BJA Advance Access first published online on November 14, 2009
This version published online on November 17, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep317
Chronic pain in adults after thoracotomy in childhood or youth
1 Department of Anaesthesiology and
2 Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, 8000 Aarhus, Denmark.
3 Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark
* Corresponding author. E-mail: anders.due.kristensen{at}ki.au.dk
Background: Chronic pain is common after thoracotomy with reported prevalence rates of 20–60%. The pain may be caused by damage to the intercostal nerves during surgery. Some studies have suggested that young age at the time of surgery reduces the risk of developing chronic pain. So far, no studies have examined if children and adolescents develop chronic pain after thoracotomy.
Methods: Eighty-eight patients, mean (SD) age 39.3 (7.7) yr, who underwent thoracotomy between the age of 0 and 25 yr were asked to recall the duration of postoperative pain and—if pain was still present—to describe intensity and character of pain. In addition, all patients underwent quantitative sensory testing.
Results: Fourteen patients (16%) recalled that their postoperative pain had lasted for more than 3 months: one (3.2%) patient in the youngest group (0–6 yr), seven (19.4%) patients in the age group 7–12 yr, and six (28.5%) patients in the age group 13–25 yr (P=0.03). Three out of the 14 patients, who were 11, 11, and 18 yr of age at the time of surgery, still had pain at present. Quantitative sensory testing revealed hypo- and hyperphenomena in most patients, including those with persistent pain. Tactile detection thresholds and pressure detection thresholds were significantly lower on the operated side when compared with the contralateral side (n=88; P<0.001).
Conclusions: The risk of developing chronic pain after thoracotomy seems to be lower if surgery is performed at a young age. Pain after thoracotomy is likely to be of neuropathic origin.
Keywords: age factors; children; pain, chronic; pain, postoperative; pain, threshold; surgery, thoracic
This is a new version as there were errors in the age ranges in the abstract and text of the original version.
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