ABSTRACT
OBJECTIVE: To determine persistent post-surgical pain prevalence after orthopaedic surgery with its impact on patient quality of life and to assess factors related to it. STUDY DESIGN: Cross-sectional cohort study. PATIENTS: A questionnaire was mailed to 2100 patients undergoing orthopaedic surgery in our teaching hospital. METHODS: Pain prevalence 3 months after surgery, pain intensity, a neuropathic pain component using the DN4 questionnaire and its impact on patient quality of life were assessed. RESULTS: One thousand two hundred and ninety-two patients answered our questionnaire. Among them, 48% suffered from chronic pain. This pain had a neuropathic component in 43%, which was responsible for analgesic overconsumption and increases in sleep disturbance and sick leave. Arthrodesis, knee arthroplasty and leg fracture were linked to increased chronic post-surgical pain (OR=2.7, OR=1.8, OR=1.9, respectively; P<0.05). Elbow surgery, meniscectomy, amputation and neurolysis were linked to increased neuropathic pain. CONCLUSIONS: Chronic, post-surgical pain is common after orthopaedic surgery, leading to analgesic consumption and sleep disturbance. Patients at high risk for developing chronic post-surgical pain must be identified preoperatively. The development of postoperative pain clinics should be one way to respond to this public health problem.
Subject(s)
Orthopedic Procedures/adverse effects , Pain, Postoperative/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/adverse effects , Analgesics, Opioid/therapeutic use , Chronic Pain/epidemiology , Chronic Pain/etiology , Chronic Pain/psychology , Cohort Studies , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neuralgia/drug therapy , Neuralgia/etiology , Neuralgia/psychology , Pain Measurement , Pain, Postoperative/psychology , Prevalence , Quality of Life , Risk Factors , Sick Leave/statistics & numerical data , Sleep Wake Disorders/etiology , Sleep Wake Disorders/psychology , Young AdultABSTRACT
BACKGROUND: In this cadaveric study we assessed the level of the emergence of the musculocutanous nerve (MCN) relative to needle insertion site during infraclavicular block. METHODS: Forty brachial plexi from 20 embalmed adult cadavers were dissected. The MCN was exposed from its origin on the lateral cord to its penetration into the coracobrachialis muscle. The point of emergence of the MCN from the lateral cord relative to a line drawn directly caudad from the anteromedial tip of the coracoid process was measured. A needle was placed predissection using our previously described technique, and the distance from the needletip to the emergence of the MCN was measured. RESULTS: MCN often emerged distal to the coracoid process. At the needle insertion site, 80% of MCN had already emerged from the lateral cord. The distance of emergence ranged from 8.5 cm proximal to 12 cm distal to the coracoid process. CONCLUSION: This anatomical study suggests that MCN may be one of the factors explaining MCN block failure for the single-injection technique of infraclavicular block using lateral needle trajectory.
