The characteristics and etiology of long-term pain after major thoracotomy and methods for its prevention have yet to be established.
One hundred and twenty patients who had completed the hospital-based portion of a prior study to evaluate the efficacy of intraoperative epidural use during major thoracotomy, all of whom had received patient-controlled thoracic epidural analgesia until at least thoracostomy tube removal, and who were followed for 48 weeks after surgery provided data for this study.
Although preoperative pain was associated with elevated pain levels during hospitalization and the first few months after discharge, there was no association with pain 48 weeks after surgery. Furthermore, pain during the first few postoperative days, although associated with pain during the first few postoperative months, was not associated with pain 48 weeks after surgery. However, for patients who reported pain 48 weeks after surgery, pain levels were elevated late in hospitalization after epidural catheter removal and pain after discharge did not decrease over time. During hospitalization, patients who would eventually report pain 48 weeks after surgery experienced a greater impact of pain and reported that analgesic therapy was less effective.
Postoperative pain that persists but eventually dissipates was a common finding whose intensity was associated with immediate preoperative and postoperative pain levels. In contrast, pain later on during hospitalization, its impact, and perceived analgesic effectiveness best identified those who would continue to report pain almost 1 year after surgery.
*Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
†Department of Anesthesiology, University of Pennsylvania Medical Center, Philadelphia, PA
Supported by National Institutes of Health Grants NIH K23 HD40914 and R01 NS041865.
Reprints: Allan Gottschalk, MD, PhD, Department of Anesthesiology and Critical Care Medicine, Meyer 8-134, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287 (e-mail: firstname.lastname@example.org).
Received for publication January 21, 2008; revised March 11, 2008; accepted March 15, 2008