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Postoperative fatigue

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Abstract

Uncomplicated major surgery is followed by a pronounced increased feeling of fatigue extending throughout the first month in about one-third of patients. Postoperative fatigue correlates with the degree of surgical trauma but is not related to duration of general anesthesia and surgery or to preoperative nutritional status, age, or sex. Fatigue also correlates with postoperative deterioration in nutritional parameters and impaired adaptability of heart rate during exercise. Furthermore, a postoperative decrease in muscle force and endurance is related to postoperative fatigue, whereas psychological factors are of minor importance. These findings suggest postoperative fatigue to be mediated by the endocrine-metabolic response to surgery, impaired nutritional intake, or immobilization, but the relative role of these factors remains to be established. Until then, therapeutic measures against the development of postoperative fatigue should aim at reducing the surgical stress response, effective treatment of pain to facilitate mobilization, and exercise to increase postoperative nutritional intake.

Résumé

Chez environ un tiers des patients ayant eu une intervention chirurgicale lourde avec des suites simples, on constate une sensation de fatigue importante et croissante durant le premier mois post-opératoire. L'asthénie post-opératoire est corrélée à l'importance du traumatisme opératoire, mais est indépendante de la durée de l'anesthésie générale et de l'acte chirurgical, ou de l'état nutritionnel pré-opératoire, de l'âge et du sexe. L'asthénie est aussi corrélée à la détérioration post-opératoire des paramètres nutritionnels et la diminution de l'adaptation cardiaque à l'effort. De plus la diminution de la force musculaire et de l'endurance après une intervention est liée à l'asthénie post-opératoire alors que les facteurs psychologiques sont de moindre importance. Ces constatations suggèrent que l'asthénie post-opératoire pourrait être sous la dépendance de la réponse endocrinienne et métabolique à la chirurgie, de l'amélioration de l'apport nutritionnel ou de l'immobilisation, mais le rôle respectif de ces différents facteurs reste à déterminer. Jusque là, les mesures thérapeutiques prises pour lutter contre l'asthénie post-opératoire doivent viser à réduire la réponse à l'aggression chirurgicale, à traiter efficacement la douleur post-opératoire pour faciliter la mobilisation et l'exercice physique, ainsi qu'à améliorer l'apport nutritionnel post-opératoire.

Resumen

La cirugía mayor no complicada es seguida de una sensación pronunciada de fatiga, la cual se extiende durante el primer mes postoperatorio en aproximadamente una tercera parte de los pacientes. La fatiga postoperatoria se relaciona con el grado de severidad del trauma quirúrgico, pero no se relaciona con la duración de la anestesia general o de la cirugía o con el estado nutricional preoperatorio, la edad o el sexo. La fatiga también aparece correlacionada con el deterioro postoperatorio de los parámetros nutricionales y con la inadecuada adaptación de la frecuencia cardiaca durante el ejercicio. Además, la disminución postoperatoria del vigor muscular se relacionan con la fatiga potoperatoria, en tanto que los factores psicológicos son de menor importancia. Estos hallazgos sugieren que la fatiga postoperatoria es mediada por la respuesta endocrina-metabólica a la cirugía, la alterada ingesta nutricional o la inmovilización, pero el valor relativo de estos factores aún está por establecerse. Hasta entonces, las medidas terapéuticas contra el desarrollo de fatiga postoperatoria deben ser orientadas a reducir la respuesta al estrés quirúrgico, al tratamiento efectivo del dolor para facilitar la movilización y el ejercicio, así como a mejorar la ingesta nutricional postoperatoria.

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Christensen, T., Kehlet, H. Postoperative fatigue. World J. Surg. 17, 220–225 (1993). https://doi.org/10.1007/BF01658930

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