Pain Trajectories After Cardiac Surgery Performed Via Midline Sternotomy.

Abstract

Objectives: Acute pain after cardiac surgery performed via midline sternotomy is reported to be moderate to severe in intensity in up to three-quarters of patients in the early postoperative period. This work was designed to describe different pain trajectories in this patient population. Furthermore, the association between patient baseline and perioperative characteristics and the development of different pain trajectories was investigated.

Design: An Institutional Review Board-approved retrospective study.

Setting: A single, large quaternary academic hospital.

Participants: Adult patients undergoing cardiac surgery via midline sternotomy over a 9-year period.

Interventions: Pain trajectories were modeled using Numeric Rating Scale pain scores collected over the first 6 postoperative days. Latent class analysis was employed to identify separate pain trajectory groups using a random-effects linear model.

Measurement and main results: The final study cohort consisted of 6,390 patients. Three pain trajectories were identified: well-controlled (n = 1,106, 17.3%), rapidly improving (n = 3,878, 60.7%), and slowly improving (n = 1,406, 22%). When comparing patients in the slowly improving pain trajectory group with the rapidly improving and well-controlled groups, they were significantly younger (both p < 0.001), had higher BMI (both p < 0.001), had a history of and/or current tobacco use (p < 0.001, p = 0.026, respectively), and received significantly more intraoperative and postoperative opioids (both p < 0.001).

Conclusions: In this study, one out of five patients had a less favorable, slowly improving pain profile, where pain was uncontrolled in the early postoperative period. Preoperative identification of these patients may allow clinicians to employ additional early interventions, including regional anesthesia, to improve pain control after midline sternotomy.