A Review on Impact of Anesthesia Techniques on Chronic Postoperative Pain

Franz Elisa^*
*Correspondence: Franz Elisa, Department of Anesthesiology and Pain Medicine, University of California, California, USA, Email:

Keywords

Postoperative pain • Surgical procedures • Chronic postoperative pain

Introduction

Chronic Postoperative Pain (CPOP) is a distressing and often debilitating condition that can persist long after the healing of surgical wounds. CPOP is typically defined as pain that lasts for at least three months following surgery. It can significantly impact a patient's quality of life, disrupt daily activities and contribute to a range of physical and psychological issues [1]. Understanding the potential impact of anesthesia techniques on the development of CPOP is crucial for improving patient outcomes and reducing the burden of this condition on individuals and healthcare systems.

This review aims to explore the relationship between anesthesia techniques and CPOP, with a focus on the role of regional anesthesia, opioids and adjuvants. We will examine the risk factors associated with CPOP and discuss preventive strategies that may help mitigate the risk of this challenging condition.

Defining chronic postoperative pain

CPOP is a complex and multifactorial condition. It can manifest as a wide range of pain types, including neuropathic pain, nociceptive pain and a combination of both. The exact mechanisms underlying the development of CPOP are not fully understood but are thought to involve a combination of factors, including surgical, patient-related and perioperative factors.

Impact of anesthesia techniques on CPOP

Anesthesia techniques play a critical role in the perioperative period and can have a significant impact on the development of CPOP. Various factors, such as the choice of anesthesia, the use of regional techniques and the administration of opioids and adjuvants, can influence the risk of CPOP.

Regional anesthesia and CPOP

Regional anesthesia techniques, including peripheral nerve blocks, epidurals and spinal anesthesia, have gained recognition for their potential to reduce the risk of CPOP. Their benefits include:

Regional anesthesia precisely targets the nerves responsible for transmitting pain signals from the surgical site. By blocking these nerves, regional techniques provide effective pain relief while minimizing the need for systemic opioids. Regional anesthesia can reduce the amount of opioids required during and after surgery [2]. Opioids are associated with various side effects, including the potential for hyperalgesia and central sensitization, which may contribute to CPOP. Some regional techniques, such as epidurals, may have anti-inflammatory effects that can help mitigate tissue damage and inflammation at the surgical site, potentially reducing the risk of CPOP.

Literature Review

Opioids and CPOP

While opioids are effective at providing pain relief during the acute postoperative phase, their chronic use can lead to several complications, including the development of CPOP. Opioids may contribute to CPOP in the following ways: Prolonged exposure to opioids can lead to central sensitization, a condition characterized by an increased sensitivity to pain. Central sensitization may amplify the perception of pain and contribute to the development of chronic pain [3]. Opioids can induce hyperalgesia, a phenomenon where patients become more sensitive to pain stimuli and pain thresholds decrease. This can lead to persistent or worsening pain after surgery. Chronic opioid use may result in tolerance, requiring patients to use higher doses for the same level of pain relief. Increasing opioid doses can escalate the risk of dependence and addiction.

Adjuvants and CPOP

Adjuvants, such as ketamine and gabapentin, have been investigated for their potential role in preventing CPOP. These medications can influence pain pathways and reduce the risk of chronic pain through various mechanisms. Ketamine, an NMDA receptor antagonist, can prevent central sensitization by modulating glutamate receptor activity. This effect may help reduce the development of CPOP. Gabapentinoids, including gabapentin and pregabalin, are commonly used to manage neuropathic pain. By controlling pain with these medications during the acute phase, the risk of CPOP may be decreased.

Risk factors for CPOP

Numerous risk factors have been associated with the development of CPOP. These factors can be categorized into surgical, patient-related and perioperative factors: Extensive tissue damage, nerve injury, or the creation of surgical incisions near nerves can increase the risk of CPOP. Certain surgical procedures, such as thoracotomy and mastectomy, are associated with a higher risk of CPOP due to the potential for nerve damage and postoperative complications [4]. Surgical procedures that result in ongoing inflammation or scar tissue formation may contribute to the development of CPOP.

