Greiner A, Rantner B, Greiner K, Kronenberg F, Schocke M, Neuhauser B, Bodner J, Fraedrich G, Schlager A
Department of Vascular Surgery, Leopold Franzens University Hospital Innsbruck, Anichstrasse 35, A-1060 Innsbruck, Austria.
J Vasc Surg. 2004 Jun;39(6):1284-7. doi: 10.1016/j.jvs.2004.02.003.
This retrospective study was performed to investigate prolonged postoperative pain in the area of the proximal or distal scar or the bypass tunnel after femoropopliteal bypass surgery to treat symptomatic peripheral arterial disease.
Ninety-three patients with peripheral arterial disease who underwent femoropopliteal bypass surgery between January 2000 and December 2002 were included in the study. The short-form McGill Pain Questionnaire was used to score pain. Ultrasound examination of the soft tissue around the graft was performed to exclude other pathologic conditions responsible for pain, such as inflammatory processes, perigraft reactions, swollen lymph nodes, and hematomas.
Pain in at least one scar existed in 22 patients on average 13.9 +/- 9.8 months after surgery. In 10 patients pain existed simultaneously along the inguinal scar and the above-knee or below-knee scar. Pain along the bypass tunnel was experienced by seven patients. Most patients had mild to moderate pain. The mean numeric ranking score of pain severity in patients with pain was 4.2 +/- 2.3. The occurrence of prolonged postoperative pain was not associated with age, gender, diabetes, indication for surgery, material or type of bypass, number of preceding operations, or postoperative wound complications. Only follow-up time after femoropopliteal bypass surgery tended to be lower in patients with pain compared with those without pain.
Prolonged postoperative neuropathic pain along the distal and proximal incision or the bypass tunnel exists in one fourth of patients after femoropopliteal bypass surgery. Patients should be informed of this kind of complication before surgery. The results of our study justify further investigations of the origin and treatment of this pain, to find effective methods to reduce the incidence of prolonged postoperative pain after femoropopliteal bypass surgery.
本回顾性研究旨在调查股腘动脉搭桥手术后近端或远端瘢痕区域或搭桥隧道处的术后长期疼痛情况，以治疗有症状的外周动脉疾病。
本研究纳入了2000年1月至2002年12月间接受股腘动脉搭桥手术的93例外周动脉疾病患者。采用简化版麦吉尔疼痛问卷对疼痛进行评分。对移植物周围软组织进行超声检查，以排除导致疼痛的其他病理状况，如炎症过程、移植物周围反应、肿大的淋巴结和血肿。
平均术后13.9±9.8个月，22例患者至少有一处瘢痕疼痛。10例患者腹股沟瘢痕与膝上或膝下瘢痕同时疼痛。7例患者有沿搭桥隧道的疼痛。大多数患者有轻至中度疼痛。疼痛患者的疼痛严重程度平均数字评分得分为4.2±2.3。术后长期疼痛的发生与年龄、性别、糖尿病、手术指征、搭桥材料或类型、既往手术次数或术后伤口并发症无关。与无疼痛患者相比，有疼痛患者的股腘动脉搭桥手术后随访时间往往较短。
股腘动脉搭桥手术后四分之一的患者在远端和近端切口或搭桥隧道处存在术后长期神经性疼痛。术前应告知患者此类并发症。我们的研究结果证明有必要进一步研究这种疼痛的起源和治疗方法，以找到有效方法降低股腘动脉搭桥手术后长期术后疼痛的发生率。
