Newly Published
Correspondence  |   January 2020
Prevention and Prediction of Postsurgical Pain: Comment
Author Notes
  • All India Institute of Medical Sciences, Raipur, India (H.M.R.K.).
  • Accepted for publication December 4, 2019.
    Accepted for publication December 4, 2019.×
Article Information
Correspondence   |   January 2020
Prevention and Prediction of Postsurgical Pain: Comment
Anesthesiology Newly Published on January 24, 2020. doi:
Anesthesiology Newly Published on January 24, 2020. doi:
Although we applaud the Heart Surgery and Persistent Postsurgical Pain (Heart PPPAIN) study by Anwar et al.1  for highlighting and addressing the complex and challenging condition of chronic pain after sternotomy, we would like to clarify some details before adopting their protocol into clinical use. The authors well recognize the fact that chronic postsurgical pain is associated with preoperative anxiety and catastrophization as well as with the intensity of perioperative pain management.1,2  Yet, missing intraoperative data let us wonder whether these issues were considered.
Although ketamine has an established role in the management of chronic pain, and as an opioid-sparing agent in acute pain, the debate about its optimal use in terms of dose, duration, and timing still continues. The dose used here was small, which was perhaps reflected in the outcome in the combined group. Possibly to minimize sedation, the authors deliberately chose this strategy. The drug also has cardiovascular and at times negative inotropic effects that may be undesirable in this population. Equally, the efficacy of pregabalin as preventive analgesia in coronary artery bypass graft surgery is to date unclear. However, lower, less-effective doses can cause postoperative sedation and hypotension, whereas higher and effective doses necessitate more perioperative vasopressors. This may impact graft survival and lead to postoperative acute renal failure.3,4  Ultimately, sedation may be prolonged, especially when pregabalin is continued postoperatively. In this regard, we would welcome data on intraoperative vitals and inotrope requirements, and in general on whether there was any impact on intraoperative hemodynamics and immediately thereafter.