Patients who experience pain or have a history of chronic pain conditions before surgery may be at higher risk for CPOP. Genetic factors may influence an individual's susceptibility to CPOP. Psychological factors, such as anxiety, depression and catastrophizing, can increase the risk of CPOP. Women and older adults are more likely to develop CPOP, although this varies depending on the surgical procedure.

Discussion

Inadequate acute pain management can lead to central sensitization and increase the risk of CPOP. The use of opioids in the perioperative period, especially in high doses, has been associated with a higher risk of CPOP. When pain becomes persistent after surgery, it can lead to central sensitization and the development of CPOP.

Preventive strategies for CPOP

Given the potential impact of anesthesia techniques on CPOP, preventive strategies should be considered. These strategies may include:

Proper patient selection, assessment and education are essential. Patients with a history of chronic pain or psychosocial risk factors may require specialized pain management plans. Additionally, educating patients about the potential risks of CPOP and the importance of adhering to their pain management regimen is crucial [5,6]. A multimodal analgesia approach that includes regional anesthesia, non-opioid medications and adjuvants can help reduce the reliance on opioids and decrease the risk of CPOP.

Encouraging early mobilization and physical therapy after surgery can help prevent the development of CPOP by reducing the risk of chronic inflammation and promoting tissue healing. Minimally invasive surgical techniques that minimize tissue trauma and nerve damage can lower the risk of CPOP in certain procedures. Individualized pain management plans that consider the patient's surgical, medical and psychosocial history can help address specific risk factors and optimize pain control.

Conclusion

The impact of anesthesia techniques on the development of CPOP is complex, with various factors at play. Regional anesthesia techniques, when employed correctly, have the potential to reduce the risk of CPOP by providing targeted pain control and minimizing the need for opioids. Conversely, opioids, when used excessively, can contribute to central sensitization and the development of CPOP. Adjuvants offer an additional avenue for prevention by influencing pain pathways and mitigating chronic pain.

Preventing CPOP requires a multifaceted approach that considers surgical, patient-related and perioperative factors. Patient selection, education and early mobilization are critical components of preventive strategies. The evolving understanding of CPOP and the continued development of anesthesia techniques offer hope for improved outcomes and a reduced burden of this challenging condition on patients and healthcare systems. By implementing preventive strategies and optimizing pain management, healthcare providers can help reduce the incidence of CPOP and improve the long-term well-being of surgical patients.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Chen, Y‐YK, K. A. Boden and K. L. Schreiber. "The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: A narrative review." Anaesthesia 76 (2021): 8-17.

   Google Scholar, Crossref, Indexed at

2. Imani, Farnad, Behrooz Zaman and Pasquale De Negri. "Postoperative pain management: Role of dexmedetomidine as an adjuvant." Anesth Pain Med 10 (2020).

   Google Scholar, Crossref, Indexed at

3. Mehrotra, Shikha. "Postoperative anaesthetic concerns in children: Postoperative pain, emergence delirium and postoperative nausea and vomiting." Indian J Anaesth 63 (2019): 763.

   Google Scholar, Crossref, Indexed at

4. Gulur, Padma and Amanda Nelli. "Persistent postoperative pain: Mechanisms and modulators." Curr Opin Anaesthesiol 32 (2019): 668-673.

   Google Scholar, Crossref, Indexed at

5. Cai, Qiang, Guo-qing Liu, Lin-sheng Huang and Zi-xuan Yang, et al. "Effects of erector spinae plane block on postoperative pain and side-effects in adult patients underwent surgery: A systematic review and meta-analysis of randomized controlled trials." Int J Surg 80 (2020): 107-116.

   Google Scholar, Crossref, Indexed at

6. Cravero, Joseph P., Rita Agarwal, Charles Berde and Patrick Birmingham, et al. "The society for pediatric anesthesia recommendations for the use of opioids in children during the perioperative period." Paediatr Anaesth 29 (2019): 547-571.

   Google Scholar, Crossref, Indexed at