Department of Anesthesiology and Intensive Care Medicine, Heart Center Leipzig, Struempellstrasse 39, 04289 Leipzig, Germany.
Department of Cardiac Surgery, Heart Center Leipzig, Germany.
J Clin Anesth. 2022 May;77:110577. doi: 10.1016/j.jclinane.2021.110577. Epub 2021 Nov 17.
The primary objective of this study was to compare the association between cardiac surgical approach (thoracotomy vs. sternotomy) and incidence of persistent postoperative pain at 3 months. Secondary objectives were the incidence and intensity of persistent pain at 6 and 12 months, acute postoperative pain, analgesic requirement and its side effects.
Single-center, prospective, observational study. Recruitment between December 2017 and August 2018.
Perioperative care at university-affiliated tertiary care centre.
202 adults scheduled for cardiac surgery. Patients with chronic pain or behavioural disorder were excluded.
Thoracotomy (n = 106) and sternotomy (n = 96).
Pain scores and pain medication requirements from extubation until hospital discharge. Persistent postoperative pain was assessed using a telephone questionnaire.
Incidence and intensity of pain was not significantly different between thoracotomy or sternotomy either in the short- or in the long-term follow-up. Incidence of persistent postoperative pain showed no differences between groups (30.2 vs 22.9% at 3 months (p = 0.297), 10.4 vs 7.3% at 6 months (p = 0.364) and 7.5 vs 7.3% at 12 months (p = 0.518) in thoracotomy and sternotomy group). A significant decrease of pain incidence was observed between 3 and 6 months (p < 0.001) but not between 6 and 12 months (p = 0.259) in both groups. ANOVA of repeated measures adjusted for confounding variable showed a decrease of acute pain intensity over time (p = 0.001) with no difference between groups (p = 0.145). Acute pain medication requirements were not different between the groups (p = 0.237 for piritramide and p = 0.743 for oxycodone) with no difference in their side effects.
Our study showed no difference in short- or long-term pain in patients undergoing anterolateral thoracotomy or median sternotomy. Both groups showed a decrease in persistent postoperative pain incidence between 3 and 6 months without any significant changes at 12 months.
本研究的主要目的是比较心脏手术入路（开胸术与胸骨切开术）与术后 3 个月持续性术后疼痛发生率之间的关系。次要目的是 6 个月和 12 个月时持续性疼痛的发生率和强度、急性术后疼痛、镇痛需求及其副作用。
单中心、前瞻性、观察性研究。招募时间为 2017 年 12 月至 2018 年 8 月。
大学附属三级保健中心围手术期护理。
202 名计划接受心脏手术的成年人。排除有慢性疼痛或行为障碍的患者。
开胸术（n=106）和胸骨切开术（n=96）。
从气管拔管到出院时的疼痛评分和疼痛药物需求。使用电话问卷调查评估术后持续性疼痛。
在短期或长期随访中，开胸术或胸骨切开术之间的疼痛发生率和强度均无显著差异。两组之间术后持续性疼痛的发生率无差异（3 个月时分别为 30.2%和 22.9%（p=0.297），6 个月时分别为 10.4%和 7.3%（p=0.364），12 个月时分别为 7.5%和 7.3%（p=0.518））。在两组中，均观察到从 3 个月到 6 个月时疼痛发生率显著下降（p<0.001），但从 6 个月到 12 个月时无差异（p=0.259）。调整混杂变量的重复测量方差分析显示，急性疼痛强度随时间呈下降趋势（p=0.001），但两组之间无差异（p=0.145）。两组之间急性疼痛药物需求无差异（哌替啶为 p=0.237，羟考酮为 p=0.743），副作用也无差异。
本研究显示，行前外侧开胸术或正中胸骨切开术的患者在短期和长期内疼痛无差异。两组在 3 个月至 6 个月之间持续性术后疼痛发生率下降，12 个月时无明显变化。
