Common Steroid Does Not Reduce Lasting Incision Pain After Cardiac Surgery

The common steroid methylprednisolone does not reduce lasting pain at the incision site after heart surgery, according to research presented at Anesthesiology 2015 and published in the journal Anesthesiology.

Alparslan Turan, MD, from the Anesthesiology Institute at the Cleveland Clinic, and colleagues originally believed that the corticosteroid methylprednisolone, which has substantial anti-inflammatory and pain-relieving properties, would likely relieve incisional pain – mainly because this common, painful result of cardiac surgery is believed to be related to inflammation and poorly managed acute pain. However, the steroid did not reduce this pain.

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“In contrast to our primary hypothesis, moderate-dose methylprednisolone (500 mg) did not reduce the prevalence of incisional pain at either 1 or 6 months after surgery,” wrote the study’s authors. “Furthermore, there was also no effect of methylprednisolone on worst pain and average pain scores, pain interference with daily life, or analgesic use at 1 or 6 postoperative months.”

For the Steriods In caRdiac Surgery (SIRS) Trial, 1110 participants were randomized to either receive 500 mg of steroids (n=523) or placebo (n=520), with 250 mg given during anesthetic induction and 250 mg given on cardiopulmonary bypass initiation.

Incisional pain at 6 months was reported by 166 out of 1043 participants (15.9%). It occurred in 78 of 520 participants in the methylprednisolone group (15.7%) and in 88 of 523 participants in the placebo group (17.8%). The average pain intensity was 1.4 ± 1.6 (mean ± SD), the worst pain intensity was 2.6 ± 2.3 (mean ± SD), and 64 (39%) of the participants who reported any pain were still taking pain medication at 6 months.

Methylprednisolone did not significantly affect persistent incisional pain at 6 months. There was also no difference in the worst pain and average pain the last 24 hours, pain interference with daily life, or use of pain medicine at 6 months.

Younger participants, females, and those with deep surgical site infections had an increased likelihood for persistent pain at 6 months.