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A considerable number of patients are not satisfied after total knee replacement (TKR) because of persistent pain. This pain can also be neuropathic in origin. Both types of pain have a large impact on function and quality of life. Furthermore, the trajectory of anxiety and depressive symptoms and pain catastrophizing has rarely been studied after TKR surgery. The primary objective of this study was to define the trajectory of knee pain after primary TKR. The secondary objectives were to evaluate how neuropathic pain, anxiety and depressive symptoms and pain catastrophizing change over time.This prospective, single-center study included patients who underwent primary TKR for primary osteoarthritis between July 2011 and December 2012. Personal data (age, sex, body mass index, knee history, operated side, surgical approach, type of implant, operative time, and rehabilitation course) and the responses to seven questionnaires (Numerical pain rating scale, DN4-interview for neuropathic pain, Oxford Knee Scale, Hospital and Anxiety Depression Scale, Beck Depression Inventory, Patient Catastrophizing Scale and Brief Pain Inventory) were determined preoperatively, at 6 months postoperative and at a mean follow-up of 7.5 years.Preoperatively, 129 patients (35 men, 94 women) filled out all the questionnaires. Subsequently, 32 patients were excluded because of incomplete responses at 6 months postoperative, 6 were excluded because they had undergone revision surgery, 11 patients were lost to follow-up and 5 patients had died. In the end, 65 patients were available for analysis (50% of the initial cohort) who were 74 years old on average at inclusion. Between the preoperative period and 6 months postoperative, pain (p 0.001), function (p 0.001), anxiety symptoms (p 0.001) and catastrophizing (p 0.001) had improved. Depressive symptoms did not change (p = 0.63). Between 6 months postoperative and the latest follow-up, none of the parameters changed further (p 0.05). Of the 65 patients analyzed, 21% had chronic pain of undefined origin at 6 months postoperative and 26% had chronic pain at the end of follow-up, with 50% also having neuropathic pain. Preoperatively, 40% of the 65 patients had neuropathic pain, 30% at 6 months (p = 0.27) and 18% at 7.5 years after TKR (p = 0.01).The number of patients who have chronic pain after TKR is considerable, especially since knee pain stabilized at 6 months postoperative. Early detection is vital to prevent the pain from becoming chronic, which makes it more difficult to treat. Half the patients with persistent pain also had neuropathic pain, which should be detected before surgery so the patients can be referred to a specialized pain management center. The presence of anxiety and depressive symptoms and pain catastrophizing is not a contraindication to TKR, but these patients should be referred to specialists for treatment before surgery.IV, prospective cohort study.

International audience; Chronic postoperative pain exists in varying degrees for every type of surgery. An evaluation of the incidence, the typology and predictive factors of chronic pain was carried out at 3 and 6months after thyroidectomy. A prospective observational study, having included each of the patients prior to their thyroidectomy, was carried out over 12months. The patients used an 11-point numerical rating scale (NRS), a neuropathic pain screening questionnaire (DN4), an evaluation scale for anxiety and for the need for information related to anaesthesia and surgery (APAIS), a questionnaire describing pain (QDSA) and a questionnaire evaluating neuropathic pain (NPSI) before surgery and at three and six months later. Three hundred and four patients were included. The questionnaires were completed by 251 patients (57 males and 194 females) at 3 and 6months (82%). At 3months, 31 out of 251 (12%) patients mentioned a DN4≥3; at 6months, this rate dropped to 23 out of 251 (9%). The average intensity of chronic postoperative pain remained low to moderate. Levels of anxiety and the need for information were higher in patients with postoperative pain at 3 and 6months. In contrast, the number of intraoperative procedures using a bilateral superficial cervical plexus block (BSCPB) was lower in patients with DN4≥3. Multivariate analysis demonstrated that the type of anaesthesia procedure interfered with the risk of delayed pain after thyroidectomy. The presence of a DN4≥3 was nearly three-fold greater in patients without BSCPB (OR 2.647, CI=1.198-5.848).

Introduction Les douleurs chroniques post-chirurgicales (DCPC) apres la mise en place d’une prothese totale de genou (PTG) restent frequentes et comprises entre 17 et 31 %. Ces douleurs parfois tres genantes pour le patient peuvent-elles etre previsibles ? Certains facteurs comme l’anxiete ou la depression sont-ils des facteurs favorisants ? Materiel et methodes Dans une enquete prospective realisee sur 2 ans (juillet 2011–juin 2013) sur des patients recevant une PTG primaire, une enquete prospective avec un auto-questionnaire fait en preoperatoire, a 3 mois et a 6 mois a ete conduite. Elle comportait une echelle numerique de la douleur (EN), un score DN4 (questionnaire de douleurs neuropathiques), un score Oxford, un Questionnaire concis de la douleur refletant la qualite de vie par 7 echelles numeriques de douleur (0–10) dans certaines activites quotidiennes (QCD/70), une echelle d’evaluation de l’anxiete et de la depression (HAD), avec un score sur 21 pour chaque versant. Une DCPC etait definie par la presence d’une EN > 4 (/10) a 6 mois postoperatoires. Une douleur etait reconnue comme neuropathique pour un DN4 > 3 (/7) a 3 6 mois. Une HAD etait positive pour le versant anxiete ou le versant depression pour un score > 11/21. Resultats Au total, 88 patients ont ete inclus, de 66 ans d’âge moyen, 21 hommes/67 femmes. Globalement 71/88 patients etaient satisfaits de leur prothese avec une amelioration significative des douleurs, l’EN passant de 6,9 a 2,6, 25 patients a 6 mois de la PTG presentaient des DCPC (28 %) et 29 patients des douleurs neuropathiques (33 %). La presence preoperatoire de douleurs neuropathiques, d’un OKS eleve (> 42/60), ainsi qu’un QCD > 35 etaient predictifs de DCPC de facon significative. Des douleurs neuropathiques, un QCD > 35 en preoperatoire etaient predictifs de douleurs neuropathiques. La presence preoperatoire d’un score HAD depression eleve etait predictif de DCPC. Sur 17 patients insatisfaits, 13 etaient porteurs de DCPC, 9 de douleurs neuropathiques. Discussion La prevention de l’apparition de DCPC peut etre faite en preoperatoire par la detection du caractere neuropathique des douleurs et l’importance de l’intensite des douleurs, la presence d’une depression a differencier de la presence d’une anxiete.

