Chronic thoracic pain in children after cardiac surgery.

Background Chronic pain after surgical procedures in children has gained limited attention. Chronic thoracic pain after cardiac surgery is common, and has a significant impact on daily life in adults. The study aim was to investigate the prevalence and etiology of chronic pain after cardiac surgery via sternotomy in children. Methods The study included a prospective clinical examination with quantitative sensory testing 3 months after surgery, and a retrospective survey of children, who underwent cardiac surgery 10-60 months earlier. Children were to be at least 4 years old at the time of completing the questionnaire. They were asked to recall the intensity of the post-operative pain. The questionnaire assessed pain descriptors, situations or activities that could worsen pain, and analgesic consumption. Faces pain scales (0-10) was used to rate the pain intensity. Results Ten children were examined three months after surgery. One child reported ongoing pain. Brush allodynia and pinprick hyperalgesia were present in 4 and 6 children respectively. Hypoesthesia to cold (20 °C) was present in 3 children, and cold allodynia was present in one child in the scar area. The average pressure pain threshold was 71.1 kPa (range 34.3-121 kPa). One hundred and seventy one questionnaires were sent out, and 121 (70.8%) were eligible for analysis. Mean age at the time of surgery was 4.7 years and mean age at questionnaire completion was 8.4. Worst pain intensity in the week after surgery was 5.6 (mean). Any pain "during the recent week" was reported by 26 children, 12 children reported pain intensity ≥4. Two children (1.17%) reported pain intensity ≥4 at the time of questionnaire completion. Pain was evoked by local pressure in 23 (19.0%), and physical activity in 15 (12.4%) children. Itch and pressing were the most frequent pain descriptors chosen by 25 (20.7%) and 20 (16.5%) children, respectively. One child used paracetamol once a week. Conclusions The prevalence of chronic pain following cardiac surgery via median sternotomy in children is low. The pain may have a neuropathic component, but appears to be mild and does not significantly affect daily activities.