Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and Thoracotomy Surgical Approaches.

OBJECTIVES

To evaluate the prevalence of chronic postsurgical pain (CPSP) in children after cardiac surgery.

DESIGN

Cohort study.

SETTING

Quaternary academic pediatric hospital.

PARTICIPANTS

Patients age 6 to 18 years at the time of their surgery and a surgery date ≥6 months prior to the study period (June 1, 2014, to November 1, 2021).

INTERVENTIONS: Patients completed 3 validated surveys measuring chronic pain, the impact of pain on quality of life (QoL), and neuropathic pain symptoms. Respondents' medical records were then reviewed for perioperative management.

MEASUREMENTS AND MAIN

RESULTS

Pain severity, pain trajectory, and analgesic consumption are described for each comparative group of interest (time period, 2014-2019 vs 2020-2021), intraoperative opioid selection (remifentanil vs sufentanil), surgical approach (sternotomy vs thoracotomy), and intraoperative pain management technique (presence/absence of fascial plane block). The response rate was 10%. Reference tables from validated scoring systems were used when available. At the time of survey completion or in the preceding week, 34% reported pain, with none to mild interference in QoL. Twenty percent reported symptoms consistent with neuropathic pain, with no difference between recipients of sternotomy and recipients of thoracotomy. Patients who received intraoperative remifentantil had higher pain scores. Single-shot fascial plane blocks reduced postoperative acute pain scores.

CONCLUSIONS

The validated surveys showed a high prevalence of CPSP, including a sizeable proportion of neuropathic pain. The prevalence of CPSP is within the reported prevalence in adults despite a mean study population age of 10 years. This finding encourages improvements in acute pain management, earlier identification of patients with CPSP for management, and further investigation of CPSP after pediatric cardiac surgery.