Background Preoperative oral gabapentin has been shown to reduce postoperative pain. However, the effects of gabapentin as an adjunct to regional anesthesia is unclear and its effects on chronic pain remains unknown. In patients undergoing thyroidectomy, we investigated the effects on early and late (at 6 mo) postoperative pain of preoperative oral gabapentin as an adjunct to superficial cervical plexus block (SCPB). Method Fifty consecutive consenting patients were randomized to receive either 1200 mg of gabapentin (Group G) or placebo (Group P) 2 h preoperatively. Preoperative anxiety was assessed on a numeric scale from 0 to 6. A SCPB was performed after a standardized induction of anesthesia. The primary outcome, analgesic drug consumption, was assessed during the procedure and postoperatively in the postanesthesia care unit and after discharge to the ward. Over the first 24 h, pain levels at rest and during swallowing were measured on a numeric scale from 0 to 10. If the pain level was more than 4/10 at rest, patients received 1 g/6 h of IV paracetamol and/or 50 mg/6 h of IV tramadol as a rescue analgesic treatment in the interval. The day before operation and 6 mo after thyroidectomy, included patients were asked to answer a neuropathic pain diagnostic questionnaire. Results Population characteristics, preoperative anxiety, intraoperative drug consumption, procedure duration, and postoperative care unit stay were comparable in both groups. Analgesic consumption during the first 24 postoperative hours was similar in both groups (G: 3 [0-5] doses/24 h; P: 3 [1-5] doses/24 h; P = NS), as well as pain at rest (G: 2,2 [0.2-3.7]; P: 2 [0-6.3]; P = NS), and during swallowing (G: 2.8 [0.4-8.9]; P: 3 [1.4-6.3]; P = NS]). Eight patients had a diagnostic questionnaire score more than 3, 6 mo after operation versus 2 in preoperative period (P = 0.04). Such delayed neuropathic pain complaints were reported in seven patients receiving SCPB alone and only in one patient receiving both SCPB and preoperative adjunctive oral gabapentin. (P = 0.01). Conclusion Oral preoperative administration of gabapentin did not modify immediate pain management in thyroidectomy patients receiving SCPB, but prevented delayed neuropathic pain at 6 mo.

The use of regional anaesthesia in thyroid surgery remains controversial. This double-blind, randomized controlled study was conducted to evaluate the analgesic efficacy of bilateral superficial cervical plexus block (BSCPB) performed under general anaesthesia in patients undergoing total thyroidectomy.Eighty-seven consecutive consenting patients were randomized to receive a BSCPB with saline (Group P, n = 29), ropivacaine 0.487% (Group R, n = 29), or ropivacaine 0.487% plus clonidine 5 microg ml(-1) (Group RC, n = 29). Sufentanil was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate in a patient with a bispectral index between 40 and 60. All patients received 4 g of acetaminophen during the first 24 h after operation. The pain score was checked every 4 h and nefopam was given for pain score4 on a numeric pain scale.During surgery, the median sufentanil requirements were significantly reduced in Group RC compared with Groups R and P (0.32 vs 0.47 and 0.62 microg kg(-1); P0.0001). After surgery, the number of patients requiring nefopam within 24 h of surgery was significantly lower in Groups R and RC than in Group P (16 and 19 vs 25; P = 0.03). At post-anaesthetic care unit admission, median (range) pain scores were significantly lower in Groups R [3 (0-10)] and RC [3 (0-8)] than in Group P [5 (0-8), P = 0.03]. No major complications of BSCPB occurred during study.BSCPB with ropivacaine and clonidine improved intraoperative analgesia. BSCPB with ropivacaine or ropivaciane and clonidine was effective in reducing analgesic requirements after thyroid surgery.

Incisional hernia is a frequent complication following abdominal surgery. Repairs that include the use of mesh have been associated with decreased recurrence. The aim of the present study was to determine the outcomes and risk factors for chronic pain after ventral hernia repair with underlay placement of a composite polypropylene mesh. A retrospective study was conducted from September 2005 to June 2008. The study included consecutive patients who underwent elective incisional hernia repair with underlay composite mesh placement. Postoperative course, recurrence, pain, and patient satisfaction were assessed by an independent observer. Chronic pain was defined as significant pain persisting after 3 months as assessed using a 10-point numeric scale (≥3: chronic pain, ≥7: severe pain). After a mean follow-up period of 24.6 months, 109 of 121 patients operated on during the period were evaluated. No patients experienced small bowel obstructions, enterocutaneous fistulas, or mesh infections leading to the need for mesh removal. The recurrence rate was 6.1 % at the repair site and 10.5% at another site. Thirty-one patients (28%) had chronic pain and seven patients (6.6%) had severe pain. Affective and nociceptive components were the majority of complaints. Chronic cough was the only variable independently associated with chronic pain in univariate and multivariate analyses (OR = 4.8; p = 0.007). Intraperitoneal composite mesh placement after ventral hernia repair is safe with regard to intra-abdominal potential complications. Chronic pain is not uncommon, with chronic cough identified as the major independent predictor.