Early Postoperative Pain Trajectories after Posterolateral and Axillary Approaches to Thoracic Surgery: A Prospective Monocentric Observational Study

Pascaline Dorges (1, 2, 3) , Mireille Michel-Cherqui (4, 2, 3) , Julien Fessler (4, 2, 3) , Barbara Székély (4, 2, 3) , Édouard Sage (5, 2, 6) , Matthieu Glorion (2, 5) , Titouan Kennel (2, 7) , Marc Fischler (2, 4, 8) , Valeria Martinez (9, 10) , Alexandre Vallée (2, 11) , Morgan Le Guen (4, 8)

1 UVSQ Santé - Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil
2 Hôpital Foch [Suresnes]
3 Department of Anesthesiology and Pain Management, Hôpital Foch
4 UVSQ - Université de Versailles Saint-Quentin-en-Yvelines
5 VIM (UR 0892) - Virologie et Immunologie Moléculaires
6 CT2P - Hôpital Foch - Chirurgie thoracique et transplantation pulmonaire [Suresnes]
7 Department of Research and Innovation, Hôpital Foch
8 Department of Anesthesiology, Hopital Foch [Suresne]
9 LPPD - Physiopathologie et Pharmacologie Clinique de la Douleur
10 Department of Anesthesiology and Pain Unit, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris
11 Department of Epidemiology - Data - Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch

Less-invasive thoracotomies may reduce early postoperative pain. The aims of this study were to identify pain trajectories from postoperative days 0–5 after posterolateral and axillary thoracotomies and to identify potential factors related to the worst trajectory. Patients undergoing a posterolateral (92 patients) or axillary (89 patients) thoracotomy between July 2014 and November 2015 were analyzed in this prospective monocentric cohort study. The best-fitting model resulted in four pain trajectory groups: trajectory 1, the “worst”, with 29.8% of the patients with permanent significant pain; trajectory 2 with patients with low pain (32.6%); trajectory 3 with patients with a steep decrease in pain (22.7%); and trajectory 4 with patients with a steep increase (14.9%). According to a multinomial logistic model multivariable analysis, some predictive factors allow for differentiation between trajectory groups 1 and 2. Risk factors for permanent pain are the existence of preoperative pain (OR = 6.94, CI 95% (1.54–31.27)) and scar length (OR = 1.20 (1.05–1.38)). In contrast, ASA class III is a protective factor in group 1 (OR = 0.02 (0.001–0.52)). In conclusion, early postoperative pain can be characterized by four trajectories and preoperative pain is a major factor for the worst trajectory of early postoperative pain.

Mots clés: lung surgery; pain; thoracotomy; trajectory

Domaines: Sciences du Vivant [q-bio]; Sciences de l'Homme et Société

Pascaline Dorges, Mireille Michel-Cherqui, Julien Fessler, Barbara Székély, Édouard Sage, et al.. Early Postoperative Pain Trajectories after Posterolateral and Axillary Approaches to Thoracic Surgery: A Prospective Monocentric Observational Study. Journal of Clinical Medicine, 2022, 11 (17), pp.5152. ⟨10.3390/jcm11175152⟩. ⟨hal-04348017⟩