Pain Trajectories After Valve Surgeries Performed via Midline Sternotomy Versus Mini-Thoracotomy

Mamoun, Negmeldeen; Wright, Mary Cooter; Bottiger, Brandi; Plichta, Ryan P.; Klinger, Rebecca Y.; Manning, Michael W.; Raghunathan, Karthik; Gulur, Padma

doi:10.1053/j.jvca.2022.05.007

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…In our study, women were at increased risk of belonging to trajectories of poor pain resolution, but no such association was found for opioid consumption trajectories. Results are consistent with some 23,30 (but not all 6,22,31 ) studies examining postoperative pain trajectories. This inconsistency might stem from the type of surgical procedure studied, frequency and measurement of pain, and statistical models used.…”

Section: Discussionsupporting

confidence: 89%

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain

Pagé,

Ganty,

Wong

et al. 2024

Anesthesia &Amp; Analgesia

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BACKGROUND: Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. METHODS: Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. RESULTS: Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: “initially moderate pain intensity remaining moderate” (n = 62), “initially mild pain intensity remaining mild” (n = 221), and “initially moderate pain intensity decreasing to mild” (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: “initially high level of MME/day gradually decreasing” (n = 89), “initially low level of MME/day remaining low” (n = 108), and “initially moderate level of MME/day decreasing to low” (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the “initially mild pain intensity remaining mild” trajectory were less likely than those in the “initially moderate pain intensity remaining moderate” trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06–0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28–2.54] and 0.95 [0.22–4.13]). CONCLUSIONS: Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.

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Section: Discussionsupporting

confidence: 89%

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain

Pagé,

Ganty,

Wong

et al. 2024

Anesthesia &Amp; Analgesia

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“…36,37 However, the intense post-thoracotomy pain, resulting from aggressive rib spreading and excessive rotation of the posterior costovertebral joint, could hinder postoperative pulmonary recovery if not well-managed. [38][39][40] Recent research demonstrates a possible two-phase local anesthetic (LA) distribution during ESP blocks. 41 Initially, LA infiltrates the retro superior costotransverse ligament (RetroSCTL) space, impacting the spinal nerve and dorsal root ganglion.…”

Section: Discussionmentioning

confidence: 99%

Erector spinae plane block reduces opioid consumption and improves incentive spirometry volume after cardiac surgery: A retrospective cohort study

Liang,

Shen,

et al. 2024

Journal of the Chinese Medical Association

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Background: Effective postoperative pain management is vital in cardiac surgery to prevent opioid dependency and respiratory complications. Previous studies on the erector spinae plane (ESP) block have focused on single-shot applications or immediate postoperative outcomes. This study evaluates the efficacy of continuous ESP block versus conventional care in reducing opioid consumption and enhancing respiratory function recovery post-cardiac surgery over 72 hours. Methods: A retrospective study at a tertiary hospital (Jan 2021 - Jul 2022) included 262 elective cardiac surgery patients. Fifty-three received a preoperative ESP block, matched 1:1 with a control group (n=53). The ESP group received 0.5% ropivacaine intraoperatively and 0.16% ropivacaine every 4 hours postoperatively. Outcomes measured were cumulative oral morphine equivalent (OME) dose within 72 hours postextubation, daily maximum numerical rating scale (NRS) ≥3, incentive spirometry volume, and %baseline performance, stratified by surgery type (sternotomy or thoracotomy). Results: Significant OME reduction was observed in the ESP group (sternotomy: median decrease of 113 mg, 95%CI 60-157.5mg, p < 0.001; thoracotomy: 172.5mg, 95%CI 45-285mg, p = 0.010). The ESP group also had a lower risk of daily maximum NRS ≥3 (adjusted OR sternotomy: 0.22, p < 0.001; thoracotomy: 0.07, p < 0.001), an higher incentive spirometry volumes (sternotomy: mean increase of 149mL, p = 0.019; thoracotomy: 521mL, p = 0.017), and enhanced spirometry %baseline (sternotomy: mean increase of 11.5%, p = 0.014; thoracotomy: 26.5%, p < 0.001). Conclusion: Continuous ESP block was associated with a reduction of postoperative opioid requirements, lower instances of pain scores ≥3, and improve incentive spirometry performance following cardiac surgery. These benefits appear particularly prominent in thoracotomy patients. Further prospective studies with larger sample size are required to validate these findings.

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“…This study supports findings from multiple other cohorts in cardiac surgery, which have reported that 18% to 23% of patients report ongoing, persistent pain beyond the immediate postoperative period. 4,5 A major gap in the previously-published literature has been linking these pain trajectories with longer term outcomes; this is where the work by Pagé et al 3 expands our knowledge. In their study, the association of a moderate-staying-moderate pain trajectory with CPSP at 1 year is simultaneously impressive and concerning; it suggests that patients who are failing to meet early postoperative pain management milestones (ie, experiencing pain resolution) have higher odds of becoming patients with chronic pain a year later.…”

mentioning

confidence: 99%

Heartfelt Healing: Charting New Trajectories in Postsurgical Pain

Vanneman,

Kiwakyou,

Harrison

et al. 2024

Anesthesia &Amp; Analgesia

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Pain Trajectories After Valve Surgeries Performed via Midline Sternotomy Versus Mini-Thoracotomy

Cited by 5 publications

References 28 publications

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain

Erector spinae plane block reduces opioid consumption and improves incentive spirometry volume after cardiac surgery: A retrospective cohort study

Heartfelt Healing: Charting New Trajectories in Postsurgical Pain

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