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Chronic pain in children after cardiac surgery via sternotomy

Published online by Cambridge University Press:  18 September 2013

Mette H. Lauridsen ,
Anders D. Kristensen ,
Vibeke E. Hjortdal ,
Troels S. Jensen  and
Lone Nikolajsen
Mette H. Lauridsen
Affiliation:
Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
Anders D. Kristensen
Affiliation:
Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
Troels S. Jensen
Affiliation:
Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
Lone Nikolajsen*
Affiliation:
Department of Anaesthesiology, Aarhus University Hospital, Aarhus, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark
*
Correspondence to: L. Nikolajsen, MD, DMSc, Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, building 1 A, 8000 Aarhus C, Denmark. Tel: +45 78464317; Fax: +45 78463269; E-mail: lone.nikolajsen@ki.au.dk
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Abstract

Introduction

Chronic pain is common after sternotomy in adults with reported prevalence rates of 20–50%. So far, no studies have examined whether children develop chronic pain after sternotomy.

Material and methods

Postal questionnaires were sent to 171 children 10–60 months after undergoing cardiac surgery via sternotomy at the age of 0–12 years. The children were asked to recall the intensity and duration of their post-operative pain, if necessary with the help from their parents, and to describe the intensity and character of any present pain. Another group of 13 children underwent quantitative sensory testing of the scar area 3 months after sternotomy.

Results

A total of 121 children, median (range) age 7.7 (4.2–16.9) years, answered the questionnaire. Their age at the time of surgery was median (range) 3.8 (0–12.9) years, and the follow-up period was median (range) 4 (0.8–5.1) years. In all, 26 children (21%) reported present pain and/or pain within the last week located in the scar area; in 12 (46%) out of the 26 children, the intensity was ≥4 on a numeric rating scale (0–10). Quantitative sensory testing of the scar area revealed sensory abnormalities – pinprick hyperalgesia and brush and cold allodynia – in 10 out of 13 children.

Conclusion

Chronic pain after cardiac surgery via sternotomy in children is a problem that should not be neglected. The pain is likely to have a neuropathic component as suggested by the sensory abnormalities demonstrated by quantitative sensory testing.

Keywords

Congenital heart diseasechildrensternotomychronic pain
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 5 , October 2014 , pp. 893 - 899
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Kehlet, H, Jensen, TS, Woolf, CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006; 367: 1618–1625.CrossRefGoogle ScholarPubMed
2. Macrae, WA. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008; 101: 77–86.CrossRefGoogle Scholar
3. Nikolajsen, L, Jensen, TS. Phantom limb pain. Br J Anaesth 2001; 87: 107–116.CrossRefGoogle ScholarPubMed
4. Wildgaard, K, Ravn, J, Nikolajsen, L, Jakobsen, E, Jensen, TS, Kehlet, H. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study. Acta Anaesthesiol Scand 2011; 55: 60–68.CrossRefGoogle ScholarPubMed
5. Gartner, R, Jensen, MB, Nielsen, J, Ewertz, M, Kroman, N, Kehlet, H. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 2009; 302: 1985–1992.CrossRefGoogle ScholarPubMed
6. Aasvang, E, Kehlet, H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005; 95: 69–76.CrossRefGoogle ScholarPubMed
7. Jensen, TS, Baron, R. Translation of symptoms and signs into mechanisms in neuropathic pain. Pain 2003; 102: 1–8.CrossRefGoogle ScholarPubMed
8. Steegers, MA, Snik, DM, Verhagen, AF, van der Drift, MA, Wilder-Smith, OH. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain 2008; 9: 955–961.CrossRefGoogle ScholarPubMed
9. Wilkins, KL, McGrath, PJ, Finley, GA, Katz, J. Phantom limb sensations and phantom limb pain in child and adolescent amputees. Pain 1998; 78: 7–12.CrossRefGoogle ScholarPubMed
10. Kristensen, AD, Pedersen, TA, Hjortdal, VE, Jensen, TS, Nikolajsen, L. Chronic pain in adults after thoracotomy in childhood or youth. Br J Anaesth 2010; 104: 75–79.CrossRefGoogle ScholarPubMed
11. Kristensen, AD, Ahlburg, P, Lauridsen, MC, Jensen, TS, Nikolajsen, L. Chronic pain after inguinal hernia repair in children. Br J Anaesth 2012; 109: 603–608.CrossRefGoogle ScholarPubMed
12. Bruce, J, Drury, N, Poobalan, AS, Jeffrey, RR, Smith, WC, Chambers, WA. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain 2003; 104: 265–273.CrossRefGoogle ScholarPubMed
13. Eisenberg, E, Pultorak, Y, Pud, D, Bar-El, Y. Prevalence and characteristics of post coronary artery bypass graft surgery pain (PCP). Pain 2001; 92: 11–17.CrossRefGoogle ScholarPubMed
14. Lahtinen, P, Kokki, H, Hynynen, M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology 2006; 105: 794–800.CrossRefGoogle ScholarPubMed
15. Meyerson, J, Thelin, S, Gordh, T, Karlsten, R. The incidence of chronic post-sternotomy pain after cardiac surgery – a prospective study. Acta Anaesthesiol Scand 2001; 45: 940–944.CrossRefGoogle ScholarPubMed
16. van Gulik, L, Janssen, LI, Ahlers, SJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg 2011; 40: 1309–1313.Google ScholarPubMed
17. Hicks, CL, von Baeyer, CL, Spafford, PA, van Korlaar, I, Goodenough, B. The Faces Pain Scale-revised: toward a common metric in pediatric pain measurement. Pain 2001; 93: 173–183.CrossRefGoogle Scholar
18. Drewes, AM, Helweg-Larsen, S, Petersen, P, et al. McGill pain questionnaire translated into Danish: experimental and clinical findings. Clin J Pain 1993; 9: 80–87.CrossRefGoogle ScholarPubMed
19. Stawowy, M, Funch-Jensen, P, Arendt-Nielsen, L, Drewes, AM. Somatosensory changes in the referred pain area in patients with cholecystolithiasis. Eur J Gastroenterol Hepatol 2005; 17: 865–870.CrossRefGoogle ScholarPubMed
20. Perquin, CW, Hazebroek-Kampschreur, AA, Hunfeld, JA, et al. Pain in children and adolescents: a common experience. Pain 2000; 87: 51–58.CrossRefGoogle ScholarPubMed
21. Keogh, E, Eccleston, C. Sex differences in adolescent chronic pain and pain-related coping. Pain 2006; 123: 275–284.CrossRefGoogle ScholarPubMed
22. Florence, SL, Jain, N, Pospichal, MW, Beck, PD, Sly, DL, Kaas, JH. Central reorganization of sensory pathways following peripheral nerve regeneration in fetal monkeys. Nature 1996; 381: 69–71.CrossRefGoogle ScholarPubMed
23. Peters, ML, Sommer, M, de Rijke, JM, et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007; 245: 487–494.CrossRefGoogle ScholarPubMed
24. von Baeyer, CL, Marche, TA, Rocha, EM, Salmon, K. Children's memory for pain: overview and implications for practice. J Pain 2004; 5: 241–249.CrossRefGoogle ScholarPubMed