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Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and
Katherine Taylor1, Barny Allan2, Carolyne Pehora3
1Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Chronic postsurgical pain (CPSP) affects 34% of children after cardiac surgery, with 20% experiencing neuropathic pain. Findings highlight the need for improved acute pain management and earlier identification of CPSP in pediatric patients.
Area of Science:
- Pediatric Surgery
- Pain Management
- Quality of Life
Background:
- Chronic postsurgical pain (CPSP) is a significant concern following cardiac surgery.
- Understanding CPSP prevalence in pediatric populations is crucial for effective management.
Purpose of the Study:
- To evaluate the prevalence of chronic postsurgical pain (CPSP) in children and adolescents undergoing cardiac surgery.
- To assess the impact of CPSP on quality of life (QoL) and identify neuropathic pain symptoms.
Main Methods:
- A cohort study was conducted at a quaternary academic pediatric hospital.
- Patients aged 6-18 years completed validated surveys on chronic pain, QoL, and neuropathic pain.
- Medical records were reviewed for perioperative management details.
Main Results:
- 34% of patients reported pain at the time of survey, with minimal impact on QoL.
- 20% reported symptoms consistent with neuropathic pain.
- Intraoperative remifentanil use was associated with higher pain scores, while fascial plane blocks reduced acute postoperative pain.
Conclusions:
- A high prevalence of CPSP, including neuropathic pain, was observed in pediatric cardiac surgery patients.
- The prevalence is comparable to adult populations, emphasizing the need for improved pain management strategies.
- Further research into CPSP after pediatric cardiac surgery is warranted to optimize patient outcomes.
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.
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