid use after OPCAB.
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Affiliation(s)
- Sujin Kim
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Seung Woo Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Yeong-Gwan Jeon
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Sang A. Song
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
| | - Soonchang Hong
- Department of Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea;
| | - Ji-Hyoung Park
- Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea; (S.K.); (S.W.S.); (Y.-G.J.); (S.A.S.)
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Charlton E, Atkins KJ, Evered L, Silbert B, Scott DA. The long-term incidence of chronic post-surgical pain after coronary artery bypass surgery - A prospective observational study. Eur J Pain 2024; 28:599-607. [PMID: 37969009 DOI: 10.1002/ejp.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Chronic post-surgical pain (CPSP) represents a significant issue for many patients following surgery; however, the long-term incidence and impact have not been well described following cardiac surgery. Our aim was to characterize CPSP at least 5 years following coronary artery bypass grafting (CABG) surgery. METHODS This prospective observational study investigated a cohort of patients from a larger trial investigating cognitive outcomes following CABG surgery, with 89 of 148 eligible patients (60.1%) assessed for CPSP at a mean (standard deviation [SD]) of 6.8 [1.2] years. Questionnaires interrogated pain presence, intensity, location, neuropathic characteristics, Geriatric Depression Scale scores (GDS) and instrumental activities of daily living (IADL). RESULTS CPSP was described in 21/89 (23.6%), with 10 rating it as moderate to severe. Six of the CPSP patients (29%) met criteria for neuropathic pain (6.7% overall). The highest rate of CPSP was associated with the leg surgical site (chest 12/89 [13.5%], arm 8/68 [11.8%] and leg (saphenous vein graft-SVG) 11/37 [29.7%]; χ2 = 6.523, p = 0.038). IADL scores were significantly lower for patients with CPSP (mean [SD]: 36.7 [1.6] vs. no CPSP 40.6 [0.6]; p = 0.006). Patients had GDS scores consistent with moderate depression (GDS >8) in 3/21 (14.3%) with CPSP, versus 3/68 (4.4%) non-CPSP patients (χ2 = 3.20, p = 0.073). CONCLUSIONS This study identified a CPSP incidence of 23.6% at a mean of 6.8 years after CABG surgery, with the highest pain proportion at SVG harvest sites. CPSP was associated with neuropathic pain symptoms and had a significant impact on IADLs. This emphasizes the need for long-term follow-up of CABG patients. SIGNIFICANCE This study highlights the impact of CPSP 7 years following cardiac surgery and highlights the effect of surgical site, neuropathic pain and the importance of including pain assessment and management in the long-term follow-up of cardiac surgical patients. Strategies to address and prevent chronic pain following cardiac surgery should be further explored.
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Affiliation(s)
- E Charlton
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - K J Atkins
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - L Evered
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - B Silbert
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - D A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Wong HMK, Chen PY, Tang GCC, Chiu SLC, Mok LYH, Au SSW, Wong RHL. Deep Parasternal Intercostal Plane Block for Intraoperative Pain Control in Cardiac Surgical Patients for Sternotomy: A Prospective Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2024; 38:683-690. [PMID: 38148266 DOI: 10.1053/j.jvca.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES Sternotomy pain is common after cardiac surgery. The deep parasternal intercostal plane (DPIP) block is a novel technique that provides analgesia to the anterior chest wall. The aim of this study was to investigate the analgesic effect of bilateral DPIP blocks on intraoperative pain control in cardiac surgery. DESIGN This is a double-blinded, prospective randomized controlled trial (Oct 2020-Dec 2022). SETTINGS This study was conducted in a single institution, which is an academic university hospital. PARTICIPANTS Eighty-six elective cardiac surgical patients with median sternotomy were recruited. INTERVENTIONS Patients were randomly divided into DPIP or control group. Either 20ml 0.25% levobupivacaine or 0.9% normal saline was injected for the DPIP under ultrasound guidance after induction of general anaesthesia. MEASUREMENTS AND MAIN RESULTS The primary outcome was intraoperative opioids consumption and hemodynamic changes at sternotomy. Secondary outcomes included postoperative morphine consumption, postoperative pain and time to tracheal extubation. Intraoperative opioids requirement was reduced from a median (IQR) intravenous morphine equivalence of 21.4mg (13.8-24.3mg) in control group to 9.5mg (7.3-11.2mg) in the DPIP group (P<0.001). Hemodynamic parameters were more stable in DPIP group at sternotomy, as evidenced by lower percentage increase in systolic, diastolic and mean arterial blood pressure from baseline. No difference was observed in time to tracheal extubation, postoperative morphine consumption, postoperative pain score and spirometry. CONCLUSIONS Bilateral DPIP block provides effective intraoperative analgesia and opioid-sparing. It may be included as part of the multimodal analgesia for enhanced recovery in cardiac surgery.
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Affiliation(s)
- Henry M K Wong
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China.
| | - P Y Chen
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Geoffrey C C Tang
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Sandra L C Chiu
- Department of Anesthesia and Intensive Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Louis Y H Mok
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Sylvia S W Au
- Department of Anesthesia and Intensive Care, Prince of Wales Hospital, New Territories, Hong Kong, China
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong, China
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Ott S, Müller-Wirtz LM, Sertcakacilar G, Tire Y, Turan A. Non-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians-A Narrative Review. J Clin Med 2024; 13:1104. [PMID: 38398416 PMCID: PMC10889232 DOI: 10.3390/jcm13041104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Multi-modal analgesic strategies, including regional anesthesia techniques, have been shown to contribute to a reduction in the use of opioids and associated side effects in the perioperative setting. Consequently, those so-called multi-modal approaches are recommended and have become the state of the art in perioperative medicine. In the majority of intensive care units (ICUs), however, mono-modal opioid-based analgesic strategies are still the standard of care. The evidence guiding the application of regional anesthesia in the ICU is scarce because possible complications, especially associated with neuraxial regional anesthesia techniques, are often feared in critically ill patients. However, chest and abdominal wall analgesia in particular is often insufficiently treated by opioid-based analgesic regimes. This review summarizes the available evidence and gives recommendations for peripheral regional analgesia approaches as valuable complements in the repertoire of intensive care physicians' analgesic portfolios.
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Affiliation(s)
- Sascha Ott
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Deutsches Herzzentrum der Charité-Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiac Anesthesiology and Intensive Care Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Lukas M Müller-Wirtz
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Saarland University Faculty of Medicine, 66424 Homburg, Germany
| | - Gokhan Sertcakacilar
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, 34147 Istanbul, Turkey
| | - Yasin Tire
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Science, 42020 Konya, Turkey
| | - Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Ruel M, Gupta S, Ponnambalam M, Chong AY. Less Invasive and Hybrid Surgical/Interventional Coronary Disease Management: The Future Is Now. Can J Cardiol 2024; 40:290-299. [PMID: 38070770 DOI: 10.1016/j.cjca.2023.11.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/26/2023] [Accepted: 11/26/2023] [Indexed: 01/14/2024] Open
Abstract
Coronary artery bypass grafting (CABG) has evolved to become the criterion standard in elective revascularisation for coronary artery disease (CAD), particularly in patients with complex or multivessel CAD, left main involvement, diabetes mellitus, or left ventricular dysfunction. Despite the superiority of CABG in patients with the most advanced forms of CAD, a standard CABG operation, through a median sternotomy and with the use of cardiopulmonary bypass, carries well recognised challenges. In this article, we describe newer approaches, such as off-pump CABG, minimally invasive bypass grafting, robotic CABG, and hybrid coronary revascularisation, which we consider as necessary ways to minimise invasion, reduce recovery time, provide the benefits of arterial grafting to more patients, and offer alternatives to mitigate the adverse effects of conventional sternotomy and cardiopulmonary bypass.
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Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Saurabh Gupta
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Menaka Ponnambalam
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun Yeong Chong
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Toscano A, Capuano P, Perrucci C, Giunta M, Orsello A, Pierani T, Costamagna A, Tedesco M, Arcadipane A, Sepolvere G, Buono G, Brazzi L. Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:48. [PMID: 37974241 PMCID: PMC10652511 DOI: 10.1186/s44158-023-00134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Parasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane block (DPIP) respectively. METHODS We designed the present prospective, observational cohort study to compare the analgesic efficacy of the two approaches. Cardiac surgical patients who underwent full sternotomy from January to September 2022 were enrolled and divided into three groups, according to pain control strategy: morphine, SPIP, and DPIP group. Primary outcomes were was postoperative pain evaluated as absolute value of NRS at 12 h. Secondary outcomes were the NRS at 24 and 48 h, the need for salvage analgesia (both opioids and NSAIDs), incidence of postoperative nausea and vomiting, time to extubation, mechanical ventilation duration, and bowel disfunction. RESULTS Ninety-six were enrolled. There was no significant difference in terms of median Numeric Pain Rating Scale at 24 h and at 48 h between the study groups. Total postoperative morphine consumption was 1.00 (0.00-3.00), 2.00 (0.00-5.50), and 15.60 mg (9.60-30.00) in the SPIP, DPIP, and morphine group, respectively (SPIP and DPIP vs morphine: p < 0.001). Metoclopramide consumption was lower in SPIP and DPIP group compared with morphine group (p = 0.01). There was no difference in terms of duration of mechanical ventilation and of bowel activity between the study groups. Two pneumothorax occurred in the DPIP group. CONCLUSIONS Both SPIP and DPIP seem able to guarantee an effective pain management in the postoperative phase of cardiac surgeries via full median sternotomy while ensuring a reduced consumption of opioids and antiemetic drugs.
