Early postoperative pain trajectories after posterolateral and axillary approaches for thoracic surgery: A prospective monocentric observational study

Less invasive thoracotomies may reduce early postoperative pain. The aims
of this study were to identify pain trajectories from postoperative day 0
to 5 after posterolateral and axillary thoracotomies and 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%), trajectory 4 with patients with a steep increase (14.9%).
According to a multinomial logistic model multivariable analysis, some
predictive factors allow 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 to be 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 the major
factor for the worst trajectory of early postoperative pain.