Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations

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.

Minimally Invasive Mitral Valve Surgery With Concomitant Cox Maze Procedure Is as Effective as a Median Sternotomy With Decreased Morbidity

“…5,[7][8][9][10] Potential benefits of an RMT are a smaller incision allowing for optimal visualization of the MV with less tissue dissection and bleeding, the cosmetic benefit of a smaller scar, less postoperative pain, and reduced length of stay in the hospital and intensive care unit (ICU) compared with an MS approach. [11][12][13][14] The long-term outcomes after MV surgery, via RMT versus MS approach, have been well described in recent meta-analyses, which found similar MV repair outcomes without significant differences in all-cause mortality, stroke rate, or reoperation rate between the surgical approaches. 10,15 However, there are few data that compare the long-term rhythm outcomes, based on surgical approach, for patients undergoing concomitant surgical ablation and MV surgery.…”

“…5,7–10 Potential benefits of an RMT are a smaller incision allowing for optimal visualization of the MV with less tissue dissection and bleeding, the cosmetic benefit of a smaller scar, less postoperative pain, and reduced length of stay in the hospital and intensive care unit (ICU) compared with an MS approach. 11 –14…”

Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis

“…Compared to traditional median full sternotomy, equivalence in terms of the safety, efficacy, and durability of operations carried out via the right mini-thoracotomy has been widely documented with increasing favor for this approach by the cardiac surgical community. Non-inferiority of the former aspects is coupled with a better outcome in terms of postoperative pain, a lower rate of transfusions and reoperation for bleeding, improved cosmesis, shorter hospital length of stay and time to return to normal activity or work, and a lower need for rehabilitation resources at discharge [ 1 , 2 , 3 , 4 , 5 , 6 ]. As a consequence, especially at high-volume institutions, the spectrum of indications has progressively shifted toward more fragile and higher-risk patients allowing them to apply the minimally invasive approach to MV disease of increasing complexity, ultimately including patients with MV infective endocarditis (IE).…”

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 ).…”