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Affiliation(s)
- Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Paolo Capuano
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC, 90127, Palermo, Italy.
| | - Chiara Perrucci
- Division of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Matteo Giunta
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Alberto Orsello
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Tommaso Pierani
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Andrea Costamagna
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
| | - Mario Tedesco
- Department of Anesthesia and Intensive Care Unit and Pain Therapy, Mater Dei Hospital, Bari, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC, 90127, Palermo, Italy
| | - Giuseppe Sepolvere
- Department of Anesthesia and Cardiac Surgery Intensive Care Unit, Casa di Cura San Michele, Maddaloni, Caserta, Italy
| | - Gabriella Buono
- Division of Cardiovascular Anesthesia and Intensive Care, Azienda Ospedaliera Ordine Mauriziano, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia, Critical Care and Emergency, 'Città della Salute e della Scienza' Hospital, Turin, Italy
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Madjarov JM, Katz MG, Hadas Y, Kim SJ, Freage-Kahn L, Madzharov S, Vincek A, Madjarova SJ, Seidman P, Shtraizent N, Robicsek SA, Eliyahu E. Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability. FRONTIERS IN PAIN RESEARCH 2023; 4:1180969. [PMID: 37637509 PMCID: PMC10450746 DOI: 10.3389/fpain.2023.1180969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The pathogenesis of chronic chest pain after cardiac surgery has not been determinate. If left untreated, postoperative sternal pain reduces the quality of life and patient satisfaction with cardiac surgery. The purpose of the study was to examine the effect of chest inflammation on postoperative pain, risk factors for chronic pain after cardiac surgery and to explore how chest reconstruction was associated with the intensity of pain. Methods The authors performed a study of acute and chronic thoracic pain after cardiac surgery in patients with and without sternal infection and compared different techniques for chest reconstruction. 42 high-risk patients for the development of mediastinitis were included. Patients with mediastinitis received chest reconstruction (group 1). Their demographics and risk factors were matched with no-infection patients with chest reconstruction (group 2) and subjects who underwent conventional sternal closure (group 3). Chronic pain was assessed by the numeric rating scale after surgery. Results The assessment of the incidence and intensity of chest pain at 3 months post-surgery demonstrated that 14 out of 42 patients across all groups still experienced chronic pain. Specifically, in group 1 with sternal infection five patients had mild pain, while one patient experienced mild pain in group 2, and eight patients in group 3. Also, follow-up results indicated that the highest pain score was in group 3. While baseline levels of cytokines were increased among patients with sternal infection, at discharge only the level of interleukin 6 remained high compared to no infection groups. Compared to conventional closure, after chest reconstruction, we found better healing scores at 3-month follow-up and a higher percentage of patients with the complete sternal union. Conclusions Overall, 14 out of 42 patients have chronic pain after cardiac surgery. The intensity of the pain in mediastinitis patients significantly decreased at 3 months follow-up after chest reconstruction. Thus, post-surgery mediastinitis is not a determining factor for development the chronic chest pain. There is no correlation between cytokines levels and pain score except interleukin 6 which remains elevated for a long time after treatment. Correlation between sternal healing score and chronic chest pain was demonstrated.
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Affiliation(s)
- Jeko M. Madjarov
- Department of Cardiovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC, United States
- Department of Cardiovascular Surgery, Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Michael G. Katz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yoav Hadas
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sofia Jisoo Kim
- Department of Biology and Environmental Studies, New York University, New York, NY, United States
| | | | - Svetozar Madzharov
- Department of Cardiovascular Surgery, Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC, United States
| | - Adam Vincek
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Piers Seidman
- Baruch College, City University of New York, New York, NY, United States
| | - Nataly Shtraizent
- Frezent Biological Solutions, New York, NY, United States
- Senex, New York, NY, United States
| | - Steven A. Robicsek
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Efrat Eliyahu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, Icahn Genomics Institute, New York, NY, United States
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Xue JJ, Cui YY, Busse JW, Ge L, Zhou T, Huang WH, Ding SS, Zhang J, Yang KH. Transversus thoracic muscle plane block for pain during cardiac surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:2500-2508. [PMID: 37246971 PMCID: PMC10442103 DOI: 10.1097/js9.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 05/30/2023]
Abstract
STUDY OBJECTIVE The role of transversus thoracic muscle plane blocks (TTMPBs) during cardiac surgery is controversial. We conducted a systematic review to establish the effectiveness of this procedure. DESIGN Systematic review. We searched PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure to June 2022, and followed the GRADE approach to evaluate the certainty of evidence. STUDY ELIGIBILITY CRITERIA Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block. MAIN RESULTS Nine trials that enrolled 454 participants were included. Compared to no block/sham block, moderate certainty evidence found that TTMPB probably reduces postoperative pain at rest at 12 h [weighted mean difference (WMD) -1.51 cm on a 10 cm visual analogue scale for pain, 95% CI -2.02 to -1.00; risk difference (RD) for achieving mild pain or less (≤3 cm), 41%, 95% CI 17-65) and 24 h (WMD -1.07 cm, 95% CI -1.83 to -0.32; RD 26%, 95% CI 9-37). Moderate certainty evidence also supported that TTMPB probably reduces pain during movement at 12 h (WMD -3.42 cm, 95% CI -4.47 to -2.37; RD 46%, 95% CI 12-80) and at 24 h (WMD -1.73 cm, 95% CI -3.24 to -0.21; RD 32%, 95% CI 5-59), intraoperative opioid use [WMD -28 milligram morphine equivalent (MME), 95% CI -42 to -15], postoperative opioid consumption (WMD -17 MME, 95% CI -29 to -5), postoperative nausea and vomiting (absolute risk difference 255 less per 1000 persons, 95% CI 140-314), and intensive care unit (ICU) length of stay (WMD -13 h, 95% CI -21 to -6). CONCLUSION Moderate certainty evidence showed TTMPB during cardiac surgery probably reduces postoperative pain at rest and with movement, opioid consumption, ICU length of stay, and the incidence of nausea and vomiting.
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Affiliation(s)
- Jian-jun Xue
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu Lanzhou
- Department of Anesthesiology, Gansu Province Hospital of Traditional Chinese Medicine
- Gansu Clinical Research Center of Integrative Anesthesiology
| | - Yi-yang Cui
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Jason W. Busse
- Department of Anesthesia
- The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Long Ge
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
| | - Ting Zhou
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Wei-hua Huang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Sheng-shuang Ding
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Jie Zhang
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Chengguan District
| | - Ke-hu Yang
- Evidence-based Medicine Center, School of Basic Medical Science, Lanzhou University, Gansu Lanzhou
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, People’s Republic of China
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10
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Miazza J, Vasiloi I, Koechlin L, Gahl B, Reuthebuch O, Eckstein FS, Santer D. Combined Band and Plate Fixation as a New Individual Option for Patients at Risk of Sternal Complications after Cardiac Surgery: A Single-Center Experience. Biomedicines 2023; 11:1946. [PMID: 37509585 PMCID: PMC10377508 DOI: 10.3390/biomedicines11071946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Due to the advent of interventional therapies for low- and intermediate-risk patients, case complexity has increased in cardiac surgery over the last decades. Despite the surgical progress achieved to keep up with the increase in the number of high-risk patients, the prevention of sternal complications remains a challenge requiring new, individualized sternal closure techniques. The aim of this study was to evaluate the safety and feasibility, as well as the in-hospital and long-term outcomes, of enhanced sternal closure with combined band and plate fixation using the new SternaLock® 360 (SL360) system as an alternative to sternal wiring. From 2020 to 2022, 17 patients underwent enhanced sternal closure using the SL360 at our institution. We analyzed perioperative data, as well as clinical and radiologic follow-up data. The results were as follows: In total, 82% of the patients were treated with the SL360 based on perioperative risk factors, while in 18% of cases, the SL360 was used for secondary closure due to sternal instability. No perioperative complications were observed. We obtained the follow-up data of 82% of the patients (median follow-up time: 141 (47.8 to 511.5) days), showing no surgical revision, no sternal instability, no deep wound infections, and no sternal pain at the follow-up. In one case, a superficial wound infection was treated with antibiotics. In conclusion, enhanced sternal closure with the SL360 is easy to perform, effective, and safe. This system might be considered for both primary and secondary sternal closure in patients at risk of sternal complications.
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Affiliation(s)
- Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Ion Vasiloi
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Friedrich S Eckstein
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
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11
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Makkad B, Heinke TL, Sheriffdeen R, Khatib D, Brodt JL, Meng ML, Grant MC, Kachulis B, Popescu WM, Wu CL, Bollen BA. Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients: Part 2. Anesth Analg 2023; 137:26-47. [PMID: 37326862 DOI: 10.1213/ane.0000000000006506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pain after cardiac surgery is of moderate to severe intensity, which increases postoperative distress and health care costs, and affects functional recovery. Opioids have been central agents in treating pain after cardiac surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure. This Practice Advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee's Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of cardiac surgical patients. This Practice Advisory provides recommendations for providers caring for patients undergoing cardiac surgery. This entails developing customized pain management strategies for patients, including preoperative patient evaluation, pain management, and opioid use-focused education as well as perioperative use of multimodal analgesics and regional techniques for various cardiac surgical procedures. The literature related to this field is emerging, and future studies will provide additional guidance on ways to improve clinically meaningful patient outcomes.
