Incidence of Chronic Postsurgical Pain after Upper Extremity Surgery and its Correlation with Preoperative Pain

Background: The incidence of chronic postsurgical pain (CPSP) after upper extremity surgery is not known. The goal was to study CPSP at 5 years postoperative and to investigate patient, surgical, and anesthetic risk factors. Methods: Patients scheduled for elective upper extremity surgery were included, and numeric rating scale (NRS) score for pain was obtained preoperatively and at 5 years postoperatively. According to the International Association for the Study of Pain definition, CPSP was defined as an increase in NRS compared with preoperatively. Results: A total 168 patients were contacted at 5 years postoperatively. Incidence of CPSP was 22%, and 35% had an NRS score of 4 or more. The number of patients with an NRS score of 0 and with an NRS score of 4 or more preoperatively was higher in the no-CPSP group, with P values of 0.019 and 0.008, respectively. Of the patients with no preoperative pain, 34% developed CPSP. Regional anesthesia was associated with a lower CPSP incidence (P = 0.001) and was more frequently applied in surgery on bony structures and in patients with a preoperative NRS score of 4 or more. Conclusions: The incidence CPSP was 22%. Patients with no pain or an NRS score of 4 or more preoperatively were less likely to develop CPSP, but individual susceptibility to pain and success of the surgery may be of influence. One-third of the patients with no preoperative pain developed CPSP. More studies are needed to reveal the exact relation between brachial plexus anesthesia and CPSP.