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 Printable version |
Management of acute, persistent and chronic pain after cardiac surgery |
Sang Thrombose Vaisseaux. Volume 17, Number 2, 93-9, Février 2005, Mini-revue
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 Résumé
Article gratuit
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Author(s) : Stéphane Donnadieu |
Summary : Despite progress in pain management, cardiac surgical patients continue to experience acute, persistant and chronic pain after sternotomy and thoracotomy. Immediate postoperative pain is induced by trauma to many pain-sensitive structures including median sternotomy, rib retraction, musculoskeletal stretching and invasion of muscle and visceral tissues. The modalities of acute pain relief include opioid analgesics such as morphine administered by PCA and regional analgesia with intercostal nerve blockade, paravertebral catheter or thoracic epidural analgesia. Persistant pain beyond the fifth day is sometime related to a complication, but most frequently emanates from myofascial structures especially the pectoral girdle. Modalities of treatment include trigger point infiltrations and physical therapy. Chronic pain is defined as pain at the site of surgery persisting beyond three months. The prevalence is about 15 %. Predictive factors are poor pain control in the immediate post operative period, previous addiction and psychological distress. Chronic pain evaluation is multidimensional with quality of life questionnaire. The most common mechanism is intercostal nerve damage inducing neuropathic pain including allodynia. The goals of treatment for chronic pain are restoration of physical and emotional functions, decreasing pain by use of co-analgesics such as anticonvulsivants and antidepressive drugs associated with transcutaneous electrical nerve stimulation and psycho-social support. |
Keywords : cardiac surgery, acute pain, chronic pain, analgesics |
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