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Affiliation(s)
- Benu Makkad
- From the Department of Anesthesiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Timothy Lee Heinke
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Raiyah Sheriffdeen
- Department of Anesthesiology, Medstar Washington Hospital Center, Washington, DC
| | - Diana Khatib
- Department of Anesthesiology, Weil Cornell Medical College, New York, New York
| | - Jessica Louise Brodt
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Conrad Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bessie Kachulis
- Department of Anesthesiology, Columbia University, New York, New York
| | - Wanda Maria Popescu
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Christopher L Wu
- Department of Anesthesiology, Hospital of Special Surgery, Weill Cornell Medical College, New York, New York
| | - Bruce Allen Bollen
- Missoula Anesthesiology, Missoula, Montana
- The International Heart Institute of Montana, Missoula, Montana
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12
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Jiang X, Cheng X, Guo S, Du C, Zhang W. Analgesic efficacy of butorphanol combined with sufentanil after heart valve surgery: A propensity score-matching analysis. Medicine (Baltimore) 2022; 101:e32307. [PMID: 36550898 PMCID: PMC9771184 DOI: 10.1097/md.0000000000032307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pain is common after heart valve surgery and can stimulate the sympathetic nervous system, causing hemodynamic instability and respiratory complications. Current treatments for postoperative pain are insufficient, and postoperative pain is difficult to control effectively with a single analgesic. Therefore, we investigated the analgesic efficacy of butorphanol with sufentanil after heart valve surgery and its hemodynamic effects. The records of 221 patients admitted to the intensive care unit after cardiac valve replacement between January 1, 2018, and May 31, 2021, were retrospectively analyzed. Patients were allocated to 2 groups based on the postoperative pain treatment they received: treatment group (administered butorphanol combined with sufentanil), and control group (administered conventional sufentanil analgesia). After propensity score matching for sex, age, Acute Physiology and Chronic Health Evaluation II score, type of valve surgery, and operation duration, 76 patients were included in the study, and analgesic efficacy, hemodynamic changes, and adverse drug reactions were compared between the 2 groups. After propensity score matching, the baseline characteristics were not significantly different between the groups. The histogram and jitter plot of the propensity score distribution indicated good matching. No significant differences were observed in the duration of mechanical ventilation, duration of stay in the intensive care unit, duration of total hospital stay, and hospitalization expenditure between the groups (P > .05). The treatment group had notably higher minimum systolic blood pressure (P = .024) and lower heart rate variability (P = .049) than those in the control group. Moreover, the treatment group exhibited better analgesic efficacy and had lower critical-care pain observation tool scores and consumption of sufentanil 24 hours after surgery than the control group (P < .05). The incidence of vomiting was notably lower in the treatment than in the control group (P = .028). Butorphanol combined with sufentanil can be used in patients after heart valve replacement. This combined treatment has good analgesic efficacy and is associated with reduced adverse drug reactions and, potentially, steady hemodynamics.
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Affiliation(s)
- Xuandong Jiang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR China
| | - Xuping Cheng
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR China
| | - Shan Guo
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR China
| | - Chaojian Du
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR China
| | - Weimin Zhang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, PR China
- * Correspondence: Weimin Zhang, Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Dongyang, Jinhua, Zhejiang 322100, China (e-mail: )
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13
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Monteiro BP, Lascelles BDX, Murrell J, Robertson S, Steagall PVM, Wright B. 2022
WSAVA
guidelines for the recognition, assessment and treatment of pain. J Small Anim Pract 2022. [DOI: 10.1111/jsap.13566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. P. Monteiro
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. D. X. Lascelles
- Comparative Pain Research Laboratory and Surgery Section North Carolina State University 4700 Hillsborough Street Raleigh NC USA
| | - J. Murrell
- Highcroft Veterinary Referrals 615 Wells Rd, Whitchurch Bristol BS149BE UK
| | - S. Robertson
- Senior Medical Director Lap of Love Veterinary Hospice 17804 N US Highway 41 Lutz FL 33549 USA
| | - P. V. M. Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine Université de Montréal 3200 rue Sicotte, Saint‐Hyacinthe Quebec Canada
| | - B. Wright
- Mistral Vet 4450 Thompson Pkwy Fort Collins CO 80534 USA
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14
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Wiech M, Żurek S, Kurowicki A, Horeczy B, Czuczwar M, Piwowarczyk P, Widenka K, Borys M. Erector Spinae Plane Block Decreases Chronic Postoperative Pain Severity in Patients Undergoing Coronary Artery Bypass Grafting. J Clin Med 2022; 11:jcm11195949. [PMID: 36233819 PMCID: PMC9571025 DOI: 10.3390/jcm11195949] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 12/02/2022] Open
Abstract
Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients’ moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using the Neuropathic Pain Symptom Inventory (NPSI). This was a prospective cohort study conducted in a cardiac surgery department of a teaching hospital. Patients undergoing OP-CABG were enrolled in an erector spinae plane block (ESPB) group (n = 27) or a control (CON) group (n = 24). Before the induction of general anesthesia, ESPB was performed on both sides under ultrasound guidance using 0.375% ropivacaine. The secondary outcomes included cumulative oxycodone consumption, acute pain intensity, mechanical ventilation time, hospital length of stay, and postoperative complications. CPSP intensity was lower in the ESPB group than in the CON group 1, 3, and 6 months post-surgery (p < 0.001). Significant between-group differences were also observed in other outcomes, including postoperative pain severity, opioid consumption, mechanical ventilation time, and hospital length of stay, in favor of the ESPB group. Preemptive ESPB appears to decrease the risk of CPSP development in patients undergoing OP-CABG. Reduced acute pain severity and shorter mechanical ventilation times and hospital stays should improve patients’ satisfaction and reduce perioperative complications.
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Affiliation(s)
- Marcin Wiech
- Second Department of Anesthesia and Intensive Therapy, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Sławomir Żurek
- Department of Cardiac Surgery, Medical Faculty, University of Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland
| | - Arkadiusz Kurowicki
- Department of Cardiac Surgery, Medical Faculty, University of Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland
| | - Beata Horeczy
- Pro-Familia Hospital, Medical College of Rzeszow University, Witolda 6B, 35-302 Rzeszow, Poland
| | - Mirosław Czuczwar
- Second Department of Anesthesia and Intensive Therapy, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Paweł Piwowarczyk
- Second Department of Anesthesia and Intensive Therapy, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Kazimierz Widenka
- Department of Cardiac Surgery, Medical Faculty, University of Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland
| | - Michał Borys
- Second Department of Anesthesia and Intensive Therapy, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
- Correspondence: ; Tel.: +48-81-532-2713; Fax: +48-81-532-2712
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15
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Arends BC, Timmerman L, Vernooij LM, Verwijmeren L, Biesma DH, van Dongen EPA, Noordzij PG, van Oud-Alblas HJB. Preoperative frailty and chronic pain after cardiac surgery: a prospective observational study. BMC Anesthesiol 2022; 22:201. [PMID: 35778674 PMCID: PMC9248159 DOI: 10.1186/s12871-022-01746-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Chronic pain after cardiac surgery, whether or not related to the operation, is common and has negative impact on health related quality of life (HRQL). Frailty is a risk factor for adverse surgical outcomes, but its relationship with chronic pain after cardiac surgery is unknown. This study aimed to address the association between frailty and chronic pain following cardiac surgery. Methods This sub-study of the Anesthesia Geriatric Evaluation study included 518 patients ≥ 70 years undergoing elective cardiac surgery. Pain was evaluated with the Short-Form 36 questionnaire prior to and one year after surgery. Associations between chronic postoperative pain and frailty domains, including medication use, nutritional status, mobility, physical functioning, cognition, HRQL, living situation and educational level, were investigated with multivariable regression analysis. Results Chronic pain one year after cardiac surgery was reported in 182 patients (35%). Medication use, living situation, mobility, gait speed, Nagi’s physical functioning and preoperative HRQL were frailty domains associated with chronic pain after surgery. For patients with chronic pain physical HRQL after one year was worse compared to patients without chronic pain (β –10.37, 99% CI –12.57 – –8.17). Conclusions Preoperative polypharmacy, living alone, physical frailty and lower mental HRQL are associated with chronic pain following cardiac surgery. Chronic postoperative pain is related to worse physical HRQL one year after cardiac surgery. These findings may guide future preoperative interventions to reduce chronic pain and poor HRQL after cardiac surgery in older patients. Trial Registration This trial has been registered before initiation under number NCT02535728 at clinicaltrials.gov. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01746-x.
