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Chronic pain in children after cardiac surgery via sternotomy
Mette H Lauridsen1, Anders D Kristensen2, Vibeke E Hjortdal3
11Department of Paediatrics,Aarhus University Hospital,Aarhus,Denmark.
Insights
Chronic pain affects 21% of children after sternotomy, with many experiencing significant pain intensity. Sensory testing suggests a neuropathic component to this persistent pain in pediatric cardiac surgery patients.
Area of Science:
- Pediatric surgery
- Pain medicine
- Cardiology
Background:
- Chronic pain is prevalent in adults post-sternotomy (20-50%).
- No prior studies investigated chronic pain in children following sternotomy.
Purpose of the Study:
- To determine the prevalence and characteristics of chronic pain in children after cardiac surgery via sternotomy.
- To investigate potential neuropathic components of this pain.
Main Methods:
- 171 children (0-12 years at surgery) completed postal questionnaires 10-60 months post-sternotomy.
- Pain intensity, duration, and character were assessed.
- Quantitative sensory testing (QST) was performed on the scar area in 13 children.
Main Results:
- 21% of 121 surveyed children reported current or recent pain in the sternotomy scar area.
- Of those with pain, 46% reported moderate to severe intensity (≥4/10).
- QST revealed sensory abnormalities (hyperalgesia, allodynia) in 10/13 children.
Conclusions:
- Chronic pain is a significant issue in children post-sternotomy.
- Findings suggest a neuropathic component to pediatric chronic post-sternotomy pain.
- Further research and clinical attention are warranted.
Introduction:
Chronic pain is common after sternotomy in adults with reported prevalence rates of 20-50%. So far, no studies have examined whether children develop chronic pain after sternotomy.
Material And Methods:
Postal questionnaires were sent to 171 children 10-60 months after undergoing cardiac surgery via sternotomy at the age of 0-12 years. The children were asked to recall the intensity and duration of their post-operative pain, if necessary with the help from their parents, and to describe the intensity and character of any present pain. Another group of 13 children underwent quantitative sensory testing of the scar area 3 months after sternotomy.
Results:
A total of 121 children, median (range) age 7.7 (4.2-16.9) years, answered the questionnaire. Their age at the time of surgery was median (range) 3.8 (0-12.9) years, and the follow-up period was median (range) 4 (0.8-5.1) years. In all, 26 children (21%) reported present pain and/or pain within the last week located in the scar area; in 12 (46%) out of the 26 children, the intensity was ≥4 on a numeric rating scale (0-10). Quantitative sensory testing of the scar area revealed sensory abnormalities--pinprick hyperalgesia and brush and cold allodynia--in 10 out of 13 children.
Conclusion:
Chronic pain after cardiac surgery via sternotomy in children is a problem that should not be neglected. The pain is likely to have a neuropathic component as suggested by the sensory abnormalities demonstrated by quantitative sensory testing.
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