Chronic post-thyroidectomy pain: Incidence, typology, and risk factors.

Chronic postoperative pain exists in varying degrees for every type of surgery. An evaluation of the incidence, the typology and predictive factors of chronic pain was carried out at 3 and 6months after thyroidectomy. A prospective observational study, having included each of the patients prior to their thyroidectomy, was carried out over 12months. The patients used an 11-point numerical rating scale (NRS), a neuropathic pain screening questionnaire (DN4), an evaluation scale for anxiety and for the need for information related to anaesthesia and surgery (APAIS), a questionnaire describing pain (QDSA) and a questionnaire evaluating neuropathic pain (NPSI) before surgery and at three and six months later. Three hundred and four patients were included. The questionnaires were completed by 251 patients (57 males and 194 females) at 3 and 6months (82%). At 3months, 31 out of 251 (12%) patients mentioned a DN4≥3; at 6months, this rate dropped to 23 out of 251 (9%). The average intensity of chronic postoperative pain remained low to moderate. Levels of anxiety and the need for information were higher in patients with postoperative pain at 3 and 6months. In contrast, the number of intraoperative procedures using a bilateral superficial cervical plexus block (BSCPB) was lower in patients with DN4≥3. Multivariate analysis demonstrated that the type of anaesthesia procedure interfered with the risk of delayed pain after thyroidectomy. The presence of a DN4≥3 was nearly three-fold greater in patients without BSCPB (OR 2.647, CI=1.198-5.848).

The efficacy of intrathecal morphine with or without clonidine for postoperative analgesia after radical prostatectomy.

BACKGROUND: In this randomized study, we compared intrathecal (i.t.) morphine with or without clonidine and i.v. postoperative patient-controlled analgesia (PCA) morphine for analgesia after radical retropubic prostatectomy. METHODS: Fifty patients were randomly divided into three groups. They were allocated to receive i.t. morphine (4 microg/kg) (M group), i.t. morphine and clonidine (1 microg/kg) (MC group), or PCA (PCA group). Each patient was given morphine PCA for postoperative analgesia. The primary objective was the quantity of morphine required during the first 48 postoperative hours. The first request for morphine, numeric pain score at rest and on coughing, the time of tracheal decannulation and adverse effects (pruritus, postoperative nausea and vomiting, respiratory depression) were recorded. RESULTS: Morphine consumption in the first 48 h was decreased in the M and MC groups. The numeric pain score at rest and on coughing were lower in the M group until the 18th postoperative hour and until the 24th postoperative hour in the MC group. The first requests for PCA were delayed in these two groups. The need for intraoperative sufentanil was significantly lower in the MC group. CONCLUSION: IT morphine provided a significant reduction in morphine requirement during the first 48 postoperative hours after a radical prostatectomy. The addition of clonidine to i.t. morphine reduced intraoperative sufentanil use, prolonged time until first request for PCA rescue, and further prolonged analgesia at rest and with coughing.

Gabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block.

BACKGROUND: Preoperative oral gabapentin has been shown to reduce postoperative pain. However, the effects of gabapentin as an adjunct to regional anesthesia is unclear and its effects on chronic pain remains unknown. In patients undergoing thyroidectomy, we investigated the effects on early and late (at 6 mo) postoperative pain of preoperative oral gabapentin as an adjunct to superficial cervical plexus block (SCPB). METHOD: Fifty consecutive consenting patients were randomized to receive either 1200 mg of gabapentin (Group G) or placebo (Group P) 2 h preoperatively. Preoperative anxiety was assessed on a numeric scale from 0 to 6. A SCPB was performed after a standardized induction of anesthesia. The primary outcome, analgesic drug consumption, was assessed during the procedure and postoperatively in the postanesthesia care unit and after discharge to the ward. Over the first 24 h, pain levels at rest and during swallowing were measured on a numeric scale from 0 to 10. If the pain level was more than 4/10 at rest, patients received 1 g/6 h of IV paracetamol and/or 50 mg/6 h of IV tramadol as a rescue analgesic treatment in the interval. The day before operation and 6 mo after thyroidectomy, included patients were asked to answer a neuropathic pain diagnostic questionnaire. RESULTS: Population characteristics, preoperative anxiety, intraoperative drug consumption, procedure duration, and postoperative care unit stay were comparable in both groups. Analgesic consumption during the first 24 postoperative hours was similar in both groups (G: 3 [0-5] doses/24 h; P: 3 [1-5] doses/24 h; P = NS), as well as pain at rest (G: 2,2 [0.2-3.7]; P: 2 [0-6.3]; P = NS), and during swallowing (G: 2.8 [0.4-8.9]; P: 3 [1.4-6.3]; P = NS]). Eight patients had a diagnostic questionnaire score more than 3, 6 mo after operation versus 2 in preoperative period (P = 0.04). Such delayed neuropathic pain complaints were reported in seven patients receiving SCPB alone and only in one patient receiving both SCPB and preoperative adjunctive oral gabapentin. (P = 0.01). CONCLUSION: Oral preoperative administration of gabapentin did not modify immediate pain management in thyroidectomy patients receiving SCPB, but prevented delayed neuropathic pain at 6 mo.