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Dynamic perioperative changes in baroreflex sensitivity predict postoperative pain.

Heberto Suarez-Roca1, Negmeldeen Mamoun2, Andrey V Bortsov1

  • 1Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States.

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Summary
This summary is machine-generated.

Steep declines in baroreflex sensitivity (BRS) after surgery, especially in those with high initial BRS, predict increased postoperative pain. Monitoring perioperative BRS changes (ΔBRS) may help personalize pain management strategies.

Keywords:
autonomic nervous systembaroreflex sensitivitycardiothoracic surgeryinflammatory markerspostoperative pain

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Area of Science:

  • Cardiovascular Physiology
  • Pain Management
  • Autonomic Nervous System Function

Background:

  • Higher baroreflex sensitivity (BRS) typically correlates with lower pain sensitivity.
  • Previous findings indicated elevated preoperative BRS predicts greater postoperative pain after cardiothoracic surgery, contradicting existing evidence.
  • This study investigated perioperative changes in BRS (ΔBRS) as a predictor of postoperative pain.

Purpose of the Study:

  • To determine if perioperative changes in baroreflex sensitivity (ΔBRS) are a better predictor of postoperative pain severity than baseline BRS.
  • To explore the relationship between BRS dynamics and pain following cardiothoracic surgery.

Main Methods:

  • Prospective observational cohort study of 72 adults undergoing elective minimally invasive cardiothoracic surgery.
  • Spontaneous cardiovagal BRS measured preoperatively and on postoperative days 1 and 2.
  • Pain severity assessed using the PEG scale; inflammatory biomarkers also measured.
  • Multivariable regression models analyzed associations between BRS metrics and pain, adjusting for covariates.

Main Results:

  • Higher preoperative BRS was linked to greater postoperative BRS decline (ΔBRS) and more severe pain on postoperative day 2.
  • ΔBRS independently and inversely associated with pain severity, even after adjusting for covariates.
  • Inflammatory markers increased postoperatively but did not mediate the BRS-pain association.

Conclusions:

  • Significant perioperative BRS declines, particularly in individuals with initially high BRS, may indicate autonomic destabilization and reduced baroreflex-mediated pain inhibition.
  • ΔBRS emerges as a dynamic and mechanistically informative predictor of postoperative pain.
  • Perioperative BRS monitoring could aid in risk stratification and guide interventions to stabilize autonomic function for improved recovery.