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Methylprednisolone Does Not Reduce Persistent Pain after Cardiac Surgery.

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  • 1From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (A.T., D.I.S., J.-P.Y., V.N., S.A.); Departments of Clinical Epidemiology and Biostatistics (E.P.B.-C., P.J.D., A.L., R.P.W.) and Medicine (P.J.D., S.Y.), McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.V., P.J.D., S.Y., A.L., R.P.W.); Department of Surgery, Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (R.v.O., G.C., A.L., R.P.W.); Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China (H.Y.); Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada (J.-F.L.); Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia (A. Royse); Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada (A. Rochon); and Department of Surgery, London Health Sciences Centre, London, Ontario, Canada (M.Q.).

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Summary

Intraoperative methylprednisolone did not reduce persistent incisional pain after cardiac surgery. This corticosteroid treatment showed no significant benefit in pain reduction at six months post-operation.

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Area of Science:

  • Cardiology
  • Pain Management
  • Pharmacology

Background:

  • Persistent incisional pain is a common complication following cardiac surgery.
  • Inflammation and inadequate acute pain control are suspected contributors to this chronic pain.
  • Corticosteroids like methylprednisolone possess anti-inflammatory and analgesic properties, suggesting potential therapeutic benefits.

Purpose of the Study:

  • To investigate the efficacy of intraoperative methylprednisolone in reducing persistent incisional pain after cardiac surgery.
  • To compare pain levels at 30 days and 6 months between patients receiving methylprednisolone and those receiving a placebo.

Main Methods:

  • A substudy of the Steroids in Cardiac Surgery (SIRS) trial included 1043 patients undergoing cardiopulmonary bypass for cardiac surgery.
  • Patients were randomized to receive either 500 mg of intraoperative methylprednisolone or a placebo.
  • Incisional pain and potential risk factors were assessed at 30 days and 6 months post-surgery.

Main Results:

  • Methylprednisolone administration did not significantly reduce pain at 30 days or persistent incisional pain at 6 months.
  • The incidence of persistent pain was 15.7% in the methylprednisolone group versus 17.8% in the placebo group (OR, 0.93; 95% CI, 0.79 to 1.09; P = 0.37).
  • No differences were observed in worst/average pain, pain interference with daily life, or pain medication use at 6 months. Younger age, female sex, and surgical infections were risk factors for persistent pain.

Conclusions:

  • Intraoperative methylprednisolone does not effectively reduce persistent incisional pain at 6 months in patients recovering from cardiac surgery.
  • The findings suggest that methylprednisolone is not a beneficial treatment for preventing long-term incisional pain after this type of surgery.