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Affiliation(s)
- Britta C Arends
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands
| | - Leon Timmerman
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands.
| | - Lisette M Vernooij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands.,Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lisa Verwijmeren
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands
| | - Douwe H Biesma
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Eric P A van Dongen
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands
| | - Heleen J Blussé van Oud-Alblas
- Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands
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16
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Parasternal After Cardiac Surgery (PACS): a prospective, randomised, double-blinded, placebo-controlled trial study protocol for evaluating a continuous bilateral parasternal block with lidocaine after open cardiac surgery through sternotomy. Trials 2022; 23:516. [PMID: 35725494 PMCID: PMC9208208 DOI: 10.1186/s13063-022-06469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multimodal analgesia that provides optimal pain treatment with minimal side effects is important for optimal recovery after open cardiac surgery. Regional anaesthesia can be used to block noxious nerve signals. Because sternotomy causes considerable pain that lasts several days, a continuous nerve block is advantageous. Previous studies on continuous sternal wound infusion or parasternal blocks with long-acting local anaesthetics have shown mixed results. This study aims to determine whether a continuous bilateral parasternal block with lidocaine, which is a short-acting local anaesthetic that has a favourable safety/toxicity profile, results in effective analgesia. We hypothesise that a 72-hour continuous parasternal block with 0.5% lidocaine at a rate of 7 ml/hour on each side provides effective analgesia and reduces opioid requirement. We will evaluate whether recovery is enhanced. METHODS In a prospective, randomised, double-blinded manner, 45 patients will receive a continuous parasternal block with either 0.5% lidocaine or saline. The primary endpoint is cumulated intravenous morphine by patient-controlled analgesia at 72 hours. Secondary end-points include the following: (1) the cumulated numerical rating scale (NRS) score recorded three times daily at 72 hours; (2) the cumulated NRS score after two deep breaths three times daily at 72 hours; (3) the NRS score at rest and after two deep breaths at 2, 4, 8 and 12 weeks after surgery; (4) oxycodone requirement at 2, 4, 8 and 12 weeks after surgery; (5) Quality of Recovery-15 score preoperatively compared with that at 24, 48 and 72 hours, and at 2, 4, 8 and 12 weeks after surgery; (6) preoperative peak expiratory flow compared with postoperative daily values for 3 days; and (7) serum concentrations of interleukin-6 and lidocaine at 1, 24, 48 and 72 hours postoperatively compared with preoperative values. DISCUSSION Adequate analgesia is important for quality of care and vital to a rapid recovery after cardiac surgery. This study aims to determine whether a continuous parasternal block with a short-acting local anaesthetic improves analgesia and recovery after open cardiac procedures. TRIAL REGISTRATION The study was registered in the European Clinical Trials Database on 27/9/2019 (registration number: 2018-004672-35).
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17
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Toscano A, Barbero C, Capuano P, Costamagna A, Pocar M, Trompeo A, Pasero D, Rinaldi M, Brazzi L. Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations. J Card Surg 2022; 37:1585-1590. [PMID: 35274774 DOI: 10.1111/jocs.16400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Chronic postsurgical pain (CPSP) is a relatively common complication after cardio-thoracic operations with well-known consequences in terms of return to normal activities and quality of life. Little is known about the prevalence and severity of CPSP after minimally invasive cardiac surgery. The aim of this study was to measure the rate of CPSP in patients undergoing right minithoracotomy mitral valve (MV) surgery and to compare the effectiveness of different approaches to pain control. METHODS A prospective observational study was conducted between March 2019 and September 2020. All patients undergoing right minithoracotomy MV surgery treated with morphine, continuous serratus anterior plane block (SAPB), or continuous erector spinae plane block (ESPB) were included. The Brief Pain Inventory questionnaire was used to evaluate 6-month CPSP and quality of life. RESULTS A total of 100 patients were enrolled: postoperative pain control was obtained with morphine in 26 cases, with SAPB in 37 cases, and with ESPB in 37 cases. Median intensive care unit and hospital length of stay were 1 day and 6 days, respectively. Pain severity index was lower than 10 in 81 patients, and no differences were recorded between groups (p = .59). No patients reported chronic use of medications for pain management or severe pain interference in daily activities at follow-up. DISCUSSION Right minithoracotomy approach is not burdened by a high incidence of CPSP: pain severity index was lower than 10 in more than 90% of patients. Then, in our experience, chronic pain seems not to be related to the type of perioperative analgesia adopted.
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Affiliation(s)
- Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Cristina Barbero
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paolo Capuano
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC, Palermo, Italy
| | - Andrea Costamagna
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Trompeo
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Daniela Pasero
- Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
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18
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Aternali A, Slepian PM, Clarke H, Ladha KS, Katznelson R, McRae K, Seltzer Z, Katz J. Presurgical distress about bodily sensations predicts chronic postsurgical pain intensity and disability 6 months after cardiothoracic surgery. Pain 2022; 163:159-169. [PMID: 34086627 DOI: 10.1097/j.pain.0000000000002325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic postsurgical pain (CPSP) and disability after cardiothoracic surgery are highly prevalent and difficult to treat. Researchers have explored a variety of presurgical risk factors for CPSP and disability after cardiothoracic surgery, including one study that examined distress from bodily sensations. The current prospective, longitudinal study sought to extend previous research by investigating presurgical distress about bodily sensations as a risk factor for CPSP and disability after cardiothoracic surgery while controlling for several other potential psychosocial predictors. Participants included 543 adults undergoing nonemergency cardiac or thoracic surgery who were followed over 6 months postsurgically. Before surgery, participants completed demographic, clinical, and psychological questionnaires. Six months after surgery, participants reported the intensity of CPSP on a 0 to 10 numeric rating scale and pain disability, measured by the Pain Disability Index. Multinomial logistic regression analyses were conducted to evaluate the degree to which presurgical measures predicted pain outcomes 6 months after surgery. The results showed that CPSP intensity was significantly predicted by age and presurgical scores on the Symptom Checklist-90-Revised Somatization subscale (Nagelkerke R2 = 0.27, P < 0.001), whereas chronic pain disability was only predicted by presurgical Symptom Checklist-90-Revised Somatization scores (Nagelkerke R2 = 0.29, P < 0.001). These findings demonstrate that presurgical distress over bodily sensations predicts greater chronic pain intensity and disability 6 months after cardiothoracic surgery and suggest that presurgical treatment to diminish such distress may prevent or minimize CPSP intensity and disability.
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Affiliation(s)
- Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | - P Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Ze'ev Seltzer
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
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19
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Cardiovasc Comput Tomogr 2022; 16:54-122. [PMID: 34955448 DOI: 10.1016/j.jcct.2021.11.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 78:e187-e285. [PMID: 34756653 DOI: 10.1016/j.jacc.2021.07.053] [Citation(s) in RCA: 318] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. STRUCTURE Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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21
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Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 144:e368-e454. [PMID: 34709879 DOI: 10.1161/cir.0000000000001029] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients. METHODS A comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
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22
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Harrogate SR, Cooper JA, Zawadka M, Anwar S. Seven-year follow-up of persistent postsurgical pain in cardiac surgery patients: A prospective observational study of prevalence and risk factors. Eur J Pain 2021; 25:1829-1838. [PMID: 33982819 DOI: 10.1002/ejp.1794] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/05/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Our aim was to describe the long-term prevalence, risk factors and impact on quality of life of persistent postsurgical pain (PPP) following cardiac surgery. METHODS All patients undergoing sternotomy in a single centre over 6 months were prospectively interviewed by telephone at six months and seven years following surgery. RESULTS We analysed data from 174 patients at six months and 146 patients at seven years following surgery, revealing a PPP prevalence of 39.7% (n = 69) and 9.6% (n = 14) respectively. At six post-operative months, younger age, higher acute pain score, intraoperative remifentanil infusion and more prolonged surgery were associated with sternotomy-site PPP. These variables, in combination, predict PPP in this study group with area under the receiver operating curve of 0.91 (95% CI 0.86-0.94) at 6 months and 0.74 (95% CI 0.57-0.86) at 7 years. Quality of life scores were significantly lower with PPP (median change in EQ-5D score = -0.23 [-0.57, -0.09] compared to 0.00 [0-0.24] without PPP at 7 years, p < 0.001). At7 years, younger age, prolonged surgery and intraoperative remifentanil infusion were associated with sternotomy-site PPP. CONCLUSIONS To the best of our knowledge, this is the longest follow-up of PPP across all surgical specialities and certainly within cardiac surgery. Prevalence of PPP and impact on QOL after cardiac surgery are high and associated with young age, high acute pain score, use of remifentanil and long operative time. We present a predictive score to highlight patients at risk of developing PPP. SIGNIFICANCE Seven years after cardiac surgery, almost 10% of patients in this cohort described persistent pain in and around the incision. While higher than previous reports in the literature (limited to up to five post-operative years), this assessment was made following three maximal coughs and therefore is movement or function evoked. High incident of persistent postsurgical pain may adversely affect long-term quality of life which is measured using a validated tool.
