Remifentanil during cardiac surgery is associated with chronic thoracic pain 1 yr
after sternotomy.
Author(s): van Gulik L, Ahlers SJ, van de Garde EM, Bruins P, van Boven WJ, Tibboel D, van
Dongen EP, Knibbe CA.
Affiliation(s): Department of Anaesthesiology, Intensive Care and Pain Management, St Antonius
Hospital, Koekoekslaan 1, Nieuwegein 3440 EM, The Netherlands.
lvangulik@hotmail.com
Publication date & source: 2012, Br J Anaesth. , 109(4):616-22
BACKGROUND: Chronic thoracic pain after cardiac surgery is a serious condition
affecting many patients. The aim of this study was to identify predictors for
chronic thoracic pain after sternotomy in cardiac surgery patients by analysing
patient and perioperative characteristics.
METHODS: A follow-up study was performed in 120 patients who participated in a
clinical trial on pain levels in the early postoperative period after cardiac
surgery. The presence of chronic thoracic pain was evaluated by a questionnaire 1
yr after surgery. Patients with and without chronic thoracic pain were compared.
Associations were studied using multivariable logistic regression analysis.
RESULTS: Questionnaires of 90 patients were analysed. Chronic thoracic pain was
reported by 18 patients (20%). In the multivariable regression model,
remifentanil during cardiac surgery, age below 69 yr, and a body mass index above
28 kg m(-2) were independent predictors for chronic thoracic pain {odds ratios
8.9 [95% confidence interval (CI) 1.6-49.0], 7.0 (95% CI 1.6-31.7), 9.1 (95% CI
2.1-39.1), respectively}. No differences were observed in patient and
perioperative characteristics between patients receiving remifentanil (58%, n=52)
compared with patients not receiving remifentanil (42%, n=38). The association
between remifentanil and chronic thoracic pain appeared dose-dependent, both for
total dose and for dose corrected for kilogram lean body mass and duration of
surgery (P-value for trend: <0.01 and <0.005, respectively).
CONCLUSIONS: In this follow-up study in cardiac surgery patients, intraoperative
remifentanil was predictive for chronic thoracic pain in a dose-dependent manner.
Randomized studies designed to evaluate the influence of intraoperative
remifentanil on chronic thoracic pain are needed to confirm these results.
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