Chronic Postsurgical Pain Common With Presurgical Hookwire Localization

Preoperative hookwire localization was associated with increased risk for chronic postsurgical pain among patients undergoing video-assisted thoracoscopic surgery.

Both the incidence and intensity of chronic postsurgical pain were found to be increased among patients undergoing hookwire localization in the setting of video-assisted thoracoscopic surgery, according to the results of a study published in the Journal of Pain Research.

Patients (N=138) undergoing video-assisted thoracoscopic surgery for lung cancer at the Fudan University Shanghai Cancer Center in China in 2021 were recruited for this prospective cohort study. Patients underwent preoperative hookwire localization (n=69) or no localization (n=69). Hookwire localization using computed tomography was performed 1 hour prior to video-assisted thoracoscopic surgery. All patients received postsurgical sufentanil and flurbiprofen delivered via patient-controlled intravenous analgesic pump. The primary outcomes were postsurgical pain rated using an 11-point numeric rating scale (NRS) and 4 questions pertaining to chronic postsurgical pain as evaluated by telephone consultation at 3 and 6 months following the procedure.

The mean ages of participants in the hookwire and control cohorts were 53.1±11.8 and 54.9±11.3 years, male:female ratios were 21:48 and 32:37, and approximately one-third reported having undergone previous surgery.

During hookwire localization, 95.65% of patients reported pain with a median NRS score of 2.0 (interquartile range [IQR], 1.0-2.0) at rest and 3.5 (IQR, 2.0-5.0) with cough.

Management of the prior pain state may be helpful for the prevention and management of pain and the transition from acute to chronic pain.

Compared with the control group, the hookwire cohort experienced shorter procedure duration (mean, 73.8 vs 91.5 min; P =.009) and shorter anesthesia duration (mean, 109.3 vs 125.5 min; P =.019). A single port was used more frequently among patients in the hookwire cohort vs patients in the control group (30 vs 15), and fewer patients required a double (7 vs 12) or triple (32 vs 42) port procedure (P =.025). Wedge resection was performed in 58.0% of the hookwire group vs 33.3% in the control group; segmentectomy was performed in 29% and 34.8%, and lobectomy was performed in 13.0% and 31.9%, respectively.

In the postanesthesia care unit and on postoperative days 1 and 2, no group differences in NRS at rest (median range, 0.0-2.0) or with cough (median range, 1.0-4.0) were observed.

Compared with participants in the control group, more participants in the hookwire cohort reported chronic postsurgical pain at 3 (30.4% vs 56.5%; P =.002) and 6 (30.4% vs 44.9%; P =.079) months. The intensity of chronic postsurgical pain was also significantly higher at 3 months among participants in the hookwire group compared with participants in the control group (median, 2.0 vs 1.0, respectively; P =.011).

Among the hookwire group, patients who experienced multiple hookwire localizations reported a significantly higher rate of chronic postsurgical pain at 6 months compared with patients who had a single localization (60.0% vs 29.4%, respectively; P =.011). No difference in the rate of chronic postsurgical pain on the basis of number of localizations was observed at 3 months (P =.281); however, the prevalence of chronic postsurgical pain was high (50.0%-62.9%).

Predictors for chronic postsurgical pain at month 3 included hookwire localization (odds ratio [OR], 6.199; 955 CI, 2.049-18.749; P =.001) and previous surgery (OR, 0.383; 95% CI, 0.151-0.698; P =.042).

Adverse event rates did not differ between cohorts.

This study was limited by its nonrandomized design and significant cohort differences at baseline.

These data indicate that preoperative hookwire localization increased the risk for chronic postsurgical pain and that patients who underwent multiple localizations had the greatest rate of chronic postsurgical pain. The study authors state, “Management of the prior pain state may be helpful for the prevention and management of pain and the transition from acute to chronic pain.”


Kong L, Gao L, Zhang H, Wang X, Zhang J. Does preoperative hookwire localization influence postoperative acute and chronic pain after video-assisted thoracoscopic surgery: a prospective cohort study. J Pain Res. 2023;16:21-32. doi:10.2147/JPR.S387543