BACKGROUND:

Bone and soft tissue (BST) cancer surgery of extremities and pelvis have high incidence of postoperative neuropathic pain (NP) due to extensive soft tissue dissection and breach of inter-nervous planes. Persistent NP can result if acute postoperative pain is not treated aggressively and causes interference with daily functional activities. Pain Detect questionnaire (PD-Q) is a reliable screening tool with high sensitivity (80%) and specificity (85%) to detect NP.

AIMS AND OBJECTIVES:

·       Primary aim-  To assess the incidence of NP in patients undergoing curative surgery for histologically confirmed BST tumors of the extremities and pelvis at 72 hours post-surgery with the use of PD-Q and establish its predisposing factors. 

·       Secondary objectives- To study the prevalent pain scores with numerical rating scale (NRS) and Brief pain inventory (BPI) at 72 hours,1 month and 3rd month follow up along with PD-Q, treatment received to the patients with NP and patient satisfaction with ongoing treatment regimen.

METHODS:  

After Institutional Ethics Committee approval and the Clinical Registry of India registration; patients undergoing BST tumour surgeries from April 2021-June 2022 were screened at a tertiary care cancer centre. Enrolment was done after applying inclusion criteria and informed consent was obtained. Preoperative, intraoperative and postoperative details were noted. NP follow up was done at 3rd day, 1 month and 3 months postoperatively with PD-Q. Pain severity was assessed with NRS and BPI was applied to look for interference of NP with patient’s quality of life. Data was analysed to find the association of patient and intraoperative variables with the incidence of NP.

RESULTS:

The incidence of NP was 23.5% at 3rd post-operative day,12.6% at 1 month and 3.6% at 3 months. The median PD-Q scores was 7[IQR-7] at 3rd day. We found a significant correlation of NP with age(P=0.05), preoperative ongoing treatment for NP(P=0.01), preoperative pain severity(P=0.005) type of surgery(P<0.001), region operative(P=0.01), intraoperative nerve handling(P<0.01) and reconstruction component(P=0.02). The median NRS scores at 72 hours was 2 [IQR-2] and was statistically correlated with PD-Q scores(P=0.01). The median of worst BPI scores at 3rd day was 4[IQR-1] and interference in daily activities was seen among patients with NP (P <0.01).

CONCLUSIONS: 

The incidence of NP is high [23.5%] among postoperative patients undergoing curative surgery of BST tumors and it can result in persistent NP in 41.5% of patients. Young adults, pre-existing NP controlled with medication, preoperative pain severity, reconstructive component of surgery, nerve handling and certain surgeries like amputation, pelvis tumors and plastic reconstructions are at risk. NP affects quality of life as detected by BPI.

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