Risk Factors for Chronic Postoperative Pain After Elective Nephrectomy

Risk Factors Affecting Chronic Postoperative Pain After Elective Nephrectomy

Chronic postoperative pain (CPP) is typically defined as pain persisting for 3 months or more after surgery[1]. CPP is a common and increasingly prevalent morbidity, leading to long-term psychological issues, reduced quality of life, and impaired functionality[2]. To reduce the incidence of CPP, high-risk patients are identified, and various surgical techniques, pharmacological agents, and regional anesthesia techniques are employed[3].

The primary aim of our study is to scale chronic pain at 1 hour, 3 months, and 1 year post-nephrectomy using the Numeric Rating Scale (NRS), ranging from 0 to 10. The secondary aim is to evaluate the effects of factors influencing chronic postoperative pain on the NRS scores.

Study Overview

• Status: Completed
• Conditions: Chronic Pain; Chronic Pain, Postoperative; Surgery; Epidural Analgesia; Anesthesia; General Anesthesia; Nephrectomy; Analgesic Drugs; Acute Pain, Postoperative
• Intervention / Treatment: Diagnostic test: Numeric Rating Scale

Detailed Description

Patients gender, age, height(m), weight(kg), body mass index(kg/m2), diagnosis, smoking and alcohol history, comorbidities, surgical technique and duration, complications, lymph node dissection, thrombectomy, adrenalectomy, amount of bleeding(cc), need for blood transfusion, need for intensive care, analgesia technique used, amount of opioids and non-opioid analgesics used perioperatively, amount of vasopressors used, heart rate(bpm) and mean arterial pressure(mmHg) at induction, post-intubation, post-extubation, and 1 hour postoperatively, presence of postoperative pain, chronic analgesic use history(more than 3 uses per week), presence of fibromyalgia, frequent urinary tract infections, diagnosed with central sensitization disorders, bruxism, depression-panic attacks, allergic asthma, irritable bowel syndrome, and migraines will be recorded. The effects of these factors on NRS scores at 1 hour, 3 months, and 1 year postoperatively will be examined.

• Study Type: Observational
• Enrollment (Actual): 204

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye)
    • Istanbul University-Cerrahpasa

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Patients aged 18-90 years, ASA I-IV, undergoing elective nephrectomy under general anesthesia will be included in the study.

Description

Inclusion Criteria: -Patients aged 18-90 years,

• ASA I-IV,
• undergoing elective nephrectomy under general anesthesia will be included in the study.

Exclusion Criteria:

• Patients who cannot be reached by phone and hose who die within the 1-year postoperative period will be excluded from the study.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Painfull: patients with Numeric Rating Score equal or higher than 4; The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain), and patients with NRS equal or higher than 4 are defined as "painfull".	Diagnostic test: Numeric Rating Scale; The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain).
Pain-free: patients with Numeric Rating Score lower than 4; The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain), and patients with NRS lower than 4 are defined as "pain-free".	Diagnostic test: Numeric Rating Scale; The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NRS 1 hour	The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain). Patients with NRS equal or higher than 4 are defined as painfull; and, patients with NRS lower than 4 are defined as pain-free	1 hour after the end of the surgery
NRS 3 months	The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain). Patients with NRS equal or higher than 4 are defined as painfull; and, patients with NRS lower than 4 are defined as pain-free	3 months after the surgery
NRS 1 year	The patients are asked to rate their pain according to the Numeric Rating Scale (0=no pain; 10=worse possible pain). Patients with NRS equal or higher than 4 are defined as painfull; and, patients with NRS lower than 4 are defined as pain-free	1 year after the surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
age	Age of the patiens as years	At the time of preoperative assesment
height	Height of the patiens as meter	At the time of preoperative assesment
BMI	body mass index of the patiens as kg/m2	At the time of preoperative assesment
smoking	Data of the patient if they are smoking or not	At the time of preoperative assesment
Amount of opioid and non-opioid analgesics used perioperatively	Amount of opioid and non-opioid analgesics used perioperatively	At the time of perioperative assesment
Gender	Woman or man	At the time of preoperative assesment
Comorbidities	hipertension, diabetus mellitus, asthma or cardiac disease etc.	At the time of preoperative assesment
surgical technique	radical or partial nephrectomy and open or laparoscopic nephrectomy	At the time of perioperative assesment
surgical duration	How long does the surgery take in minutes?	The time recorded at the end of the surgery will be reported
additional procedures next to the nephrectomy	lymph node dissection, thrombectomy, adrenalectomy procedures used	At the time of perioperative assesment
need for blood transfusion	How many blood product tranfusions were required?	At the time of perioperative assesment
need for intensive care units	Whether there is a need for intensive care after surgery	At the time of postoperative assesment, the data evaluated at the end of the surgery will be reported
Analgesia technique	Epidural analgesia or intravenous analgesia was used as analgesic technique	At the time of perioperative assesment
Amount of vasopressors used	Amount of vasopressors used at the perioperative period	At the time of perioperative assesment
Value of postoperative acute pain score on NRS score	Value of postoperative acute pain score on NRS score(0:no pain, 10:the worst pain imaginable)	1 hour postoperative period
Chronic analgesic use history	More than 3 uses per a week	1 year before the operation
Clinical conditions that will be reported under the title of central sensitization disorder	Presence of fibromyalgia, frequent urinary tract infection, bruxism, diagnosed with depression-panic attack, allergic asthma, irritable bowel syndrome and migraines will be recorded.	At the time of preoperative assesment

Collaborators and Investigators

• Sponsor: Istanbul University - Cerrahpasa
• Investigators: Study Director: Aylin Nizamoglu, Doctor, Istanbul Univerisity-Cerrahpasa Cerrahpasa Faculty of Medicine; Study Chair: Safak E Erbabacan, associate professor, Istanbul Univerisity-Cerrahpasa Cerrahpasa Faculty of Medicine; Study Chair: Fatis Altindas, Professor, Istanbul Univerisity-Cerrahpasa Cerrahpasa Faculty of Medicine; Principal Investigator: İlayda Bilgili Altuntaş, Physician, Istanbul Univerisity-Cerrahpasa Cerrahpasa Faculty of Medicine

Publications and helpful links

General Publications

• Sharma LR, Schaldemose EL, Alaverdyan H, Nikolajsen L, Chen D, Bhanvadia S, Komen H, Yaeger L, Haroutounian S. Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis. Pain. 2022 Mar 1;163(3):425-435. doi: 10.1097/j.pain.0000000000002361.

Helpful Links

• Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: A systematic review and meta-analysis

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2025
• Primary Completion (Actual): March 24, 2026
• Study Completion (Actual): March 24, 2026

Study Registration Dates

• First Submitted: September 25, 2024
• First Submitted That Met QC Criteria: November 2, 2024
• First Posted (Actual): November 5, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: chronic pain; surgery; acute pain; postoperative pain; nephrectomy; pain risk factors
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Chronic Pain; Acute Pain
• Other Study ID Numbers: E-83045809-604.01-1084787

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No