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Affiliation(s)
- Suzanne R Harrogate
- Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK
| | - Jackie A Cooper
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK
| | - Mateusz Zawadka
- Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK.,William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK.,Medical University of Warsaw, Polish National Agency for Academic Exchange, Warsaw, Poland
| | - Sibtain Anwar
- Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK.,William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
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23
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The Incidence of New Persistent Opioid Use Following Cardiac Surgery via Sternotomy. Ann Thorac Surg 2021; 113:33-40. [PMID: 33930358 DOI: 10.1016/j.athoracsur.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years, increased attention has turned toward the risk of chronic opioid use after surgery. In this nationwide cohort study, we examined the rate of new persistent opioid use after cardiac surgery by sternotomy. METHODS All opioid-naive patients undergoing heart surgery by sternotomy from 2005 to 2018 in Iceland were included in the study. Naivety was defined as not filling an opioid prescription within 6 months before surgery. Persistent opioid use was defined as filling at least 1 opioid prescription during the first 90 days after surgery and another 90 to 180 days after the operation. In addition to estimating the incidence of new persistent opioid use, differences in patient characteristics, survival, and readmission rates were compared between the group with and without new persistent opioid use. RESULTS Of 1227 patients who underwent cardiac surgery by sternotomy during the study period, 925 were included in the study. Of those, 4.6% developed new persistent opioid use. When only patients who filled an opioid prescription after surgery were included, 10.1% developed new persistent opioid use. Chronic obstructive pulmonary disease, preoperative use of nonsteroidal anti-inflammatory drugs, gabapentinoids, and nitrates were associated with increased risk for new persistent opioid use. Patients with new persistent opioid use did not have higher rates of readmission nor all-cause mortality. CONCLUSIONS The rate of new persistent opioid use after cardiac surgery was 4.6%. Future steps should identify strategies to minimize the development of new persistent opioid use.
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24
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Nazarnia S, Subramaniam K. Nonopioid Analgesics in Postoperative Pain Management After Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2021; 25:280-288. [PMID: 33899581 DOI: 10.1177/1089253221998552] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Opioid analgesia is still considered the standard of practice for cardiac surgery. In recent years, combinations of several nonnarcotic analgesics and regional analgesia have shown promise in restricting opioid use during and after cardiac surgery. Ketamine infusion, dexmedetomidine infusion, acetaminophen, ketorolac, and gabapentin are useful adjuvants in cardiac anesthesia practice and have opioid-sparing properties. The beneficial effects of nonnarcotic multimodal analgesia on intraoperative stress response, recovery profile, postoperative pain, and persistent opioid use after cardiac surgery are yet to be established, and further randomized clinical trials are required.
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Affiliation(s)
- Soheyla Nazarnia
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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25
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Chen H, Song W, Wang W, Peng Y, Zhai C, Yao L, Xia Z. Ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in mediastinal mass resection by median sternotomy: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2021; 21:98. [PMID: 33784983 PMCID: PMC8011112 DOI: 10.1186/s12871-021-01291-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ultrasound-guided parasternal intercostal nerve block is rarely used for postoperative analgesia, and its value remains unclear. This study aimed to evaluate the effectiveness of ultrasound-guided parasternal intercostal nerve block for postoperative analgesia in patients undergoing median sternotomy for mediastinal mass resection. METHODS This randomized, double-blind, placebo-controlled trial performed in Renmin Hospital, Wuhan University, enrolled 41 participants aged 18-65 years. The patients scheduled for mediastinal mass resection by median sternotomy were randomly assigned were randomized into 2 groups, and preoperatively administered 2 injections of ropivacaine (PSI) and saline (control) groups, respectively, in the 3rd and 5th parasternal intercostal spaces with ultrasound-guided (USG) bilateral parasternal intercostal nerve block. Sufentanil via patient-controlled intravenous analgesia (PCIA) was administered to all participants postoperatively. Pain score, total sufentanil consumption, and postoperative adverse events were recorded within the first 24 h. RESULTS There were 20 and 21 patients in the PSI and control group, respectively. The PSI group required 20% less PCIA-sufentanil compared with the control group (54.05 ± 11.14 μg vs. 67.67 ± 8.92 μg, P < 0.001). In addition, pain numerical rating scale (NRS) scores were significantly lower in the PSI group compared with control patients, both at rest and upon coughing within 24 postoperative hours. Postoperative adverse events were generally reduced in the PSI group compared with controls. CONCLUSIONS USG bilateral parasternal intercostal nerve block effectively reduces postoperative pain and adjuvant analgesic requirement, with good patient satisfaction, therefore constituting a good option for mediastinal mass resection by median sternotomy.
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Affiliation(s)
- Hexiang Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Wenqin Song
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Wei Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Yawen Peng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Chunchun Zhai
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Lihua Yao
- Department of Psychiatry, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, No. 99 Zhang Road, Wuhan, 430060, Hubei Province, China.
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Katijjahbe MA, Royse C, Granger C, Denehy L, Md Ali NA, Abdul Rahman MR, King-Shier K, Royse A, El-Ansary D. Location and Patterns of Persistent Pain Following Cardiac Surgery. Heart Lung Circ 2021; 30:1232-1243. [PMID: 33608196 DOI: 10.1016/j.hlc.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population. METHODS A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively. RESULTS Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p<0.005) over time. CONCLUSION Mild-to-moderate pain was frequent after sternotomy, improved over time and was mostly located over the incision and mammary (internal thoracic) artery harvest site. Persistent pain at 3 months remained a significant problem in the community within this surgical population.
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Affiliation(s)
- Mohd Ali Katijjahbe
- Department of Physiotherapy, Hospital Canselor Tunku Mukhriz, University, Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.
| | - Colin Royse
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Australian Director, Outcomes Research Consortium, Cleveland Clinic, Cleveland, USA
| | - Catherine Granger
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
| | - Nur Ayub Md Ali
- Cardiothoracic Surgery, Heart and Lung Centre, UKM Medical Centre, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd Ramzisham Abdul Rahman
- Cardiothoracic Surgery, Heart and Lung Centre, UKM Medical Centre, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Kathryn King-Shier
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Alistair Royse
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia
| | - Doa El-Ansary
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Clinical Research Institute, Westmead Private Hospital, Westmead, Australia
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27
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Minami K, Kabata D, Kakuta T, Fukushima S, Fujita T, Yoshitani K, Ohnishi Y. Association Between Sternotomy Versus Thoracotomy and the Prevalence and Severity of Chronic Postsurgical Pain After Mitral Valve Repair: An Observational Cohort Study. J Cardiothorac Vasc Anesth 2021; 35:2937-2944. [PMID: 33593650 DOI: 10.1053/j.jvca.2021.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Investigate differences in the prevalence and severity of chronic postsurgical pain (CPSP) after cardiac surgery via thoracotomy versus sternotomy are not well-understood. DESIGN An observational cohort study. SETTING A tertiary care hospital. PARTICIPANTS Four hundred twenty-eight patients (sternotomy: 192 patients, thoracotomy: 236 patients) who underwent mitral valve repair. INTERVENTIONS A questionnaire about the severity of surgical wound pain evaluated with a numerical rating scale (NRS) was sent. NRS responses for current pain, peak pain in the last four weeks, and average pain in the last four weeks were evaluated. MEASUREMENTS AND MAIN RESULTS The main outcomes were the severity of CPSP evaluated using NRS and the prevalence of CPSP. CPSP was defined as pain >0 that developed after a surgical procedure. During the median follow-up of 29 months, 79 patients complained of CPSP. (sternotomy: 15 patients, thoracotomy: 64 patients). Multivariate ordinal logistic regression showed that NRS responses for current pain (adjusted odds ratio [aOR], 3.17; 95% confidence interval [CI] 1.64-6.12; p = 0.001), peak pain in the last four weeks (aOR, 2.00; 95% CI 1.11-3.61; p = 0.021), and average pain in the last four weeks (aOR, 2.21; 95% CI 1.31-3.72; p = 0.003) were significantly higher in patients who underwent thoracotomy. Multivariate logistic regression showed that thoracotomy was an independent predictor of CPSP (aOR, 3.63; 95% CI 1.67-7.88; p = 0.001). CONCLUSIONS The prevalence and severity of CPSP were higher among patients who underwent mitral valve repair via thoracotomy than sternotomy.
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Affiliation(s)
- Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenji Yoshitani
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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28
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Qiu L, Bu X, Shen J, Li M, Yang L, Xu Q, Chen Y, Yang J. Observation of the analgesic effect of superficial or deep anterior serratus plane block on patients undergoing thoracoscopic lobectomy. Medicine (Baltimore) 2021; 100:e24352. [PMID: 33546068 PMCID: PMC7837840 DOI: 10.1097/md.0000000000024352] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/22/2020] [Indexed: 02/05/2023] Open
Abstract
The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group): 1. general anesthesia group (P group); 2. combined general anesthesia and SSPB group (S group), and 3. combined general anesthesia and DSPB group (D group). The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group P (all P < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group P (P < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S (P < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.
