Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and Thoracotomy Surgical Approaches.

IF 2.3 4区 医学 Q2 ANESTHESIOLOGY
Katherine Taylor, Barny Allan, Carolyne Pehora, Marisa Signorile, Kyle Runeckles, Naiyi Sun, Christoph Haller
{"title":"Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and Thoracotomy Surgical Approaches.","authors":"Katherine Taylor, Barny Allan, Carolyne Pehora, Marisa Signorile, Kyle Runeckles, Naiyi Sun, Christoph Haller","doi":"10.1053/j.jvca.2025.05.059","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the prevalence of chronic postsurgical pain (CPSP) in children after cardiac surgery.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Quaternary academic pediatric hospital.</p><p><strong>Participants: </strong>Patients age 6 to 18 years at the time of their surgery and a surgery date ≥6 months prior to the study period (June 1, 2014, to November 1, 2021).</p><p><strong>Interventions: </strong>Patients completed 3 validated surveys measuring chronic pain, the impact of pain on quality of life (QoL), and neuropathic pain symptoms. Respondents' medical records were then reviewed for perioperative management.</p><p><strong>Measurements and main results: </strong>Pain severity, pain trajectory, and analgesic consumption are described for each comparative group of interest (time period, 2014-2019 vs 2020-2021), intraoperative opioid selection (remifentanil vs sufentanil), surgical approach (sternotomy vs thoracotomy), and intraoperative pain management technique (presence/absence of fascial plane block). The response rate was 10%. Reference tables from validated scoring systems were used when available. At the time of survey completion or in the preceding week, 34% reported pain, with none to mild interference in QoL. Twenty percent reported symptoms consistent with neuropathic pain, with no difference between recipients of sternotomy and recipients of thoracotomy. Patients who received intraoperative remifentantil had higher pain scores. Single-shot fascial plane blocks reduced postoperative acute pain scores.</p><p><strong>Conclusions: </strong>The validated surveys showed a high prevalence of CPSP, including a sizeable proportion of neuropathic pain. The prevalence of CPSP is within the reported prevalence in adults despite a mean study population age of 10 years. This finding encourages improvements in acute pain management, earlier identification of patients with CPSP for management, and further investigation of CPSP after pediatric cardiac surgery.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jvca.2025.05.059","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: To evaluate the prevalence of chronic postsurgical pain (CPSP) in children after cardiac surgery.

Design: Cohort study.

Setting: Quaternary academic pediatric hospital.

Participants: Patients age 6 to 18 years at the time of their surgery and a surgery date ≥6 months prior to the study period (June 1, 2014, to November 1, 2021).

Interventions: Patients completed 3 validated surveys measuring chronic pain, the impact of pain on quality of life (QoL), and neuropathic pain symptoms. Respondents' medical records were then reviewed for perioperative management.

Measurements and main results: Pain severity, pain trajectory, and analgesic consumption are described for each comparative group of interest (time period, 2014-2019 vs 2020-2021), intraoperative opioid selection (remifentanil vs sufentanil), surgical approach (sternotomy vs thoracotomy), and intraoperative pain management technique (presence/absence of fascial plane block). The response rate was 10%. Reference tables from validated scoring systems were used when available. At the time of survey completion or in the preceding week, 34% reported pain, with none to mild interference in QoL. Twenty percent reported symptoms consistent with neuropathic pain, with no difference between recipients of sternotomy and recipients of thoracotomy. Patients who received intraoperative remifentantil had higher pain scores. Single-shot fascial plane blocks reduced postoperative acute pain scores.

Conclusions: The validated surveys showed a high prevalence of CPSP, including a sizeable proportion of neuropathic pain. The prevalence of CPSP is within the reported prevalence in adults despite a mean study population age of 10 years. This finding encourages improvements in acute pain management, earlier identification of patients with CPSP for management, and further investigation of CPSP after pediatric cardiac surgery.

儿童心脏手术后急性和慢性术后疼痛:一项胸骨切开和开胸手术入路的队列研究。
目的:了解儿童心脏术后慢性术后疼痛(CPSP)的发生率。设计:队列研究。单位:第四专科儿科医院。参与者:手术时年龄为6至18岁,手术日期在研究期(2014年6月1日至2021年11月1日)前≥6个月的患者。干预措施:患者完成3项有效的调查,测量慢性疼痛、疼痛对生活质量(QoL)的影响和神经性疼痛症状。然后审查应答者的医疗记录以进行围手术期管理。测量和主要结果:描述了每个感兴趣的比较组的疼痛严重程度、疼痛轨迹和镇痛药物消耗(时间段,2014-2019 vs 2020-2021)、术中阿片类药物选择(瑞芬太尼vs舒芬太尼)、手术入路(胸骨切开术vs开胸术)和术中疼痛管理技术(有无筋膜平面阻滞)。回复率为10%。在可用的情况下,使用来自经过验证的评分系统的参考表。在调查完成时或前一周,34%的人报告疼痛,生活质量无轻微干扰。20%的患者报告的症状与神经性疼痛一致,胸骨切开术患者和开胸手术患者之间没有差异。术中使用瑞芬替尔的患者疼痛评分较高。单次筋膜平面阻滞可降低术后急性疼痛评分。结论:经过验证的调查显示CPSP的患病率很高,包括相当大比例的神经性疼痛。尽管研究人群的平均年龄为10岁,但CPSP的患病率在报告的成人患病率范围内。这一发现鼓励了急性疼痛管理的改进,CPSP患者的早期识别管理,以及小儿心脏手术后CPSP的进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.80
自引率
17.90%
发文量
606
审稿时长
37 days
期刊介绍: The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信