A prospective observational study to assess the incidence of neuropathic pain after bone and soft tissue cancer surgery.

BACKGROUND AND AIMS: Bone and soft tissue (BST) cancer surgeries of extremities and pelvis have a high incidence of postoperative neuropathic pain (NP) due to extensive soft tissue dissection and breach of internervous planes. The primary aim of this study is to assess the incidence of NP in patients undergoing BST tumor surgery and establish its predisposing factors.

MATERIAL AND

METHODS

This prospective observational study assessed the incidence of NP after BST surgery at a tertiary care cancer center from April 2021 to June 2022. Postoperatively, NP follow-up was done with PainDETECT Questionnaire (PD-Q). Pain severity was assessed with Numerical Rating Scale, and Brief Pain Inventory was applied to look for interference of NP with active daily life. Preoperative and intraoperative data were analyzed to find the association with the NP. The association with causative factors was done using Mann-Whitney U test for continuous measures and Pearson's Chi-squared test/Fischer's test for categorical variables.

RESULTS

Of total 278 patients, the incidence of NP was 23.5% (n = 65) at the third postoperative day, 12.6% (n = 35) at 1 month, and 3.6% (n = 10) at 3 months. We found a significant correlation of NP with age (P = 0.05), preoperative ongoing treatment for NP (P = 0.01), preoperative pain severity (P = 0.005), type of surgery (P < 0.001), region operative (P = 0.01), intraoperative nerve handling (P < 0.01), and reconstruction component (P = 0.02).

CONCLUSIONS

The incidence of postoperative NP is high [23.5%] in young adults, patients with pre-existing NP controlled with medication, preoperative pain severity, reconstructive component of surgery, and nerve handling. Certain surgeries like amputation, pelvis tumors, and plastic reconstructions are associated with a higher incidence of NP.