手术围术期疼痛强度、疼痛性质和阿片类药物使用对术后慢性疼痛的影响：一项前瞻性队列研究。

Impact of perioperative pain intensity, pain qualities, and opioid use on chronic pain after surgery: a prospective cohort study.

机构信息

Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada.

出版信息

Reg Anesth Pain Med. 2012 Jan-Feb;37(1):19-27. doi: 10.1097/AAP.0b013e318237516e.

DOI:10.1097/AAP.0b013e318237516e

PMID:22157741

Abstract

BACKGROUND AND OBJECTIVES

A better understanding of the pathogenesis of chronic postsurgical pain is needed in order to develop effective prevention and treatment interventions. The objective of this study was to evaluate the incidence and risk factors for chronic postsurgical pain in women undergoing gynecologic surgery.

METHODS

Pain characteristics, opioid consumption, and psychologic factors were captured before and 6 months after surgery. Analyses included univariate statistics, relative risks (RRs) and 95% confidence intervals (95% CIs), and modified Poisson regression for binary data.

RESULTS

Pain and pain interference 6 months after surgery was reported by 14% (n = 60/433) and 12% (n = 54/433), respectively. Chronic postsurgical pain was reported by 23% (n = 39/172) with preoperative pelvic pain, 17% (n = 9/54) with preoperative remote pain, and 5.1% (n = 10/197) with no preoperative pain. Preoperative state anxiety (RR = 1.8; 95% CI, 1.1-2.8), preoperative pain (pelvic RR = 3.7; 95% CI, 1.9-7.2; remote RR = 3.0; 95% CI, 1.3-6.9), and moderate/severe in-hospital pain (RR = 3.0; 95% CI, 1.0-9.4) independently predicted chronic postsurgical pain. The same 3 factors predicted pain-interference at 6 months. Participants describing preoperative pelvic pain as "miserable" and "shooting" were 2.8 (range, 1.3-6.4) and 2.1 (range, 1.1-4.0) times more likely to report chronic postsurgical pain, respectively. Women taking preoperative opioids were 2.0 (range, 1.2-3.3) times more likely to report chronic postsurgical pain than those not taking opioids. Women with preoperative pelvic pain who took preoperative opioids were 30% (RR = 1.3; 95% CI, 0.8-1.9) more likely to report chronic postsurgical pain than those with preoperative pelvic pain not taking opioids.

CONCLUSIONS

Preoperative pain, state anxiety, pain quality descriptors, opioid consumption, and early postoperative pain may be important predictors of chronic postsurgical pain, which require further investigation.

摘要

背景与目的

为了开发有效的预防和治疗干预措施，需要更好地了解慢性术后疼痛的发病机制。本研究的目的是评估妇科手术后女性慢性术后疼痛的发生率和危险因素。

方法

在手术前和手术后 6 个月，记录疼痛特征、阿片类药物的使用和心理因素。分析包括单变量统计、相对风险 (RR) 和 95%置信区间 (95%CI)，以及二元数据的修正泊松回归。

结果

14%（n=60/433）和 12%（n=54/433）的患者在手术后 6 个月报告疼痛和疼痛干扰。慢性术后疼痛的发生率为 23%（n=39/172），其中 23%（n=39/172）术前有盆腔疼痛，17%（n=9/54）术前有远处疼痛，5.1%（n=10/197）术前无疼痛。术前状态焦虑 (RR=1.8；95%CI，1.1-2.8)、术前疼痛（盆腔 RR=3.7；95%CI，1.9-7.2；远处 RR=3.0；95%CI，1.3-6.9）和中度/重度住院疼痛 (RR=3.0；95%CI，1.0-9.4) 独立预测慢性术后疼痛。这 3 个因素也预测了 6 个月时的疼痛干扰。术前盆腔疼痛描述为“痛苦”和“刺痛”的患者发生慢性术后疼痛的可能性分别为 2.8（范围，1.3-6.4）和 2.1（范围，1.1-4.0）倍。术前服用阿片类药物的女性发生慢性术后疼痛的可能性是未服用阿片类药物的女性的 2.0（范围，1.2-3.3）倍。术前有盆腔疼痛且服用阿片类药物的女性发生慢性术后疼痛的可能性比术前有盆腔疼痛且未服用阿片类药物的女性高 30%（RR=1.3；95%CI，0.8-1.9）。