Prevalence and Risk Factors of Post Thoracotomy Pain Syndromeinaddis Abeba Publichospitals, Ethiopia, A Prospective Cohort Study Frojuoctober 2024 Gc.
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Date
2024-06-15
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Addis Ababa University
Abstract
Background: Thoracotomy is one of the most painful operative procedures. Ineffective postoperative pain management practice in this procedure will result in physiological and psychosocial deterioration which increases the risk of morbidity and mortality. This can be reduced by ensuring adequate analgesia using multimodal technique with regional blocks. So far epidural block is the gold standard, intercostal, and paravertebral blocks are the alternatives which results in somatic and sympathetic blockade of multiple dermatomes and reduce pain.
Objective: The Prevalence and Risk factors of post thoracotomy pain syndrome in TAH, Addis Ababa, Ethiopia, was assessed during the study period from July to November 2024 GC. Method: A prospective Crossectional study was done
Results: Overall Prevalence of Acute Post thoracotomy Pain Syndrome was 100%. Of this 29.3% of patients had a pain intensity Numeric Rating Scale >7(severe), 56.1% of patients had a pain intensity Numeric Rating Scale is between 4 and 6(moderate) and 14.6% had mild pain (=3). The Prevalence of Chronic Post Thoracotomy pain syndrome was 87.8% with 51.2% having moderate pain, 36.6% mild pain and 12.2% of patients did not have any pain. Ordinal regression analysis showed the association of Preoperative pain with Acute PTPS is strong with crude odds ratio of 18.7 with P value of 0.001 and CI of 95% and Adjusted Odds ratio of 21.7. The association of Preoperative pain with Chronic PTPS is also strong with crude odds ratio of 6.8. The association of APTPS with CPTPS was also computed in this study using both the Crude odds Ratio and Adjusted Odds Ratio. Patients who had APTPS had COR of 17.7 with P value of 0.001 and CI of 95%. The AOR is 9.6 with P of 0.012 and CI of 95%.
Conclusions: The prevalence of both APTPS and CPTPS is high in our setup. In both types of PTPS most of the patients report a moderate intensity of pain on the NRS scale. The Use of epidural anesthesia has statistically insignificant but weak association with APTPS but interestingly its effect though still statistically insignificant it is stronger with CPTPS. The association of Preoperative pain with CPTPS is strong with patients who had preoperative pain are 21.7 times more likely to have APTPS. The association of APTPS with CPTPS is also strong with patients having APTPS are 9.6 times more likely to have CPTPS. Pre-operative pain status and presence of APTPS are both strong predictors of CPTPS hence close follow up adequate analgesic management and use of epidural anesthesia in this type of patients would reduce the prevalence as well as intensity of pain. Keywords: post-thoracotomy pain and analgesia,
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post-thoracotomy pain and analgesia