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Pain Trajectories After Cardiac Surgery Performed Via Midline Sternotomy.

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Postoperative pain after cardiac surgery can be severe. This study identified three pain trajectories, with 22% of patients experiencing slow improvement, highlighting a need for early interventions to manage pain effectively.

Keywords:
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Area of Science:

  • Cardiology
  • Pain Management
  • Anesthesiology

Background:

  • Acute pain is common after cardiac surgery via midline sternotomy.
  • Up to 75% of patients report moderate to severe pain postoperatively.
  • Understanding pain trajectories is crucial for effective management.

Purpose of the Study:

  • To describe distinct pain trajectories in patients undergoing cardiac surgery.
  • To investigate patient characteristics associated with different pain trajectories.
  • To identify factors influencing postoperative pain development.

Main Methods:

  • Retrospective study of 6,390 adult patients undergoing cardiac surgery via midline sternotomy.
  • Pain trajectories modeled using Numeric Rating Scale scores over 6 postoperative days.
  • Latent class analysis identified three distinct pain trajectory groups.

Main Results:

  • Three pain trajectories identified: well-controlled (17.3%), rapidly improving (60.7%), and slowly improving (22%).
  • Patients with slowly improving pain were younger, had higher BMI, history of tobacco use, and received more opioids.
  • Slowly improving pain was associated with younger age, higher BMI, tobacco use, and increased opioid consumption.

Conclusions:

  • Approximately 22% of patients experience a slowly improving pain profile post-cardiac surgery.
  • Preoperative identification of at-risk patients is essential.
  • Early interventions, such as regional anesthesia, may improve pain control.