title: Reduced incidence of chronic postsurgical pain after epidural analgesia for abdominal surgery.
abstract: 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, Short-Form-36 Health Survey (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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesiology, Maastricht University Medical Center+, Maastricht, The Netherlands.
authors.forename: Esther A
authors.initials: EA
authors.lastname: Bouman
authors.forename: Maurice
authors.initials: M
authors.lastname: Theunissen
authors.forename: Sabrina A
authors.initials: SA
authors.lastname: Bons
authors.forename: Walther N
authors.initials: WN
authors.lastname: van Mook
authors.forename: Hans-F
authors.initials: HF
authors.lastname: Gramke
authors.forename: Maarten
authors.initials: M
authors.lastname: van Kleef
authors.forename: Marco A
authors.initials: MA
authors.lastname: Marcus
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D015360:Analgesia, Epidural; D016022:Case-Control Studies; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome
keywords: chronic postsurgical pain; epidural; predictor