Audit of postoperative pain management after open thoracotomy and the incidence of chronic postthoracotomy pain in more than 500 patients at a tertiary center.
OBJECTIVE
To evaluate the quality of postoperative pain relief during the first 3 days after surgery and to evaluate with the incidence of persistent pain at 6 months after surgery.


METHODS
Retrospective single-center audit.


METHODS
University hospital.


METHODS
Five hundred four patients who underwent thoracotomy.


METHODS
Review of patient records, questionnaire, and telephone review.


RESULTS
Of the 364 survivors, 306 were contacted. Five or more episodes of severe pain (numerical rating scale >6/10 at rest or movement) during the first 72 hours after surgery occurred in 133 patients. Persistent postsurgical pain at 6 months was present in 82% (109/133) of these patients. Patient satisfaction with acute postoperative pain management was excellent (36%), good (43%), and fair or poor (21%).The incidence of postthoracotomy pain was 56% (mild 32%, moderate 18%, and severe 6%).


CONCLUSIONS
Poorly controlled acute postoperative pain correlated with persistent postsurgical pain at 6 months. In view of such a high incidence in thoracotomy patients, preventative strategies assume great significance.
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK. Electronic address: nirajgopinath@yahoo.co.uk.
G
G
Niraj
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK.
A
A
Kelkar
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK.
Vipul
V
Kaushik
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK.
Yee
Y
Tang
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK.
Danny
D
Fleet
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK.
Frances
F
Tait
Clinical Research Unit in Pain Medicine, Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, LE5 4PW, UK.
Theresa
T
Mcmillan
Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, LE3 5QP, UK.
Sridhar
S
Rathinam
D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods / Q000592:standards; D016058:Analgesia, Patient-Controlled / Q000379:methods / Q000592:standards; D059350:Chronic Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000592:standards; D013908:Thoracotomy / Q000009:adverse effects*
Chronic postthoracotomy pain; Epidural analgesia; Postoperative pain management