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Persistent postoperative pain: risk factors and prevention

Author: Belîi Natalia
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Scientific adviser: Serghei Şandru
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova


The thesis was presented on the 6 March, 2019
Approved by NCAA on the 19 April, 2019


Adobe PDF document1.06 Mb / in romanian


CZU 616-089.168.1-009.7

Adobe PDF document 5.54 Mb / in romanian
172 pages


risk factors, intense postoperative pain, persistent postoperative pain (PPOP), prevention, quality of life


The present thesis is written on 134 pages and includes: introduction, 4 chapters, conclusions, bibliography of 257 sources, 12 annexes, 20 figures and 28 tables. The results obtained are published in 17 scientific papers, including 3 without coauthors.

Field of study: 321.19 – Anesthesiology and intensive care.

Aim of the study: Prevalence estimation and identification of risk factors for intense and persistent postoperative pain and elaboration of prevention strategies.

Study objectives: (1) Assessment of prevalence of intense and persistent postoperative pain in Republic of Moldova; (2) Identification of risk factors for intense postoperative pain (12-36 hours after surgery) from a series of perioperative parameters and conditions, presumed to have such an influence; (3) Identification of risk factors for PPOP at 3 and 6 months after surgery, from a series of perioperative parameters, presumed to have that influence; (4) Evaluation of the impact of PPOP at 3 and 6 months after surgery on patient’s quality of life; (5) Formulation and argumentation of the strategies for the optimization of the perioperative pain management, as well as the proposal of the preventive strategies for PPOP.

Scientific novelty and originality. It was found that the main risk factors for persistence of postoperative pain at 3 months postoperatively are catastrophising of magnificative nature and duration of surgery ≥60 minutes. These, together with the intense postoperative pain, lead to PPOP in 50.7% and 48.0% of cases, at 3 and 6 months, respectively. The persistence of postoperative pain is at least 6 months and has a negative impact on quality of life. Among the mechanisms contributing to pain chronification were find the prolonged surgery duration with increased potential of tissue lesion and the altered psycho-emotional status. A protective factor has been determined for transition of acute postoperative pain to chronic, which opens the opportunity for prevention. It was evaluated an index of postoperative pain management quality.

The scientific problem solved in the thesis. The clinical study proposed, investigated and validated or withdrew the quality of risk factor for a wide list of perioperative parameters. There were applied methods of statistical analysis similar to transnational clinical studies in the field and which will be used in future at the elaboration of the primary and secondary prevention of PPOP protocols.

The theoretical significance: It has been completed theoretical basis of knowledge on PPOP chronication mechanisms and it was estimated its prevalence. It were described and discussed the circumstances, risk triggering mechanisms for PPOP, their management and prevention strategies. It was elucidated the impact of PPOP on patient quality of life at 3 and 6 months after surgery. Based on the study, the quality of risk factor for PPOP was denied for previously reported risk factors or around which there were controversies.

The application value of the study results: Taking into consideration during the anesthetic visit the risk factors such as catastrophizing of magnificative nature and duration of anesthesia ≥60 minutes, and applying preventive measures – non-pharmacological anxiolysis, neuropathic postsurgical pain prophylaxis, chromotherapy – allows avoidance of PPOP, and, implicitly, avoidance of deterioration of life qualit y at 6 months postoperatively and collateral losses associated with this clinical condition. Persons at increased risk for PPOP will be preoperatively targeted by antihyperalgesic prophylaxis, prioritizing neuraxial and locoregional techniques of anesthesia and analgesia.

Implementation of the scientific results. The results of the study were implemented in the curative, didactic and research activity of the Chisinau Institute of Emergency Medicine, Nicolae Testemitanu SUMPh (4 papers of implementation, anexes 9-12).