. 2021 May 21;23(5):748-756.

doi: 10.1093/europace/euaa349.

Post-operative pain following cardiac implantable electronic device implantation: insights from the BRUISE CONTROL trials

Girish M Nair¹, David H Birnie¹, Glen L Sumner², Andrew D Krahn³, Jeffrey S Healey⁴, Pablo B Nery¹, Eli Kalfon⁵, Atul Verma⁶, Felix Ayala-Paredes⁷, Benoit Coutu⁸, Giuliano Becker⁹, François Philippon¹⁰, John Eikelboom⁴, Roopinder K Sandhu², John Sapp¹¹, Richard Leather¹², Derek Yung¹², Bernard Thibault¹³, Christopher S Simpson¹⁴, Kamran Ahmad¹⁵, Marcio Sturmer¹⁶, Katherine Kavanagh², Eugene Crystal¹⁷, George A Wells¹, Vidal Essebag¹⁶; BRUISE CONTROL Investigators

Affiliations

¹ Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
² Department of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, AB, Canada.
³ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ Division of Cardiology, Department of Medicine, McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada.
⁵ Department of Medicine, Galilee Medical Center, Nahariya, Israel.
⁶ Department of Medicine, Southlake Regional Health Center, University of Toronto, Toronto, ON, Canada.
⁷ Department of Medicine, Universite de Sherbrooke, Sherbrooke, QC, Canada.
⁸ Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Hopital Hotel-Dieu, Montreal, QC, Canada.
⁹ Department of Medicine, McGill University Health Center, Montreal, QC, Canada.
¹⁰ Department of Medicine, Quebec Heart Institute, Sainte-Foy, QC, Canada.
¹¹ Department of Medicine, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
¹² Scarborough Health Network, University of Toronto, Toronto, ON, Canada.
¹³ Division of Cardiology, Department of Medicine, Montreal Heart Institute Montreal, QC, Canada.
¹⁴ Department of Medicine, Queen's University, Kingston, ON, Canada.
¹⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁶ Division of Cardiology, Department of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, AB, Canada.
¹⁷ Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.

PMID: 33367623
PMCID: PMC8139821
DOI: 10.1093/europace/euaa349

Post-operative pain following cardiac implantable electronic device implantation: insights from the BRUISE CONTROL trials

Girish M Nair et al. Europace. 2021.

. 2021 May 21;23(5):748-756.

doi: 10.1093/europace/euaa349.

Authors

Affiliations

¹ Arrhythmia Service, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
² Department of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, AB, Canada.
³ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ Division of Cardiology, Department of Medicine, McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON, Canada.
⁵ Department of Medicine, Galilee Medical Center, Nahariya, Israel.
⁶ Department of Medicine, Southlake Regional Health Center, University of Toronto, Toronto, ON, Canada.
⁷ Department of Medicine, Universite de Sherbrooke, Sherbrooke, QC, Canada.
⁸ Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Hopital Hotel-Dieu, Montreal, QC, Canada.
⁹ Department of Medicine, McGill University Health Center, Montreal, QC, Canada.
¹⁰ Department of Medicine, Quebec Heart Institute, Sainte-Foy, QC, Canada.
¹¹ Department of Medicine, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
¹² Scarborough Health Network, University of Toronto, Toronto, ON, Canada.
¹³ Division of Cardiology, Department of Medicine, Montreal Heart Institute Montreal, QC, Canada.
¹⁴ Department of Medicine, Queen's University, Kingston, ON, Canada.
¹⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁶ Division of Cardiology, Department of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, AB, Canada.
¹⁷ Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada.

PMID: 33367623
PMCID: PMC8139821
DOI: 10.1093/europace/euaa349

Abstract

Aims: Post-operative pain following cardiac implantable electronic device (CIED) insertion is associated with patient dissatisfaction, emotional distress, and emergency department visits. We sought to identify factors associated with post-operative pain and develop a prediction score for post-operative pain.

Methods and results: All patients from the BRUISE CONTROL-1 and 2 trials were included in this analysis. A validated Visual Analogue Scale (VAS) was used to assess the severity of pain related to CIED implant procedures. Patients were asked to grade the most severe post-operative pain, average post-operative pain, and pain on the day of the first post-operative clinic. Multivariable regression analyses were performed to identify predictors of significant post-operative pain and to develop a pain-prediction score. A total of 1308 patients were included. Multivariable regression analysis found that the presence of post-operative clinically significant haematoma {CSH; P value < 0.001; odds ratio (OR) 3.82 [95% confidence interval (CI): 2.37-6.16]}, de novo CIED implantation [P value < 0.001; OR 1.90 (95% CI: 1.47-2.46)], female sex [P value < 0.001; OR 1.61 (95% CI: 1.22-2.12)], younger age [<65 years; P value < 0.001; OR 1.54 (95% CI: 1.14-2.10)], and lower body mass index [<20 kg/m2; P value < 0.05; OR 2.05 (95% CI: 0.98-4.28)] demonstrated strong and independent associations with increased post-operative pain. An 11-point post-operative pain prediction score was developed using the data.

Conclusion: Our study has identified multiple predictors of post-operative pain after CIED insertion. We have developed a prediction score for post-operative pain that can be used to identify individuals at risk of experiencing significant post-operative pain.

Keywords: Predictors of post-operative pain; BRUISE CONTROL trials; Cardiac implantable electronic device implantation; Implantable cardioverter-defibrillator; Pacemaker; Pain prediction score.

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Figures

**Figure 1**
ROC curve and AUC (C-statistic) for the He⁻⁻ADSS score (A). ROC curve and AUC (C-statistic) for the He⁺⁺ADSS score (B). AUC, area under the curve; ROC, receiver operating characteristic.

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Post-operative pain following cardiac implantable electronic device implantation: insights from the BRUISE CONTROL trials

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Post-operative pain following cardiac implantable electronic device implantation: insights from the BRUISE CONTROL trials

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