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Affiliation(s)
- Lan Qiu
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, the First Affiliated Hospital of Soochow University, Suzhou
- Department of Anesthesiology
| | | | | | - Min Li
- Department of Anesthesiology
| | | | | | - Yongjun Chen
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jianping Yang
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, the First Affiliated Hospital of Soochow University, Suzhou
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29
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Park S, Nahm FS, Han WK, Park S, Han S, Park KH, Lim C. The 5% Lidocaine Patch for Decreasing Postoperative Pain and Rescue Opioid Use in Sternotomy: A Prospective, Randomized, Double-blind Trial. Clin Ther 2020; 42:2311-2320. [DOI: 10.1016/j.clinthera.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 12/12/2022]
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30
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Roncada G. Osteopathic treatment leads to significantly greater reductions in chronic thoracic pain after CABG surgery: A randomised controlled trial. J Bodyw Mov Ther 2020; 24:202-211. [PMID: 32825989 DOI: 10.1016/j.jbmt.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/30/2019] [Accepted: 03/08/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are a number of long-term postoperative complications after coronary artery bypass graft (CABG) surgery. Pulmonary function is decreased by 12% and 30%-50% of the patients have chronic thoracic pain. METHODS This randomised controlled trial with two parallel groups aimed to explore the effectiveness of osteopathic treatments (OTs) on these conditions. The standard care (SC) group and the and OT group received a 12-week standard cardiac rehabilitation programme, which was supplemented with four OTs for the OT group only. The outcome assessors were blinded to the patients' allocation. RESULTS Eighty-two patients with median sternotomy after CABG surgery were randomly allocated in a 1:1 ratio (SC: n = 42, OT: n = 42). Slow vital capacity and pain intensity were measured at baseline and at 12 weeks and 52 weeks after surgery. Pain intensity was significantly lower in the OT group 12 weeks after surgery (3.6-0.80 vs. 2.6 to 1.2, p = 0.030). One year after surgery, there still was a significantly lower pain intensity in the OT group (3.6-0.56, vs. 2.6 to 1.2, p = 0.014). No significant changes between groups were found in pulmonary function. There were no adverse events reported. CONCLUSIONS From this study, it can be concluded that the addition of OT to exercise-based cardiac rehabilitation may lead to significantly greater reductions in thoracic pain after CABG surgery. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov (NCT01714791).
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Affiliation(s)
- Gert Roncada
- Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium; Commission for Osteopathic Research, Practice and Promotion, Mechelen, Belgium.
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31
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Huang LC, Chen DZ, Chen LW, Xu QC, Zheng ZH, Dai XF. Health-related quality of life following minimally invasive totally endoscopic mitral valve surgery. J Cardiothorac Surg 2020; 15:194. [PMID: 32723379 PMCID: PMC7388519 DOI: 10.1186/s13019-020-01242-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/20/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To compare the impact of two different types of mitral valve surgery on health-related quality of life, we conducted a retrospective study comparing modified totally endoscopic mitral valve surgery with median sternotomy mitral valve surgery. METHODS A total of 163 patients who underwent mitral valve surgery at our institution between January 1, 2019 and December 31, 2019 were enrolled. For these 163 patients, mitral valve surgery was performed using either a modified totally endoscopic approach or median sternotomy approach. We used the numerical rating scale and the Scar Cosmesis Assessment and Rating Scale to measure pain intensity and the aesthetic appearance of the surgical incision and used the MOS 36-item Short-Form Health Survey to assess health-related quality of life. RESULTS Seventy-eight patients underwent the modified totally endoscopic mitral valve surgery, and eighty-five patients underwent the median sternotomy mitral valve surgery. The two groups of patients were similar in terms of demographics and echocardiography findings. The number of bioprosthetic valve replacements performed was significantly higher in the totally endoscopic group than in the median sternotomy group (p = 0.04), whereas the subvalvular apparatus was less preserved in only 33 cases in the totally endoscopic group (p = 0.01). The rate of postoperative adverse events was similar between the two groups. The pain was mild and aesthetic appearance was significantly better in the totally endoscopic approach group than in the sternotomy approach group. Significant differences in the scores for the bodily pain and mental health subscales of the MOS 36-item Short-Form Health Survey were found between the two groups. CONCLUSIONS Compared with median sternotomy mitral valve surgery, totally endoscopic mitral valve surgery has an equally good treatment effect, improving patient's health-related quality of life with a better cosmetic appearance and a lower pain intensity. Our study suggested that the totally endoscopic approach is superior to the median sternotomy approach in terms of pain intensity, aesthetic appearance and health-related quality of life.
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Affiliation(s)
- Ling-Chen Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Dao-Zhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Qi-Chen Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zi-He Zheng
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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Jin J, Min S, Peng L, Du X, Zhang D, Ren L. No Differences in the Prevalence and Intensity of Chronic Postsurgical Pain Between Laparoscopic Hysterectomy and Abdominal Hysterectomy: A Prospective Study. J Pain Res 2020; 13:1-9. [PMID: 32021389 PMCID: PMC6954852 DOI: 10.2147/jpr.s225230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/24/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To compare the prevalence and characteristics of chronic postsurgical pain (CPSP) between laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) groups 3, 6, and 12 months after surgery, and to assess the impact of pain on the activities of daily living (ADL) of patients. Methods The demographic characteristics, intraoperative clinical factors, and postoperative pain score were collected prospectively in patients scheduled for elective LH or AH for benign disease at our institution from July 2014 to June 2015. Patients were interviewed by telephone and followed up for pain assessment 3, 6, and 12 months after surgery. The prevalence, intensity, and specific locations of pain, as well as analgesic administration and impact on the ADL, were included in the questionnaire. Results The results from 406 patients (225 patients in the LH group and 181 patients in the AH group) were obtained. Three months after surgery, the prevalence of CPSP was 20.9% in the LH group and 20.4% in the AH group. At 6 months, the prevalence of pain declined to 11.6% in the LH group and 9.4% in the AH group. At 12 months after surgery, only 13 (5.8%) patients in the LH group and 11 (6.1%) patients in the AH group complained about persistent pain. The prevalence of CPSP, as well as the average numerical rating scale pain scores at rest and during movement, during 12 months after surgery were not significantly different between the groups. CPSP after hysterectomy exhibited a negative impact on the ADL. Conclusion The prevalence and intensity of CPSP were not significantly different between patients undergoing LH or AH within 12 months after surgery. A tendency towards a reduction in chronic pain over time was documented. Chronic post-hysterectomy pain exhibited a negative impact on the ADL.
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Affiliation(s)
- Juying Jin
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Lihua Peng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Xunsong Du
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Dong Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Li Ren
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
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Matsuda M, Takemura H, Yamashita A, Matsuoka Y, Sawa T, Amaya F. Post-surgical chronic pain and quality of life in children operated for congenital heart disease. Acta Anaesthesiol Scand 2019; 63:745-750. [PMID: 30869169 DOI: 10.1111/aas.13346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/29/2018] [Accepted: 01/19/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Advances in medical technology have resulted in an increased life expectancy in pediatric patients with congenital heart diseases. Assessment of health-related quality of life is crucial to improving their healthcare status. We aimed to assess post-surgical pain prevalence and its impact on health-related quality of life in pediatric patients who underwent cardiac surgery during childhood. METHODS This cross-sectional study recruited patients aged 4 years or older who underwent cardiac surgery for congenital heart disease at least 1 year prior, during the age of 0-10 years, and were admitted for post-surgical follow-up at our institute. The prevalence, intensity, and location of pain and health-related quality of life were assessed in an interview. Perioperative information was collected from the patients' medical records. Health-related quality of life was assessed using the Pediatric quality of life inventory 4.0 (PedsQL). RESULTS Pain was reported by 24 (17%) of the 141 participants. One-third of them reported moderate to severe pain that required medical intervention. After adjustment for several confounding factors, multivariable linear regression analysis demonstrated that the presence of pain and the number of surgeries were associated with lower total PedsQL scores. CONCLUSIONS Pain was present in 17% of the patients who underwent cardiac surgery during childhood. Presence of pain had a negative impact on long-term health-related quality of life after pediatric cardiac surgery.
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Affiliation(s)
- Megumi Matsuda
- Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan
| | - Hitomi Takemura
- Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan
| | - Ayahiro Yamashita
- Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan
| | - Yutaka Matsuoka
- Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan
| | - Teiji Sawa
- Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine Kyoto Prefectural University of Medicine Kyoto Japan
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Yimer H, Woldie H. Incidence and Associated Factors of Chronic Pain After Caesarean Section: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:840-854. [DOI: 10.1016/j.jogc.2018.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 10/28/2022]
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Macaire P, Ho N, Nguyen T, Nguyen B, Vu V, Quach C, Roques V, Capdevila X. Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery—A Patient-Matched, Controlled Before-and-After Study. J Cardiothorac Vasc Anesth 2019; 33:1659-1667. [DOI: 10.1053/j.jvca.2018.11.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 11/11/2022]
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Comacchio GM, Marulli G, Mammana M, Natale G, Schiavon M, Rea F. Surgical Decision Making. Thorac Surg Clin 2019; 29:203-213. [DOI: 10.1016/j.thorsurg.2018.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee J, Paeng SH, Lee WH, Kim ST, Lee KS. Cervicothoracic Junction Approach using Modified Anterior Approach: J-type Manubriotomy and Low Cervical Incision. Korean J Neurotrauma 2019; 15:43-49. [PMID: 31098349 PMCID: PMC6495574 DOI: 10.13004/kjnt.2019.15.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/15/2022] Open
Abstract
Spinal surgery of the anterior aspect of the cervicothoracic junction is difficult and has technological challenges because of the kyphotic alignment of the upper thoracic spine. This approach requires knowledge of the cervicothoracic regional anatomy. Surgery in this region is rare because of its indications; despite this rarity, surgeons must be prepared to expose this region. In addition, surgery in this region demands extensive opening of the surgical field and results in severe postoperative pain. Therefore, a less invasive procedure must be considered. Six cases of cervicothoracic lesion operation have been reported. The patients were successfully treated using an anterior modified approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable anterior implant bone construction while preserving the posterior osseo-ligamentous tension band. Moreover, the modified anterior approach (J-type manubriotomy) provides the same exposure of the cervicothoracic junction without a full median sternotomy and avoids injury to subclavian vessels during resection of the clavicle or sternoclavicular junction. Therefore, the anterior cervical approach combined with J-type manubriotomy allows extensive exposure of the cervicothoracic junction and causes less complications. We performed preoperative radiological evaluation to identify the cases in which J-type manubriotomy was necessary.
