Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and Thoracotomy Surgical Approaches

Katherine Taylor; Barny Allan; Carolyne Pehora; Marisa Signorile; Kyle Runeckles; Naiyi Sun; Christoph Haller

doi:10.1053/j.jvca.2025.05.059

Acute and Chronic Postsurgical Pain in Children Following Cardiac Surgery: A Cohort Study of Sternotomy and Thoracotomy Surgical Approaches

J Cardiothorac Vasc Anesth. 2025 May 30:S1053-0770(25)00451-3. doi: 10.1053/j.jvca.2025.05.059. Online ahead of print.

Authors

Katherine Taylor¹, Barny Allan², Carolyne Pehora³, Marisa Signorile⁴, Kyle Runeckles⁴, Naiyi Sun⁵, Christoph Haller⁶

Affiliations

¹ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: Katherine.taylor@sickkids.ca.
² Consultant Pediatric Cardiac Hospital, Bristol Royal Infirmary for Children, Bristol, United Kingdom; Formerly Anesthesia Fellow, Hospital for Sick Children, Toronto, Ontario, Canada.
³ Clinical Research Nurse Coordinator, Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Ted Rogers Computational Program, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Cardiovascular Surgery, Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8.

PMID: 40579245
DOI: 10.1053/j.jvca.2025.05.059

Abstract

Objectives: To evaluate the prevalence of chronic postsurgical pain (CPSP) in children after cardiac surgery.

Design: Cohort study.

Setting: Quaternary academic pediatric hospital.

Participants: Patients age 6 to 18 years at the time of their surgery and a surgery date ≥6 months prior to the study period (June 1, 2014, to November 1, 2021).

Interventions: Patients completed 3 validated surveys measuring chronic pain, the impact of pain on quality of life (QoL), and neuropathic pain symptoms. Respondents' medical records were then reviewed for perioperative management.

Measurements and main results: Pain severity, pain trajectory, and analgesic consumption are described for each comparative group of interest (time period, 2014-2019 vs 2020-2021), intraoperative opioid selection (remifentanil vs sufentanil), surgical approach (sternotomy vs thoracotomy), and intraoperative pain management technique (presence/absence of fascial plane block). The response rate was 10%. Reference tables from validated scoring systems were used when available. At the time of survey completion or in the preceding week, 34% reported pain, with none to mild interference in QoL. Twenty percent reported symptoms consistent with neuropathic pain, with no difference between recipients of sternotomy and recipients of thoracotomy. Patients who received intraoperative remifentantil had higher pain scores. Single-shot fascial plane blocks reduced postoperative acute pain scores.

Conclusions: The validated surveys showed a high prevalence of CPSP, including a sizeable proportion of neuropathic pain. The prevalence of CPSP is within the reported prevalence in adults despite a mean study population age of 10 years. This finding encourages improvements in acute pain management, earlier identification of patients with CPSP for management, and further investigation of CPSP after pediatric cardiac surgery.

Keywords: child; chronic post-surgical pain; humans; neuralgia; pain; patient-reported outcome measures; prevalence; quality of life; surveys and questionnaires.