RESUMO
The development of chronic pain after surgery or persistent postoperative pain is a significant public health problem that affects between 10%-56% of patients undergoing surgical intervention. It produces great restrictions of mobility, limitation of daily activities, dependence on opioids, anxiety, depression, a great alteration of the quality of life and important legal and medical-economic consequences. There is a very close correlation between acute postoperative pain, and persistent postoperative pain. For this reason, pain must be treated effectively in its acute phase to reduce the incidence of chronic pain after surgery. There are risk factors that predispose to its appearance and that must be known by the anesthesiologist. In an individualized and meticulous pre-anesthetic consultation, these risk factors can be detected, as well as the presence of surgical procedures related to chronic pain, with the purpose of the therapeutic approach of the first ones if necessary, and a good planning of the anesthetic and analgesic technique, which reduces the participation of the second, in the chronicity of acute pain. The role of the anesthesiologist in the pre-anesthetic consultation is essential for the planning of preventive and multimodal analgesia that, together with other resources, should reduce the incidence of persistent postoperative pain.
El desarrollo del dolor crónico después de la cirugía o dolor posoperatorio persistente, es un problema de salud pública significativo que afecta entre el 10%-56% de los pacientes sometidos a una intervención quirúrgica. Produce grandes restricciones de la movilidad, limitación de las actividades de vida diaria, dependencia a los opioides, ansiedad, depresión, una gran alteración de la calidad de vida e importantes consecuencias legales y médico-económicas. Hay una correlación muy estrecha entre el dolor agudo posoperatorio, y el dolor posoperatorio persistente. Por esa razón, el dolor debe ser tratado de manera eficaz en su fase aguda para disminuir la incidencia del dolor crónico posterior a la cirugía. Existen factores de riesgo que predisponen a su aparición y que deben ser conocidos por el anestesiólogo. En una consulta pre-anestésica individualizada y minuciosa, se podrán detectar estos factores de riesgo, como también la presencia de procedimientos quirúrgicos relacionados con el dolor crónico, con la finalidad del abordaje terapéutico de los primeros de ser necesario, y una buena planificación de la técnica anestésica y analgésica, que disminuya la participación de los segundos, en la cronicidad del dolor agudo. El rol del anestesiólogo en la consulta pre-anestésica, es fundamental para la planificación de la analgesia preventiva y multimodal que junto a otros recursos deberían disminuir la incidencia del dolor postoperatorio persistente.
Assuntos
Humanos , Dor Pós-Operatória/prevenção & controle , Dor Crônica/prevenção & controle , Analgésicos/administração & dosagem , Assistência PerioperatóriaRESUMO
@#Objective To analyze the incidence and possible risk factors of the chronic postsurgical pain (CPSP) in patients undergoing cardiac surgery with cardiopulmonary bypass via median sternotomy. Methods A total of 248 cardiac surgery patients (104 males, 144 females with age of 20–74 years) were enrolled in this single-center, prospective observational study. The severity of acute postoperative pain at first 7 days was evaluated by numeric rating scale (NRS) and pain at 30 days after surgery and CPSP at 3 and 6 months after surgery was evaluated with modified brief pain inventory. Results The CPSP at postoperative 6 months occurred in 45.2% (112/248) patients and 24.1% of them suffered moderate to severe pain (NRS≥4). The CPSP at postoperative 3 months occurred in 60.9% (151/248) patients and 25.8% of them suffered moderate to severe pain. Moderate to severe postoperative pain at postoperative 30 days and 3 months, and intraoperative remifentanil infusion were the risk factors of the CPSP at postoperative 6 months. Conclusion CPSP is common in patients undergoing cardiac surgery with median sternotomy. Moderate to severe postoperative pain at 30 days and 3 months, and intraoperative remifentanil infusion can predict the presence of CPSP at 6 months.