Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia Department of Anesthesiology and Intensive Care, University Hospital Muenster, Muenster, Germany School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia Christian-Albrechts-University, Kiel, Germany.
Pain. 2012 Apr;153(4):759-764. doi: 10.1016/j.pain.2011.11.002. Epub 2012 Feb 4.
Postoperative pain is often stated to be a significant contributor to a sympathetic stress response after surgery. However, hardly any evidence has been published to support this assumption. Hence it was the aim of this trial to investigate the relationship between postoperative pain and hemodynamic, endocrine, and autonomic parameters. A total of 85 postoperative patients in the recovery room were repeatedly asked to rate their pain on a numeric rating scale (NRS). Concurrently, the parameters of heart rate variability (HRV) were analysed, and mean arterial pressure (MAP), heart rate (HR) and respiration rate (RR) were recorded. Pain was categorized into no, mild, moderate, and severe. Blood samples were taken for epinephrine (EPI) and norepinephrine (NE) plasma level assessment at the time of recovery room admission and discharge, and each time pain was found decreased in categorized severity. A total of 239 pain readings were obtained. None of the investigated parameters correlated with NRS scores. NE was higher at NRS 5 to 10 vs. NRS 0 to 4 (mean [SEM]: 1009 [73] pg/mL vs. 872 [65] pg/mL; P<0.01). This was also found for MAP, but not for EPI or the parameters of HRV, HR, and RR. In contrast to common belief, the severity of postoperative pain does not appear to be associated with the degree of sympathetic stress response after surgery, and other factors such as surgical trauma may be more important. Importantly, the absence of signs of sympathetic stimulation cannot be seen as a guarantee for the absence of significant pain.
术后疼痛常被认为是手术后交感应激反应的一个重要因素。然而，几乎没有证据支持这一假设。因此，本试验旨在研究术后疼痛与血液动力学、内分泌和自主神经参数之间的关系。共有 85 名术后恢复室的患者被反复要求用数字评分量表（NRS）对其疼痛进行评分。同时，对心率变异性（HRV）参数进行了分析，并记录了平均动脉压（MAP）、心率（HR）和呼吸频率（RR）。疼痛分为无、轻度、中度和重度。在恢复室入院和出院时以及每次疼痛程度减轻时，采集肾上腺素（EPI）和去甲肾上腺素（NE）的血浆水平进行评估。共获得 239 次疼痛读数。没有一个调查参数与 NRS 评分相关。NRS 评分 5-10 时 NE 高于 NRS 0-4（平均值 [SEM]：1009 [73] pg/mL 比 872 [65] pg/mL；P<0.01）。MAP 也有类似的情况，但 EPI 或 HRV、HR 和 RR 的参数则不然。与普遍看法相反，术后疼痛的严重程度似乎与手术后交感应激反应的程度无关，而手术创伤等其他因素可能更为重要。重要的是，没有交感刺激的迹象不能被视为没有显著疼痛的保证。
