Effects of Epidural Anesthesia on Acute and Chronic Pain After Coronary Artery Bypass Grafting

Onan, Burak; Onan, Ismihan Selen; Kiliçkan, L; Sanisoglu, Ilhan

doi:10.1111/jocs.12086

Cited by 31 publications

(32 citation statements)

References 21 publications

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“…Five of the nine studies examined local anesthetics in several surgical populations [12][13][14][15][16], one study compared a tumor necrosis factor-alpha (TNF-a) inhibitor (i.e., enteracept) for inguinal hernia compared to placebo [17], another study compared pregabalin versus placebo in a cardiac surgery model [18], and another study examined minocycline (a broad-spectrum cycline antibiotic which has been shown to block microglial activation) compared to placebo following lumbar discectomy [19]. These eight trials were negative and did not demonstrate a preventive analgesic effect [12][13][14][15][16][17][18][19]. Only one of the nine studies identified in our updated literature search found a preventive effect on the incidence of CPSP [20].…”

Section: Search Resultsmentioning

confidence: 99%

“…Similarly, in their second trial comparing mexiletine to gabapentin and placebo, no significant difference was found between trial groups [64]. Within the past year, an additional five studies have been published evaluating the use of local anesthetics for CPSP [12][13][14][15][16]. No significant difference in incidence or pain score was found for any of the agents 2 months or more following the surgery.…”

Section: Local Anestheticsmentioning

confidence: 99%

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Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute postoperative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. Key PointsThe development of chronic post-surgical pain (CPSP) is a complex process which involves biologic, psychosocial, and environmental mechanisms.Ketamine (an NMDA antagonist) appears to be the pharmacologic agent with the most consistent positive preventive analgesic results.The variation in patient response to pharmacologic agents can be explained, in part, by genetic polymorphisms.Understanding the heritability of CPSP will be useful when developing predictive algorithms to determine the preoperative risk for developing CPSP.Psychological treatments delivered before and after surgery have the potential to influence the trajectory of CPSP from the earliest days, in combination with multimodal, preventive analgesia.

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Section: Search Resultsmentioning

confidence: 99%

Section: Local Anestheticsmentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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“…[100][101][102] Thoracic Epidural Anesthesia Thoracic epidural anesthesia is associated with a lower incidence of cardiopulmonary complications and provides excellent postoperative pain control 75,[103][104][105] Despite studies showing decreased pain scores and opioid consumption in the acute postoperative period, no reduction in chronic pain incidence or severity has been shown. 106,107 Intrathecal Opioids Intrathecal opioids are often used in fast-track cardiac anesthesia to improve acute postoperative pain scores. However, there is no evidence that they improve chronic postoperative pain.…”

Section: Transdermal Lidocainementioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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“…Various trials have assessed CPSP with less specific movement, for instance “while coughing” [125,165], “during daily activities” [12], “while moving” [88,170] or during a defined movement protocol [3]. Procedure-specific validated assessments of pain-related functional consequences, such as those described for hernia surgery [54], thoracic surgery [140], and breast [4] surgery, have been developed.…”

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

Research design considerations for chronic pain prevention clinical trials

Gewandter

Dworkin

Turk

et al. 2015

Pain

126

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Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (i.e., chronic post-surgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (i.e., surgery, viral infection, injury, and toxic/noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

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Effects of Epidural Anesthesia on Acute and Chronic Pain After Coronary Artery Bypass Grafting

Abstract: TEA significantly reduced the intensity of postoperative pain and analgesic consumption in the early postoperative period following CABG. The delivery of effective analgesia along with conventional medications may prevent chronic pain after surgery.

Cited by 31 publications

References 21 publications

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Chronic Poststernotomy Pain

Research design considerations for chronic pain prevention clinical trials

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