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Affiliation(s)
- Jin Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Won Hee Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Sung Tae Kim
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Keun Soo Lee
- Department of Neurosurgery, School of Medicine, Inje University Busan Paik Hospital, Busan, Korea
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Chanoit G, Pell CA, Bolotin G, Buckner GD, Williams JP, Crenshaw HC. Retraction mechanics of Finochietto-style self-retaining thoracic retractors. Biomed Eng Online 2019; 18:45. [PMID: 30991997 PMCID: PMC6469031 DOI: 10.1186/s12938-019-0664-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Analyze the mechanics of Finochietto-style retractors, including the responses of thoracic tissues during thoracotomy, with an emphasis on tissue trauma and means for its reduction. METHODS Mechanical analyses of the retractor were performed, including analysis of deformation under load and kinematics of the crank mechanism. Thoracotomies in a porcine model were performed in anesthetized animals (7) and fresh cadavers (17) using an instrumented retractor. RESULTS Mechanical analyses revealed that arm motion is a non-linear function of handle rotation, that deformation of the retractor under load concentrates force at one edge of the retractor blade, and that the retractor behaves like a spring, deforming under the load of retraction and continuing to force open the incision long after crank rotation stops. Experimental thoracotomies included retractions ranging from 50 to 112 mm over 30 to 370 s, generating maximum forces of 118 to 470 N (12-50 kgf). Tissue ruptures occurred in 12 of the 24 retractions. These ruptures all occurred at retraction distances wider than 30 mm and at forces greater than 122.5 N. Significant tissue ruptures were observed for nearly all retractions at higher retraction rates (exceeding ½ rotation of the crank per 10 s). CONCLUSIONS The Finochietto-style retractor can generate large forces and some aspects of its design increase the probability of tissue trauma.
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Affiliation(s)
- Guillaume Chanoit
- Bristol Veterinary School and Bristol Heart Institute, University of Bristol, Langford, Bristol, BS40 5DU, UK.,College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27606, USA
| | - Charles A Pell
- Physcient Inc., 112 South Duke St., Suite 4A, Durham, NC, 27701, USA
| | - Gil Bolotin
- Cardiac Surgery Department, Rambam Health Care Campus, P.O.B. 9602, 31096, Haifa, Israel
| | - Gregory D Buckner
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Campus Box 7910, Raleigh, NC, 27695, USA.
| | | | - Hugh C Crenshaw
- Physcient Inc., 112 South Duke St., Suite 4A, Durham, NC, 27701, USA
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Abstract
Chronic postsurgical pain affects between 5 and 75% of patients, often with an adverse impact on quality of life. While the transition of acute to chronic pain is a complex process-involving multiple mechanisms at different levels-the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. In the present paper, we first present an up-to-date narrative literature review of these interventions. In the second section, we develop several ways by which we could overcome the limitations of the current approaches and enhance the outcome of our surgical patients, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management. The third and final section covers the treatment of established CPSP. Given that evidence for the current therapeutic options is limited, we need high-quality trials studying multimodal interventions matched to pain characteristics.
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Affiliation(s)
- Arnaud Steyaert
- Department of Anesthesiology, Acute and Transitional Pain Service, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Patricia Lavand'homme
- Department of Anesthesiology, Acute and Transitional Pain Service, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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Fujii S, Roche M, Jones PM, Vissa D, Bainbridge D, Zhou JR. Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study. Reg Anesth Pain Med 2019; 44:556-560. [DOI: 10.1136/rapm-2018-100178] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 11/04/2022]
Abstract
IntroductionCardiac surgery patients often experience significant pain after median sternotomy. The transversus thoracis muscle plane (TTP) block is a newly developed, single-shot nerve block technique that provides analgesia for the anterior chest wall. In this double-blind pilot study, we assessed the feasibility of performing this novel block as an analgesic adjunct.MethodsAll patients aged 18–90 undergoing elective cardiac surgery were randomized to the block or standard care control group on admission to the intensive care unit after surgery. Under ultrasound guidance, patients in the block group received the TTP block with 20 mL of either 0.3% or 0.5% ropivacaine bilaterally, based on weight. The control group did not receive any injections. All blocks were performed by a single anesthesiologist, and data collection was performed by blinded assessors. The primary feasibility outcomes were rate of recruitment, adherence, and adverse events. The rate of recruitment was defined as the ratio of patients giving informed consent to the number of eligible patients who were approached to participate. Secondary outcomes included 12-hour and 24-hour Numeric Rating Scale (NRS) pain scores, 24-hour hydromorphone and acetaminophen requirements, time to extubation, time to first opioid administration, and patient satisfaction (on a yes/no questionnaire) at 24 hours.ResultsTwenty patients were approached for this study and 19 were enrolled. Eight patients received the intended intervention in each group. The recruitment rate was 95% of all approached eligible patients, and the adherence rate to treatment group was 94%. There were no block-related adverse events. The mean (SD) NRS pain scores at rest were 3.3 (3.2) in the block group vs 5.6 (3.2) in the control group at 12 hours. At 24 hours, the pain scores were 4.1 (3.9) vs 4.1 (3.3) in the block and control group, respectively. The mean (SD) 24-hour hydromorphone administration was 1.9 (1.1) mg in the block group vs 1.8 (0.9) mg in the control group.DiscussionThe TTP block is a novel pain management strategy poststernotomy. The results reveal a high patient recruitment, adherence, and satisfaction rate, and provide some preliminary data supporting safety.Trial registration numberNCT03128346.
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McGillion MH, Henry S, Busse JW, Ouellette C, Katz J, Choinière M, Lamy A, Whitlock R, Pettit S, Hare J, Gregus K, Brady K, Dvirnik N, Yang SS, Parlow J, Dumerton-Shore D, Gilron I, Buckley DN, Shanthanna H, Carroll SL, Coyte PC, Ebrahim S, Isaranuwatchai W, Guerriere DN, Hoch J, Khan J, MacDermid J, Martorella G, Victor JC, Watt-Watson J, Howard-Quijano K, Mahajan A, Chan MTV, Clarke H, Devereaux PJ. Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study. BMJ Open 2019; 9:e022995. [PMID: 30826789 PMCID: PMC6398732 DOI: 10.1136/bmjopen-2018-022995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not. METHODS AND ANALYSES In this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score. ETHICS AND DISSEMINATION This protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals. TRIAL REGISTRATION NUMBER NCT01842568.
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Affiliation(s)
- Michael H McGillion
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shaunattonie Henry
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Carley Ouellette
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Manon Choinière
- Centre de recherche de Centre hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Andre Lamy
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Richard Whitlock
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shirley Pettit
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jacqueline Hare
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Krysten Gregus
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Katheryn Brady
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Nazari Dvirnik
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Su Yang
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Joel Parlow
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Norman Buckley
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Sandra L Carroll
- School of Nursing, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shanil Ebrahim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Denise N Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Hoch
- Department of Public Health Sciences, University of California, Davis, Davis, California, USA
| | - James Khan
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Western University, London, Ontario, Canada
| | | | - J Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Howard-Quijano
- Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Matthew T V Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hance Clarke
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - P J Devereaux
- Anesthesiology, Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Hirji SA, Landino S, Cote C, Lee J, Orhurhu V, Shah RM, McGurk S, Kaneko T, Shekar P, Pelletier MP. Chronic opioid use after coronary bypass surgery. J Card Surg 2019; 34:67-73. [PMID: 30625257 DOI: 10.1111/jocs.13981] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opioid dependence has become a major health care issue. Pain management of invasive surgical procedures with opioids may potentially contribute to this epidemic. We sought to determine the association of opioid-prescribing patterns with chronic opioid use. METHODS We retrospectively reviewed all patients undergoing isolated coronary artery bypass graft (CABG) procedures during 2016 at a single institution. Prescribing patterns and medication usage were compared between opioid-naïve and opioid-exposed patients (patients with reported opioid use within 30 days prior to surgery). Chronic opioid dependence was defined as opioid usage beyond 90 days after discharge. RESULTS We included 284 opioid-naïve and 46 opioid-exposed patients. Although overall prescribing patterns were similar between groups, a higher proportion of opioid-exposed patients were prescribed a total dose >150 mg of oxycodone per discharge prescription (15.2% vs 4.9%; P = 0.024), and had a higher proportion of refills within 30 days (28.3% vs 10.9%; relative risk [RR] 3.2 [95% confidence interval (CI): 1.5-6.8]; all P < 0.05). The incidence of chronic opioid dependence was higher among opioid-exposed patients compared to opioid-naïve patients (21.7% vs 3.2%; RR 8.5 [95%CI: 3.2-22.3]; P = 0.001). CONCLUSIONS Ongoing opioid use 3 months after CABG is present in 21.7% of opioid-exposed patients and 3.2% of opioid-naïve patients. These preliminary findings highlight the burden of prescribing patterns on the overall opioid epidemic and the need to develop alternative pain management strategies.
