Article of the Month – February 2021

Association between sternotomy versus thoracotomy and the prevalence and severity of chronic postsurgical pain after mitral valve repair: An observational cohort study

URL: https://www.jcvaonline.com/article/S1053-0770(21)00073-2/fulltext

DOI: https://doi.org/10.1053/j.jvca.2021.01.036

Published: J Cardiothorac Vasc Anesth. January 2021, in press.

Authors: Kimito Minami MD, PhD, Daijiro Kabata MPH, Takashi Kakuta MD, Satsuki Fukushima MD, PhD, Tomoyuki Fujita MD, PhD,  Kenji YoshitaniMD, PhD, Yoshihiko Ohnishi MD.

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Article Description:

This survey evaluated chronic postsurgical pain (CPSP) after mitral valve cardiac surgery.

Summary:

The investigators included 428 potential participants who underwent either through sternotomy for conventional mitral valve surgery or thoracotomy for minimally invasive mitral valve surgery. between January 2014 and March 2020.

A  questionnaire was to prospective study participants in July 2020 because CPSP was defined as pain that develops after a surgical procedure and persists at least 3 months after surgery in the World Health Organization’s International Classification of Disease.

Postoperative pain management regimen included intravenous acetaminophen and patient controlled opioid-based analgesia. Breakthrough pain was treated with rescue doses of pentazocine. Oral loxoprofen was used a a a rescue analgesic during the hospital stay and as needed after discharge.

They had 276 responses (64.5%) 126 with sternotomy; and 150 with thoracotomy after waiting for two month period for replies.Using the numerical rating scale (NRS), they assessed their patients for their current pain, peak pain in the last month, and average pain in the past month. They considered CPSP when pain (NRS ≥1) persists beyond three months after surgery. Besides, they assessed the type of pain (nociceptive, neuropathic, or mixed) with the Japanese version of the painDETECT questionnaire.

The authors found CPSP in 15/126 (11.9%) among the sternotomy group, while in 65/150 (42.7%) among the thoracotomy group – with statistical significance.

There are several limitations to the study’s design including low response rate, low response rate, the probability of time bias (from 2014 to 2020), influencing the CPSP with several factors (e.g. preceding pain, psychological factors), and inability to adjust for the effect of postoperative activity level.

Despite the limitations, this study highlighted the differences in the chronic pain between sternotomy and thoracotomy after cardiac surgery.