Department of Anesthesiology, Walter Reed National Military Medical Center, 550 North Broadway, Suite 301, Baltimore, MD 21205, USA.
Anesth Analg. 2013 Feb;116(2):455-62. doi: 10.1213/ANE.0b013e318273f71c. Epub 2013 Jan 9.
Chronic postsurgical pain (CPSP) affects between 5% and 70% of surgical patients, depending on the surgery. There is no reliable treatment for CPSP, which has led to an increased emphasis on prevention. In this study, we sought to determine whether preventive etanercept can decrease the magnitude of postoperative pain and reduce the incidence of CPSP.
We performed a multicenter, randomized study in 77 patients comparing subcutaneous etanercept 50 mg administered 90 minutes before inguinal hernia surgery with saline. Patients, surgeons, anesthesiologists, the injecting physician, nursing staff, and evaluators were blinded. The primary outcome measure was a 24-hour numerical rating scale pain score. Secondary outcome measures were postanesthesia care unit pain scores, 24-hour opioid requirements, time to first analgesic, and pain scores recorded at 1 month, 3 months, 6 months, and 12 months.
Mean 24-hour pain scores were 3.3 (95% confidence interval [CI], 3.2-4.6) in the etanercept and 3.9 (95% CI, 2.6-4.0) in the control group (P=0.22). The mean number of analgesic pills used in the first 24 hours was 4.0 (SD, 2.8) in the treatment versus 5.8 (SD, 4.2) in the control group (P=0.03). At 1 month, 10 patients (29%) in the treatment group reported pain versus 21 (49%) control patients (P=0.08). The presence of pain at 1 month was significantly associated with pain at 3 months (hazard ratio, 0.74; 99% CI, 0.52-0.97; P=0.03).
Although preventive etanercept was superior to saline in reducing postoperative pain on some measures, the effect sizes were small, transient, and not statistically significant. Different dosing regimens in a larger population should be explored in future studies.
慢性术后疼痛（CPSP）影响 5％至 70％的手术患者，具体取决于手术类型。目前尚无可靠的 CPSP 治疗方法，因此人们越来越重视预防。在这项研究中，我们旨在确定预防性依那西普是否可以减轻术后疼痛的严重程度并降低 CPSP 的发生率。
我们在 77 名患者中进行了一项多中心、随机研究，比较了皮下注射依那西普 50mg 与生理盐水，分别在腹股沟疝手术前 90 分钟给药。患者、外科医生、麻醉师、注射医师、护士和评估人员均处于盲态。主要观察指标为 24 小时数字评分量表疼痛评分。次要观察指标为麻醉后护理病房疼痛评分、24 小时阿片类药物需求、首次镇痛时间以及术后 1 个月、3 个月、6 个月和 12 个月的疼痛评分。
依那西普组的平均 24 小时疼痛评分为 3.3（95％置信区间[CI]，3.2-4.6），对照组为 3.9（95％CI，2.6-4.0）（P=0.22）。治疗组在 24 小时内使用的镇痛药片数为 4.0（SD，2.8），对照组为 5.8（SD，4.2）（P=0.03）。治疗组在术后 1 个月时有 10 名（29％）患者报告疼痛，对照组为 21 名（49％）（P=0.08）。1 个月时存在疼痛与 3 个月时疼痛明显相关（风险比，0.74；99％CI，0.52-0.97；P=0.03）。
尽管在某些措施上，预防性依那西普在减轻术后疼痛方面优于生理盐水，但治疗效果的差异较小、短暂，且无统计学意义。在未来的研究中，应探讨更大人群中不同的给药方案。