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Affiliation(s)
- Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samantha Landino
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Claudia Cote
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jiyae Lee
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vwaire Orhurhu
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rohan M Shah
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc P Pelletier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med 2018; 36:2289-2297. [PMID: 30217621 DOI: 10.1016/j.ajem.2018.09.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications. Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors. Emergency physicians will be faced with several postoperative complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary surgical team is needed, which improves patient outcomes. This review provides several guiding principles for management of acute complications. Understanding these complications and an approach to the management of hemodynamic instability is essential to optimizing patient care. CONCLUSIONS Postoperative complications of CABG surgery can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Early surgical consultation is imperative, as is optimizing the patient's hemodynamics, including preload, heart rate, cardiac rhythm, contractility, and afterload.
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Zubrzycki M, Liebold A, Skrabal C, Reinelt H, Ziegler M, Perdas E, Zubrzycka M. Assessment and pathophysiology of pain in cardiac surgery. J Pain Res 2018; 11:1599-1611. [PMID: 30197534 PMCID: PMC6112778 DOI: 10.2147/jpr.s162067] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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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Affiliation(s)
- Marek Zubrzycki
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Andreas Liebold
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Christian Skrabal
- Department of Cardiac Surgery, University of Ulm Medical Center, Ulm, Germany,
| | - Helmut Reinelt
- Department of Cardiac Anesthesiology, University of Ulm Medical Center, Ulm, Germany
| | - Mechthild Ziegler
- Department of Cardiac Anesthesiology, University of Ulm Medical Center, Ulm, Germany
| | - Ewelina Perdas
- Department of Cardiovascular Physiology, Medical University of Lodz, Lodz, Poland
| | - Maria Zubrzycka
- Department of Cardiovascular Physiology, Medical University of Lodz, Lodz, Poland
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Dharaniprasad G, Samantaray A, Hanumantha Rao M, Chandra A, Sarma PVGK. Association of G472A allele of membrane bound catechol-O-methyltransferase gene with chronic post-sternotomy pain. Gen Thorac Cardiovasc Surg 2018; 67:806-810. [PMID: 30073475 DOI: 10.1007/s11748-018-0981-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/30/2018] [Indexed: 12/17/2022]
Abstract
Chronic persistent surgical pain (CPSP) is a complex disease with strong genetic component. The studies on revealed association of mutations in membrane bound catechol-O-methyltransferase gene with CPSP were reported indifferent ethnic populations across the globe. We identify that one out of four patients who underwent sternotomy procedure showed CPSP even after 3 months of surgery. The Mb.COMT gene sequence analysis revealed of the four patients, three patients had no mutation in Mb.COMT gene, while in one patient exhibited G472A mutation. Interestingly, this patient showed CPSP even after 90 days of surgery. The magnitude of the CPSP was evaluated with pain questionnaires' at the end of 3 months after discharge from the hospital. In this study 25% (1/4) showed presence G472A allele correlating with CPSP. Further the study suggested that evaluation of G472A allele of Mb.COMT gene in the patients undergoing sternotomy for monitoring pain in pre and post-surgical events.
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Affiliation(s)
- Goduguchintha Dharaniprasad
- Department of Anesthesiology and Critical care, Sri Venkateswara Institute of Medical Sciences (SVIMS) University, Tirupati, Andhra Pradesh, India
| | - Aloka Samantaray
- Department of Anesthesiology and Critical care, Sri Venkateswara Institute of Medical Sciences (SVIMS) University, Tirupati, Andhra Pradesh, India.
| | - Mangu Hanumantha Rao
- Department of Anesthesiology and Critical care, Sri Venkateswara Institute of Medical Sciences (SVIMS) University, Tirupati, Andhra Pradesh, India
| | - Abha Chandra
- Department of Cardio Vascular and Thoracic Surgery, Sri Venkateswara Institute of Medical Sciences (SVIMS) University, Tirupati, Andhra Pradesh, India
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The Functional Difficulties Questionnaire: A New Tool for Assessing Physical Function of the Thoracic Region in a Cardiac Surgery Population. Cardiopulm Phys Ther J 2018. [DOI: 10.1097/cpt.0000000000000074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain 2018; 158:1869-1885. [PMID: 28767509 DOI: 10.1097/j.pain.0000000000000997] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Persistent postoperative pain (PPP) has been described as a complication of cardiac surgery (CS). We aimed to study PPP after CS (PPPCS) by conducting a systematic review of the literature regarding its incidence, intensity, location, and the presence of neuropathic pain, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The review comprised 3 phases: a methodological assessment of 6 different databases identifying potential articles and screening for inclusion criteria by 2 independent reviewers; data extraction; and study quality assessment. Meta-analysis was used to estimate the pooled incidence rates using a random effects model. We have identified 442 potentially relevant studies through database searching. A total of 23 studies (involving 11,057 patients) met our inclusion criteria. Persistent postoperative pain affects 37% patients in the first 6 months after CS, and it remains present more than 2 years after CS in 17%. The reported incidence of PPP during the first 6 months after CS increased in recent years. Globally, approximately half of the patients with PPPCS reported moderate to severe pain. Chest is the main location of PPPCS followed by the leg; neuropathic pain is present in the majority of the patients. This is the first systematic review and meta-analysis to provide estimates regarding incidence and intensity of PPPCS, which elucidates its relevance. There is an urgent need for adequate treatment and follow-up in patients with PPPCS.
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Sng BL, Ching YY, Han NLR, Ithnin FB, Sultana R, Assam PN, Sia ATH. Incidence and association factors for the development of chronic post-hysterectomy pain at 4- and 6-month follow-up: a prospective cohort study. J Pain Res 2018; 11:629-636. [PMID: 29628772 PMCID: PMC5877488 DOI: 10.2147/jpr.s149102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Chronic pain has major adverse effects on health-related quality of life and contributes to significant socioeconomic burden. Hysterectomy is a very common gynecological surgery, resulting in chronic post-hysterectomy pain (CPHP), an important pain syndrome. We conducted a prospective cohort study in 216 Asian women who underwent abdominal or laparoscopic hysterectomy for benign conditions. Demographic, psychological, and perioperative data were recorded. Postoperative 4- and 6-month phone surveys were conducted to assess the presence of CPHP and functional impairment. The incidence rates of CPHP at 4 and 6 months were 32% (56/175) and 15.7% (25/159), respectively. Women with CPHP at 4 and 6 months had pain that interfered with their activities of daily living. Independent association factors for CPHP at 4 months were higher mechanical temporal summation score, higher intraoperative morphine consumption, higher pain score in the recovery room, higher pain score during coughing and itching at 24 hours postoperatively, and preoperative pain in the lower abdominal region. Independent association factors for CPHP at 6 months were preoperative pain during sexual intercourse, higher mechanical temporal summation score, and higher morphine consumption during postoperative 24 and 48 hours. In a majority of cases, CPHP resolved with time, but may have significant impact on activities of daily living.
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Affiliation(s)
- Ban Leong Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Nian-Lin R Han
- Division of Clinical Support Services, KK Women's and Children's Hospital, Singapore, Singapore
| | - Farida Binte Ithnin
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | | | - Alex Tiong Heng Sia
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Morel F, Crampon F, Adnot J, Litzler PY, Duparc F, Trost O. Rerouting the internal thoracic pedicle: a novel solution for maxillofacial reconstruction in vessel-depleted situations? A preliminary anatomic study. Surg Radiol Anat 2018; 40:911-916. [PMID: 29289988 DOI: 10.1007/s00276-017-1965-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions. METHODS We performed a descriptive single centre anatomical study on 20 formalin-embalmed cadavers. The ITP was harvested on both sides from the emergence of the artery under the brachiocephalic vein to its terminal division. The level reached by the ITP in the cervicofacial area was described. Distal arterial and venous diameters, pedicle length and other parameters were measured. RESULTS In at least 85% of the cases, the ITP reached the mandibular angle. The mean diameter at the distal extremity for the ITA was 2.36 ± 0.15, and 2.48 ± 0.19 mm for the committing vein. The mean length of the ITP was 177.3 mm. CONCLUSION Rerouting the ITP towards the cervicofacial area could provide a reliable pedicle for free-flap reconstructions in patients with a vessel-depleted neck but it should be limited to selected patients. This novel solution for situations where current techniques are unfeasible warrants further clinical research.
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Affiliation(s)
- François Morel
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen, France
| | - Frédéric Crampon
- Laboratory of Anatomy, Rouen Faculty of Medicine, 22, Boulevard Léon-Gambetta, 76000, Rouen, France
| | - Jérôme Adnot
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen, France
| | - Pierre-Yves Litzler
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, Rouen, France.,French National Institute for Health (INSERM), U-1096, Rouen, France
| | - Fabrice Duparc
- Laboratory of Anatomy, Rouen Faculty of Medicine, 22, Boulevard Léon-Gambetta, 76000, Rouen, France
| | - Olivier Trost
- Department of Oral and Maxillofacial Surgery, Rouen University Hospital, Rouen, France. .,Laboratory of Anatomy, Rouen Faculty of Medicine, 22, Boulevard Léon-Gambetta, 76000, Rouen, France. .,French National Institute for Health (INSERM), LIMICS UMR-1142, Rouen, France.
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Turan A, Karimi N, Zimmerman NM, Mick SL, Sessler DI, Mamoun N. Intravenous Acetaminophen Does Not Decrease Persistent Surgical Pain After Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:2058-2064. [DOI: 10.1053/j.jvca.2017.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Indexed: 11/11/2022]
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