Risk factors of neuropathic pain after thoracic surgery

Homma, Takashi; Doki, Yoshinori; Yamamoto, Yutaka; Ojima, Toshihiro; Shimada, Yasuhiro; Kitamura, Naoya; Yoshimura, Naoki

doi:10.21037/jtd.2018.05.25

Cited by 50 publications

(44 citation statements)

References 23 publications

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“…However, the scale used, VAS, is routinely performed scale for evaluation of pain in surgical unit of our Hospital, and both the nurses and the doctors are familiar with it. Neuropathic pain occurs usually with a delay of 7 days after thoracic surgery and persists thereafter (Homma et al, 2018); thus, the scales for neuropathic pain could be used at the end of the stay in hospital as a mean duration of hospitalization of our patients was 10.4 ± 7.7 days. However, this would not allow to repeat the evaluation of the pain intensity, as the study was not extended to ambulatory care of the patients.…”

Section: Discussionmentioning

confidence: 99%

Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery

et al. 2019

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Background: Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions. Objective: To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy. Material and Methods: In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m 2 ] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m 2 ) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating “worst imaginable pain”) beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D). Results: The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 vs 3.4 ± 1.1; p < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 vs 2.6 ± 0.9, p < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, p < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m 2 vs 28.8 ± 5.2 kg/m 2 , p < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days vs 9.5 ± 3.6 days, p < 0.05). Conclusion: The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.

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Section: Discussionmentioning

confidence: 99%

Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery

et al. 2019

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“…Pregabalin reduced scores by 1.69 points (n=235; 95% CI, −2.71 to −0.66, I 2 =83%, P =0.001). There was no difference on postoperative 7 days (n=184; 95% CI: −2.38–0.84; I 2=92%; P =0.35; Figure 4).…”

Section: Resultsmentioning

confidence: 97%

“…A higher incidence of chronic pain especially chronic neuropathic pain in the surgical style of thoracotomy, and pregabalin was used for chronic pain especially chronic neuropathic pain better than acute pain. It may be the reason why pregabalin is effective in thoracotomy 1,2. But the number of included articles was small.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy of pregabalin for the management of acute and chronic postoperative pain in thoracotomy: a meta-analysis with trial sequential analysis of randomized-controlled trials

Liu²,

Zeng

et al. 2018

JPR

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PurposePregabalin is commonly used as an analgesic for neuropathic pain. But pregabalin as an adjunct to a multimodal analgesic regimen – although standard clinical protocol in some settings – has remained controversial. This meta-analysis was conducted to identify the efficacy of pregabalin for management of postoperative pain in thoracotomy.Materials and methodsPubmed, Embase, Cochrane, Web of Science, Springer, and Clinical Trial Register database were searched for randomized controlled trials (RCTs) of pregabalin in preventing postoperative pain in thoracotomy. Review Manager 5.3 and STATA 12.0 were selected to conduct the meta-analysis. Trial sequential analysis was used to control random errors and calculate the required information size.ResultsNine RCTs with 684 patients were included in our meta-analysis. Outcomes favoring pregabalin included less pain on a 0–10 scale on 1 day [mean difference (MD): −0.87; 95% CI: −1.55 to −0.19; P=0.01], 3 days (MD: −1.55; 95% CI: −1.93 to −1.18; P<0.00001), 1 month (MD: −1.58; 95% CI: −2.75 to −0.42; P=0.008), 3 months (MD: −1.69; 95% CI: −2.71 to −0.66; P=0.001) postoperatively, and less incidence of neuropathic pain (OR: 0.20; 95% CI: 0.05–0.91; P=0.04), less mean morphine consumption (MD: −5.03; 95% CI: −8.06 to −1.99; P=0.001), but more dizziness (OR: 3.33; 95% CI: 1.36–8.17; P=0.009), more drowsiness (OR: 8.61; 95% CI: 2.23–33.20; P=0.002), and less constipation (OR: 0.23; 95% CI: 0.09–0.59; P=0.002). There was no statistical differences in pain score on 7 days (MD:–0.77; 95% CI: −2.38 to 0.84; P=0.35), nausea (OR: 0.73; 95% CI: 0.42–1.26; P=0.26), and vomiting (OR: 0.83; 95% CI: 0.36–1.90; P=0.65).ConclusionPregabalin can prevent postoperative pain in thoracotomy and decrease incidence of neuropathic pain and morphine consumption. Pregabalin may be a valuable asset in management of acute and persistent postoperative pain in thoracotomy.

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“…The sources of the acute postoperative pain vary, including the surgical incision and chest drain insertion, as well as inflammation of adjacent chest wall structures [5]. Inadequate pain control in the early postoperative period can cause hypoxia, atelectasis, and pulmonary infections [6] and may lead to chronic neuralgia [7, 8]. Therefore, appropriate pain management is essential to improve outcomes of these patients.…”

Section: Introductionmentioning

confidence: 99%

Improved Analgesic Effect of Paravertebral Blocks before and after Video-Assisted Thoracic Surgery: A Prospective, Double-Blinded, Randomized Controlled Trial

Chu

Zhang

et al. 2019

Pain Research and Management

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Despite being less invasive, patients who underwent video-assisted thoracic surgery (VATS) suffered considerable postoperative pain. Paravertebral block (PVB) was proven to provide effective analgesia in patients with VATS; however, there is no difference in pain relief between preoperative PVB and postoperative PVB. This study was aimed to investigate the analgesic efficacy of combination of preoperative and postoperative PVB on the same patient undergoing VATS. In this prospective, double-blinded, randomized controlled trial, 44 patients undergoing VATS were enrolled, and they received patient-controlled intravenous analgesia (PCIA) with sufentanil plus preoperative PVB (Group A, n = 15) or postoperative PVB (Group B, n = 15), or combination of preoperative and postoperative PVB (Group C, n = 14). The primary outcome was sufentanil consumption and PCIA press times in the first 24 hours postoperatively. Also, data of postoperative use of PCIA and visual analogue scale (VAS) were collected. In the first 24 hours postoperatively, median sufentanil consumption in Group C was 0 (0–34.75) μg, which was much less than that in Group A (45.00 (33.00–47.00) μg, p=0.005) and Group B (36 (20.00–50.00) μg, p=0.023). Patients in Group C pressed less times of PCIA (0 (0–0) times) than patients in Group A (2 (1–6) times, p < 0.001) and Group B (2 (1–3) times, p=0.009). Kaplan–Meier analysis showed patients with combination of preoperative and postoperative PVB had a higher PCIA-free rate than patients with either technique alone (p=0.003). The VAS among the three groups was comparable postoperatively. The combination of both preoperative and postoperative PVB provides better analgesic efficacy during the early postoperative period and may be an alternative option for pain control after VATS. This trial is registered with ChiCTR1800017102.

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Risk factors of neuropathic pain after thoracic surgery

Cited by 50 publications

References 23 publications

Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery

Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery

The efficacy of pregabalin for the management of acute and chronic postoperative pain in thoracotomy: a meta-analysis with trial sequential analysis of randomized-controlled trials

Improved Analgesic Effect of Paravertebral Blocks before and after Video-Assisted Thoracic Surgery: A Prospective, Double-Blinded, Randomized Controlled Trial

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