Persistent postsurgical pain after abdominal surgery

Chronic postsurgical pain (CPSP) syndrome has received recognition in literature for over a decade, yet preventive measures are limited in the perioperative period. Given the large number of abdominal surgeries performed worldwide, CPSP presents both social and economic burden on society. The incidence of CPSP varies between 15% and 30% after minor and major abdominal or pelvic procedures. Intraoperative nerve damage and severe acute postoperative pain are two main predictors of CPSP. Central sensitization may be an underlying mechanism behind CPSP. Because the same pathway has been proposed to cause wound hyperalgesia, studies have proposed using multimodal analgesic techniques with ketamine and neuraxial anesthesia to reduce the incidence of CPSP after abdominal surgeries. Similarly, effective multimodal preemptive analgesia that blocks both the segmental and the heterosegmental nociceptive inputs (vagus, phrenic nerve) has been recommended to prevent central neuroplasticity. The focus of this review article is chronic pain after abdominal and pelvic surgery, highlighting issues unique to this surgical model.