Häufigkeit und Intensität von chronischen Schmerzen nach offenen thoraxchirurgischen Eingriffen - eine Analyse verschiedener Einflussfaktoren wie Alter, Geschlecht, Anästhesie und OP-Verfahren

Abstract

Background: Thoracotomy is often necessary for major lung surgery. Unfortunately chronic pain after thoracotomy called post-thoracotomy-pain is not rare but the exact frequency is not known. Determinants like gender, age, preoperative pain etc. are discussed in former studies without a clear etiological correlation with post-thoracotomy pain. Methods: The study was designed as a monocentre, open labelled, randomized observational trial. A total of 92 patients undergoing elective lung surgery were randomly assigned to the epidural (n = 47) or intercostal group (n = 45). 83 patients completed the study. NRS and activity score were assessed preoperatively, during the first 4 postoperative days and 1, 3, 6 and 12 months after anterolateral thoracotomy. Results: At rest 15 % had pain (NRS > 0) preoperatively. One month after surgery 50 % had pain. One year after surgery 16,1 % are still suffering pain at rest. During coughing 22,5 % had pain preoperatively; 61,9 % one month after surgery. One year after thoracotomy 15 % are still suffering pain during coughing. Only a few patients had severe pain (NRS > 3). Regarding the gender significant more women than men had pain during coughing preoperatively (p = 0,028) and one year after surgery (p = 0,023). Regarding age significant more patients < 65 years had pain at rest preoperatively (p = 0,025) and tendentially 6 months after surgery. Patient activity levels are significant lower in those patients with NRS > 3 than those without pain (NRS = 0) 6 months after thoracotomy (p = 0,015). Conclusions: All in all the frequency of post-thoracotomy-pain in this study is low in comparison to earlier studies. With regard to gender and age significant more women and patients < 65 years are still suffering pain preoperatively and one year after thoracotomy. Patient activity levels 1 year after surgery were less than preoperative levels.