Premium
Reduced Incidence of Chronic Postsurgical Pain after Epidural Analgesia for Abdominal Surgery
Author(s) -
Bouman Esther A.,
Theunissen Maurice,
Bons Sabrina A.,
Mook Walther N.,
Gramke HansF.,
Kleef Maarten,
Marcus Marco A.
Publication year - 2014
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12091
Subject(s) - medicine , anesthesia , odds ratio , chronic pain , confidence interval , quality of life (healthcare) , incidence (geometry) , surgery , logistic regression , neuropathic pain , complication , abdominal surgery , physical therapy , physics , nursing , optics
Background Chronic postsurgical pain ( CPSP ) is a common complication of surgery with high impact on quality of life. Peripheral and central sensitization caused by enhanced and prolonged afferent nociceptive input are considered important mechanisms for the development of CPSP . This case–control study investigated whether epidural analgesia is associated with a reduced incidence of CPSP after open abdominal surgery. Methods Six months after surgery, S hort‐ F orm‐36 H ealth S urvey ( SF ‐36) pain scores, possible predictors of chronic pain, and quality of life were assessed. Patients treated with epidural analgesia in combination with general anesthesia (epidural group, N = 51) were compared to patients undergoing matched surgical procedures receiving general anesthesia alone ( GA ‐group, N = 50). Multivariate analysis was performed by logistic regression analysis. Results Twenty‐six (25.7%) patients experienced chronic pain, 9 in the epidural group (17.6%), 17 in the GA ‐group (34%), crude odds ratio ( OR ) 0.42 (95% confidence interval ( CI ) 0.16 to 1.05). After adjustment for the most prominent predictors of CPSP , such as age, sex, pre‐operative pain, and acute postoperative pain, the OR for chronic pain in the epidural group was 0.19 (95% CI 0.05 to 0.76). Patients with CPSP reported a significantly lower quality of life compared to patients without CPSP ( SF ‐36 total score median ( IQR ) 39.2 (27.2 to 56.7) vs. 84.3 (69.9 to 92.5, P < 0.001) and a lower level of long‐term global perceived recovery (70.0% (50.0 to 80.0) vs. 90.0% (80.0 to 100.0), P < 0.001). Conclusion Chronic postsurgical pain occurs in a significant number of patients 6 months after open abdominal surgery. Postoperative epidural analgesia is associated with a reduced incidence of CPSP after abdominal surgery.