Chronic postsurgical pain after minimally invasive adrenalectomy: prevalence and impact on quality of life

Abstract

Background Minimally invasive adrenalectomy is the standard of care for small adrenal tumours. Both the transperitoneal lateral approach and posterior retroperitoneal approach are widely used and have been proven to be safe and effective. However, the prevalence of chronic postsurgical pain has not been specifically investigated in previous studies. The primary goal of this study was to identify the prevalence of chronic postsurgical pain after minimally invasive adrenalectomy. Methods A cross-sectional study was performed among all consecutive patients who had undergone minimally invasive adrenalectomy in a single university medical centre. The primary outcome was the prevalence of chronic postsurgical pain. Secondary outcomes were the prevalence of localized hypoesthesia, risk factors for the development of chronic postsurgical pain, and the Health-Related Quality of Life. Three questionnaires were used to measure the prevalence and severity of chronic postsurgical pain, hypoesthesia, and Health-Related Quality of Life. Logistic regression analysis was performed to determine risk factors for development of chronic postsurgical pain. Results Six hundred two patients underwent minimally invasive adrenalectomy between January 2007 and September 2019, of whom 328 signed informed consent. The prevalence of chronic postsurgical pain was 14.9%. In the group of patients with chronic postsurgical pain, 33% reported hypoesthesia as well. Young age was a significant predictor for developing chronic postsurgical pain. The prevalence of localized hypoesthesia was 15.2%. In patients with chronic postsurgical pain, Health-Related Quality of Life was significantly lower, compared to patients without pain. Conclusions The prevalence of chronic postsurgical pain following minimally invasive adrenalectomy is considerable. Furthermore, the presence of chronic postsurgical pain was correlated with a significant and clinically relevant lower Health-Related Quality of Life. These findings should be included in the preoperative counselling of the patient. In the absence of evidence for effective treatment in established chronic pain, prevention should be the key strategy and topic of future research.

A prospective case series to evaluate subcostal nerve injury with high-resolution ultrasound in posterior retroperitoneoscopic adrenalectomy

“…After living-donor nephrectomy, the incidence of chronic postsurgical pain was 5.7%, resulting in a significant decrease in quality of life [ 25 ]. Although no significant association between postsurgical pain and nerve damage was found in the current study, the incidence of chronic postsurgical pain was lower compared to our previous retrospective data [ 5 ]. Therefore, it remains unclear whether subcostal nerve injury is the only culprit for development of chronic postsurgical pain in our patients.…”

“…Baseline characteristics were collected: age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, side of adrenalectomy, duration of surgery, blood loss, perioperative medication, duration of admission, and perioperative surgical complications. Preoperatively, patients were asked to fill out three questionnaires: the McGill Pain Questionnaire to evaluate preoperative pain [ 10 ], the self-designed Hypoesthesia questionnaire to evaluate preoperative hypoesthesia [ 5 ], and the Pain Catastrophizing Scale questionnaire to evaluate pain catastrophizing [ 11 ]. Pain catastrophizing is defined as ‘an exaggerated negative orientation toward actual or anticipated pain experiences’ .…”

“…Recently, we performed a large retrospective case series to investigate chronic postsurgical pain and hypoesthesia in patients undergoing minimally invasive adrenalectomy [ 5 ]. In this case series, 10% of the patients who underwent PRA reported chronic postsurgical pain and 21% reported hypoesthesia or altered sensations in the abdominal and lumbar skin regions.…”

Chronic postsurgical pain after laparoscopic surgery: a systematic review

“…(7)(8)(9) Possible risk factors in patients after general surgery include female gender, younger age, preoperative pain, preoperative psychological status and acute postoperative pain. (10)(11)(12) The surgical technique might also in uence the development of CPSP, possibly related to the extent of intraoperative nerve injury and adhesion formation. Adhesions are the sole pathological nding in 60% of cases of chronic post-operative pain.…”

The peripheral Epac1/p-Cav-1 pathway underlies the disruption of the vascular endothelial barrier following skin/muscle incision and retraction-induced chronic postsurgical pain

“…Chronic postsurgical pain (CPSP) is a potential adverse outcome after surgery with an estimated incidence of up to 50% among postsurgical patients ( 1 ). This chronic pain is accompanied by depression, disability, and reduced quality of life ( 2 , 3 ). The development of chronic postsurgical pain is multifactorial, and its understanding remains scientifically basic and a clinical challenge ( 4 , 5 ).…”